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Trauma Patient Assessment

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Trauma Assessment

R a p id T ra u m a A ssessm e nt P rio r i ty

O n go in g A sse ssm e nt

D e ta i le d A sse ssm e nt

F o cu sed H is to ry a nd P h ysica l

In i t ia l A ssessm e nt

S ce n e S u rv ey

T ra um a P atie n t A ssessm e nt

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Size-Up

• Safety

• BSI

• MOI

• Number of Patients

• Additional Resources

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Safety

• Traffic• Smoke• Electricity• Haz-Mat

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Safety

• Hostile Persons• Weapons• Drugs• Silence

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BSI

• Gloves• Goggles• Mask• Gown

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BSI

• Gloves for minimal fluids

• Add eye protection if there’s any chance of splatter

• Add gown and mask for gross contamination

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Mechanism of Injury

• Ejection

• Death of another passenger in the same vehicle

• Falls >15’ or 3X patients height (child = >10’)

• Roll-over

• High speed collision (child = moderate speed)

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Mechanism of Injury (cont.)

• Pedestrian Involvement

• Motorcycle (child = bicycle)

• Altered mental status

• Penetrating wounds to head, chest, abdomen)

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Number of PatientsNumber of Patients

• Call for additional resources ASAP

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Additional resources

• Extrication

• Traffic control

• Utilities

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Initial Assessment

• General Impression

• Mental Status

• Airway

• Breathing

• Circulation

• Determine priority

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General Impression

• Age, Weight, Gender

• Position (relative to posture and surroundings)

• Activity

• Obvious Injuries/Bleeding

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Assess Mental Status

• Take C-Spine control

• A – Alert and immediately responsive

• V – Responsive to verbal stimuli

• P – Responsive to painful stimuli

• U – Unresponsive

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Assess Airway

• Open if necessary using jaw-thrust maneuver

• Consider oro- or naso-pharyngeal airway

• Note unusual sounds and correct cause– Snoring – oro-/naso-pharyngeal airway– Gurgling – suction– Stridor – consider intubation– Silence

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Correcting silence

• Attempt ventilation

• Reposition

• Heimlich

• Visualize and remove

• Intubate

• Trans-laryngeal jet insuflation

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Assess Breathing

• Look, Listen, Feel• Rate, Rhythm, Depth (tidal volume)• Use of accessory muscles/retractions• Treat

– Absent – ventilate x2, check pulse

– < 12/min – assist ventilation

– Decreased tidal volume – assist ventilation

– Labored – oxygen 10 liters NRB

– Normal or rapid – consider oxygen

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Assess Circulation - Pulses

• Compare radial and corotid

• Rate– Normal

– Fast

– Slow

• Rhythm– Regular

– Irregular

• Quality– Weak

– Thready

– Bounding

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Assess Circulation - Skin

• Color

• Temperature

• Moisture

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Assess Circulation - Bleeding

• Direct pressure

• Pressure dressing

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Determine priority

– Poor general impression– Mental status changes– Difficulty breathing– Shock– Chest pain– Severe bleeding– Severe pain

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Rapid Trauma Assessment

• Head to toe

• Rapid sweep to identify major injuries which could prove life threatening

• DCAP-BTLS

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Rapid Trauma Assessment (cont.)DCAP/BTLS

• D - deformities• C - contusions/

crepitation• A - abrasions• P - penetrations/

paradoxical movement

• B - burns• T - tenderness• L - lacerations• S - swelling

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Package and begin transport

• Immediate – immobilize, load, go

• Delayed – immobilize, treat as necessary, transport

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Focused History and Physical

• Baseline vital signs

• SAMPLE History

• Focus on and treat injuries found during initial assessment and rapid trauma assessment as appropriate considering priority

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Focused History and Physical SAMPLE History

• S – signs/symptoms

• A – allergies

• M – medications

• P – past medical history

• L – last oral intake

• E – events leading up to the incident

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Detailed Physical Exam

• As appropriate, considering priority

• Repeat initial assessment

• Complete critical interventions

• Careful head to toe survey (DCAP/BTLS)

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Detailed Physical ExamHead to Toe

• Head – DCAP/BTLS and creptiation

• Ears – DCAP/BTLS and blood/fluid

• Face – DCAP/BTLS and blood/fluid

• Eyes – DCAP/BTLS and discoloration, pupils, foreign bodies, blood

• Nose – DCAP/BTLS and blood/fluid

• Mouth – DCAP/BTLS and teeth, foreign bodies, swelling, lacerations, odor

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Head to Toe

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Detailed Physical ExamHead to Toe

• Neck – DCAP/BTLS and JVD, crepitation

• Chest – DCAP/BTLS and palpate for paradoxical motion, symmetry, crepitation, and auscultate breath sounds

• Abdomen – DCAP/BTLS and tenderness, rigidity, distention

• Pelvis – DCAP/BTLS and pain, tenderness, motion, crepitation

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Head to Toe

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Detailed Physical ExamHead to Toe

• Upper extremities – DCAP/BTLS and PMS

• Lower extremities – DCAP/BTLS and PMS

• Posterior – DCAP/BTLS

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On-Going Assessment

• Reassess vital signs

• Reassess injuries

• Reassess interventions