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  • 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
  • 15. Deformed Dashboard
  • 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
  • 19. Deformities Contusions
  • 20. Abrasions Punctures/penetrations
  • 21. Burns Tenderness
  • 22. Lacerations Swelling
  • 23. Mechanism of Injury
  • 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
  • 31. Posterior: DCAP-BTLS
  • 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
  • 34. Interventions and Transport
  • 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
  • 64. Posterior: DCAP-BTLS
  • 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