Ch08 eec3
- 1. Eight Chapter Assessment of the Trauma Patient
- 2. Distinguishing between patients who have and don’t have significant MOI Performing a focused history and physical exam for a trauma patient Sizing and applying a cervical collar Ongoing assessment Eight Chapter CORE CONCEPTS
- 3. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
- 4. S IGNIFICANT MECHANISM OF INJURY
- 5. Significant Mechanism of Injury Ejection from vehicle Death in same passenger compartment Fall of greater than 20 feet (Continued)
- 6. Rollover of vehicle High-speed vehicle collision Vehicle-pedestrian collision (Continued) Significant Mechanism of Injury
- 7. Motorcycle crash Unresponsive, or altered Penetrating injury of head, mental status chest, or abdomen Significant Mechanism of Injury
- 8. Hidden Injuries Seat belts Airbags Lift and look
- 9. Significant Mechanism of Injury Falls greater than 10 feet Bicycle collision Vehicle in medium-speed Differences for Infants and Children collision
- 10. If Significant Mechanism of Injury: Reconsider mechanism of Continue spine stabilization. Consider requesting ALS. Reconsider transport decision . (Continued) injury.
- 11. If Significant Mechanism of Injury: Assess mental status. Do rapid physical exam. Assess baseline vital signs. Obtain SAMPLE history.
- 12. Mechanism of Injury Interior of Vehicle Deformities to a vehicle’s interior may show where person struck the surface and reveal a mechanism of injury. (Continued)
- 13. Bent Steering Wheel Broken Mirror
- 14. Distorted Pedals Spiderwebbed Windshield
- 16. P RECEPTOR P EARL The assessment and management of a trauma patient need to focus on time and patient priority. In some cases, the patient does not have the time available in his/her life for the EMT-B to take a lengthy approach. On patients with significant MOI, try to limit the scene time to a “platinum ten minutes!”
- 17. Rapid Trauma Assessment Head Neck Chest Abdomen Pelvis Extremities Posterior
- 18. Inspect and Palpate for DCAP-BTLS = = = = D C A P Deformities Contusions Abrasions Punctures/ penetrations = = = = B T L S Burns Tenderness Lacerations Swelling
- 21. Burns Tenderness
- 24. Head: DCAP-BTLS + Crepitation
- 25. Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation
- 26. Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)
- 27. Mid-clavicular Mid-axillary Listen to both sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to right side.
- 28. Abdomen: DCAP-BTLS + Firmness and Distention
- 29. Pelvis: DCAP-BTLS (Compress Gently)
- 30. Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function
- 32. Vital Signs Respirations Pulse Skin color, temperature, condition Pupils Blood pressure
- 33. SAMPLE History Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to problem = = = = = = S A M P L E
- 35. Cervical Collar Sizing and Application STIFNECK TM Rigid Extrication Collar Philadelphia Cervical Collar TM
- 36. Measure patient’s neck. Measure collar. 1 2 Sizing a Cervical Collar
- 37. STIFNECK TM Collar — Seated Patient Stabilize head and neck manually. Slide collar up toward patient’s chin.
- 38. Position front of collar under chin. Wrap collar around back of neck. STIFNECK TM Collar — Seated Patient
- 39. Secure collar. Rearrange fingers to maintain support. STIFNECK TM Collar — Seated Patient
- 40. Kneel at patient’s head. Stabilize head and neck. STIFNECK TM Collar — Supine Patient
- 41. Maintain stabilization. Slide back of collar under patient’s neck. STIFNECK TM Collar — Supine Patient
- 42. Secure collar. Maintain manual stabilization. STIFNECK TM Collar — Supine Patient
- 43. N O SIGNIFICANT MECHANISM OF INJURY
- 44. No Significant Mechanism of Injury Reconsider mechanism of injury. Perform focused physical exam based on: Chief complaint Mechanism of injury (Continued)
- 45. Assess baseline vital signs. Obtain SAMPLE history. No Significant Mechanism of Injury
- 46. Who Needs a Detailed Physical Exam? Patient’s condition determines whether a detailed physical exam is needed. (Continued)
- 47. A patient with minor injury of injury probably does not. and no significant mechanism (Continued) Who Needs a Detailed Physical Exam?
- 48. mechanism of injury. A patient who has a significant If unsure, do a detailed physical exam. Who Needs a Detailed Physical Exam?
- 49. S TEPS IN THE DETAILED PHYSICAL EXAM
- 50. Detailed Physical Exam Face Ears Eyes Nose Mouth Assess areas examined in rapid trauma assessment plus : (Continued)
- 51. Examine more slowly than trauma assessment. Reassess vital signs. Detailed Physical Exam
- 52. = = = = D C A P Deformities Contusions Abrasions Punctures/ penetrations = = = = B T L S Burns Tenderness Lacerations Swelling
- 53. Head DCAP-BTLS
- 54. Ears DCAP-BTLS + Drainage
- 55. Eyes DCAP-BTLS plus Discoloration Unequal pupils Foreign bodies Blood in anterior chamber
- 56. Nose and Mouth Teeth Obstructions Swollen or lacerated tongue (Continued) DCAP-BTLS plus
- 57. Odors Discoloration Drainage Bleeding Nose and Mouth DCAP-BTLS plus
- 58. Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation
- 59. Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)
- 60. Mid-clavicular Mid-axillary Listen to both sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to right side.
- 61. Abdomen: DCAP-BTLS + Firmness and Distention
- 62. Pelvis: DCAP-BTLS (Compress Gently)
- 63. Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function
- 65. Perform the steps of the rapid trauma assessment — BUT MORE SLOWLY.
- 66. Reassess Vital Signs Respirations Pulse Skin color, temperature, condition Pupils Blood pressure
- 67. 1. Give examples of patients with and without significant mechanism of injury. 2. What do the letters DCAP-BTLS stand for? 3. Which trauma patients should have a detailed physical examination? R EVIEW QUESTIONS