Trauma Assessment

Trauma AssessmentBasic Trauma CourseThe goal of the primary assessment is to rapidly identify potentially life-threatening condition requiring immediate intervention. Airway/Cervical SpineA- Airway-Open or patent-Cervical Spine immobilizedCan they vocalize?Tongue obstructing airwayLoose teeth, blood, or vomit in mouthEdemaIf patient already intubated when arrives:Equal rise and fall of the chest with ventilationListening over epigastrium and then over the lung fieldsSpecific device to confirm tube placement

Interventions to clear airway-Jaw thrust/chin lift, suction, remove debris.Oral/NP AirwaysIntubationProvide Spinal ImmobilizationBack Board, rigid cervical collar with head immobilized.

Signs that need immediate attention:Increased work of breathing.Speaks in incomplete sentences.Lack of integrity of chest wall.Tracheal deviationJVD

BreathingAssess presence and effectivenessSpontaneous breathingRise and fall of the chestRate and pattern of breathingUse of accessory muscles, diaphragmatic breathing or bothSkin colorBilateral breath soundsTracheal deviation and JVD

All trauma patients get high flow oxygen.Interventions for ineffective breathing:PositioningNeedle decompressionVentilate with Ambu Bag

CirculationPresence of major pulses, Presence of external hemorrhagePalpate a central pulse (carotid, femoral, or brachial in infants under one year of age)Inspect and palpate skinCapillary refill time

Interventions for impaired circulation:Control BleedingElevateDirect PressureOxygenVascular accessBlood drawVolume ReplacementTrendelenburg

Interventions for Pulselessness:CPR/Defibrillation

DisabilityBrief neurologic assessment to determine the degree of disability.Level of consciousness-Determine level of consciousness using the AVPU mnemonic A AlertV Verbal stimuliP Painful stimuliU Unresponsive

Glasgow Coma Scale-Variations for pediatricsBest Eye OpeningBest Verbal ResponseBest Motor ResponsePupillary assessment-Size, shape, equality , and reaction to light

Assessment of brain injury hinges on the GCS so it is essential that it is performed during the initial assessment. Page 102-103 Chapter for GCS

If the patient is not alert or verbal then airway has to become a concern.Expose/Environment/EvidenceGet Naked!Decontaminate if needed. Cover up & keep warm. Consider if clothing may be evidence and preserve it.

Observe for all injuries quickly.

Beware of weapons, glass, needles.

Consider TransferConsider the need for transfer for following conditions:Significant head or spinal cord injury, major chest wall trauma, open pelvic or solid organ injury, major crush injuries, traumatic amputation with potential for re-implantation, major burns, multiple long bone fractures, and Multi-system trauma.

Arrangements should follow EMTALA guidelines.Secondary AssessmentF-Full set of Vitals, Focused adjuncts (Labs, monitors, F/C, NG), Facilitate family presenceG-Give comfort-touch, talking, and pharmacologic pain management.H-History-MIVT (MOI, Injuries, VS, TX), Past medical hx, Head to toe- Inspection, palpation, Percussion, AuscultationI-Inspect Posterior, rectal tone, temp

F-Cardiac Monitor, Pulse OX, Capnography if intubated. Foley is to monitor urine output. Gastric Tube-distention may lead to vomiting, aspiration, stimulation of vagal nerve. Contraindications for NG are mid facial fractures. Facilitate diagnostics & Labs- Blood typing should be a high priority. Determine need for tetanus.Head to Toe-Inspection, auscultation, palpation.Inspect- Maintain cervical spine immobilization-logroll at least 3 people.

Focused AssessmentTrauma documentation Wound careTetanus prophyxAntibioticsPrepare for transferBasic Simple wound care to prevent contamination.Evaluation & MonitoringContinually monitor and treat:Airway patencyLevel of ConsciousnessHemodynamic statusBreath sounds and pulse oximetryCardiac rate and rhythmPain reliefIntake and output