Ch08 eec3

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Ch08 eec3

  1. 1. Eight Chapter Assessment of the Trauma Patient
  2. 2. <ul><li>Distinguishing between patients who have and don’t have significant MOI </li></ul><ul><li>Performing a focused history and physical exam for a trauma patient </li></ul><ul><li>Sizing and applying a cervical collar </li></ul><ul><li>Ongoing assessment </li></ul>Eight Chapter CORE CONCEPTS
  3. 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. 4. S IGNIFICANT MECHANISM OF INJURY
  5. 5. Significant Mechanism of Injury <ul><li>Ejection from vehicle </li></ul><ul><li>Death in same passenger </li></ul>compartment <ul><li>Fall of greater than 20 feet </li></ul>(Continued)
  6. 6. <ul><li>Rollover of vehicle </li></ul><ul><li>High-speed vehicle collision </li></ul><ul><li>Vehicle-pedestrian collision </li></ul>(Continued) Significant Mechanism of Injury
  7. 7. <ul><li>Motorcycle crash </li></ul><ul><li>Unresponsive, or altered </li></ul><ul><li>Penetrating injury of head, </li></ul>mental status chest, or abdomen Significant Mechanism of Injury
  8. 8. Hidden Injuries <ul><li>Seat belts </li></ul><ul><li>Airbags </li></ul><ul><li>Lift and look </li></ul>
  9. 9. Significant Mechanism of Injury <ul><li>Falls greater than 10 feet </li></ul><ul><li>Bicycle collision </li></ul><ul><li>Vehicle in medium-speed </li></ul>Differences for Infants and Children collision
  10. 10. If Significant Mechanism of Injury: <ul><li>Reconsider mechanism of </li></ul><ul><li>Continue spine stabilization. </li></ul><ul><li>Consider requesting ALS. </li></ul><ul><li>Reconsider transport decision . </li></ul>(Continued) injury.
  11. 11. If Significant Mechanism of Injury: <ul><li>Assess mental status. </li></ul><ul><li>Do rapid physical exam. </li></ul><ul><li>Assess baseline vital signs. </li></ul><ul><li>Obtain SAMPLE history. </li></ul>
  12. 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. 13. Bent Steering Wheel Broken Mirror
  14. 14. Distorted Pedals Spiderwebbed Windshield
  15. 15. Deformed Dashboard
  16. 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. 17. Rapid Trauma Assessment <ul><li>Head </li></ul><ul><li>Neck </li></ul><ul><li>Chest </li></ul><ul><li>Abdomen </li></ul><ul><li>Pelvis </li></ul><ul><li>Extremities </li></ul><ul><li>Posterior </li></ul>
  18. 18. Inspect and Palpate for DCAP-BTLS = = = = D C A P Deformities Contusions Abrasions Punctures/ penetrations = = = = B T L S Burns Tenderness Lacerations Swelling
  19. 19. Deformities Contusions
  20. 20. Abrasions Punctures/penetrations
  21. 21. Burns Tenderness
  22. 22. Lacerations Swelling
  23. 23. Mechanism of Injury
  24. 24. Head: DCAP-BTLS + Crepitation
  25. 25. Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation
  26. 26. Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)
  27. 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. 28. Abdomen: DCAP-BTLS + Firmness and Distention
  29. 29. Pelvis: DCAP-BTLS (Compress Gently)
  30. 30. Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function
  31. 31. Posterior: DCAP-BTLS
  32. 32. Vital Signs <ul><li>Respirations </li></ul><ul><li>Pulse </li></ul><ul><li>Skin color, temperature, condition </li></ul><ul><li>Pupils </li></ul><ul><li>Blood pressure </li></ul>
  33. 33. SAMPLE History Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to problem = = = = = = S A M P L E
  34. 34. Interventions and Transport
  35. 35. Cervical Collar Sizing and Application STIFNECK TM Rigid Extrication Collar Philadelphia Cervical Collar TM
  36. 36. Measure patient’s neck. Measure collar. 1 2 Sizing a Cervical Collar
  37. 37. STIFNECK TM Collar — Seated Patient Stabilize head and neck manually. Slide collar up toward patient’s chin.
  38. 38. Position front of collar under chin. Wrap collar around back of neck. STIFNECK TM Collar — Seated Patient
  39. 39. Secure collar. Rearrange fingers to maintain support. STIFNECK TM Collar — Seated Patient
  40. 40. Kneel at patient’s head. Stabilize head and neck. STIFNECK TM Collar — Supine Patient
  41. 41. Maintain stabilization. Slide back of collar under patient’s neck. STIFNECK TM Collar — Supine Patient
  42. 42. Secure collar. Maintain manual stabilization. STIFNECK TM Collar — Supine Patient
  43. 43. N O SIGNIFICANT MECHANISM OF INJURY
  44. 44. No Significant Mechanism of Injury <ul><li>Reconsider mechanism of injury. </li></ul><ul><li>Perform focused physical exam </li></ul>based on: <ul><li>Chief complaint </li></ul><ul><li>Mechanism of injury </li></ul>(Continued)
  45. 45. <ul><li>Assess baseline vital signs. </li></ul><ul><li>Obtain SAMPLE history. </li></ul>No Significant Mechanism of Injury
  46. 46. Who Needs a Detailed Physical Exam? <ul><li>Patient’s condition determines </li></ul>whether a detailed physical exam is needed. (Continued)
  47. 47. <ul><li>A patient with minor injury </li></ul>of injury probably does not. and no significant mechanism (Continued) Who Needs a Detailed Physical Exam?
  48. 48. mechanism of injury. <ul><li>A patient who has a significant </li></ul><ul><li>If unsure, do a detailed </li></ul>physical exam. Who Needs a Detailed Physical Exam?
  49. 49. S TEPS IN THE DETAILED PHYSICAL EXAM
  50. 50. Detailed Physical Exam <ul><li>Face </li></ul><ul><li>Ears </li></ul><ul><li>Eyes </li></ul><ul><li>Nose </li></ul><ul><li>Mouth </li></ul><ul><li>Assess areas examined in rapid </li></ul>trauma assessment plus : (Continued)
  51. 51. <ul><li>Examine more slowly than </li></ul>trauma assessment. <ul><li>Reassess vital signs. </li></ul>Detailed Physical Exam
  52. 52. = = = = D C A P Deformities Contusions Abrasions Punctures/ penetrations = = = = B T L S Burns Tenderness Lacerations Swelling
  53. 53. Head DCAP-BTLS
  54. 54. Ears DCAP-BTLS + Drainage
  55. 55. Eyes DCAP-BTLS plus <ul><li>Discoloration </li></ul><ul><li>Unequal pupils </li></ul><ul><li>Foreign bodies </li></ul><ul><li>Blood in anterior </li></ul>chamber
  56. 56. Nose and Mouth <ul><li>Teeth </li></ul><ul><li>Obstructions </li></ul><ul><li>Swollen or </li></ul>lacerated tongue (Continued) DCAP-BTLS plus
  57. 57. <ul><li>Odors </li></ul><ul><li>Discoloration </li></ul><ul><li>Drainage </li></ul><ul><li>Bleeding </li></ul>Nose and Mouth DCAP-BTLS plus
  58. 58. Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation
  59. 59. Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence and Equality)
  60. 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. 61. Abdomen: DCAP-BTLS + Firmness and Distention
  62. 62. Pelvis: DCAP-BTLS (Compress Gently)
  63. 63. Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function
  64. 64. Posterior: DCAP-BTLS
  65. 65. Perform the steps of the rapid trauma assessment — BUT MORE SLOWLY.
  66. 66. Reassess Vital Signs <ul><li>Respirations </li></ul><ul><li>Pulse </li></ul><ul><li>Skin color, temperature, </li></ul>condition <ul><li>Pupils </li></ul><ul><li>Blood pressure </li></ul>
  67. 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

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