12)Focused History And Physical Exam Trauma Pt

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  • 1. Focused History and Physical Exam- Trauma Pt.
  • 2. Focused History and Physical Exam- Trauma Pt.
      • MOI Guides physical exam
    • Significant MOI
      • Rapid Trauma Assess
    • Not Significant MOI
      • Focused Trauma Assessment
  • 3. Significant MOIs
    • Significant MOI
      • Ejection from a vehicle
      • Death in same passenger compartment
      • Fall greater than 20 ft (adult)
      • Roll-over vehicle
      • High-speed vehicle collision
      • Vehicle-pedestrian collision
      • Motorcycle crash
      • Unresponsive/AMS pt
      • Penetrations
        • Head
        • Chest
        • Abdomen
  • 4. Special Populations & MOI
    • Infants/Peds
      • Significant MOI
        • Falls greater than 10 ft.
        • Bicycle Collision
        • Vehicle in medium speed collision
        • Compensate well and then crash
    • Elderly
      • Tend to compensate poorly
      • Decompensate FAST
      • Prescribed meds could interfere with assessment
      • Lesser MOI = Greater injury
  • 5.  
  • 6.  
  • 7. Thoracic Stab Wound Abdominal Stab Wound
  • 8. Hidden Injuries
    • Safety devices cant prevent everything
    • If they had one on it does not exclude all injury
      • Deceleration = Sheering Forces
      • Loose lap belt
        • Compression of abd
      • Shoulder belt minus lap belt
        • Neck injury
      • Airbag deployment
        • Pt could still have hit the wheel
        • “ Lift and Look”
          • Inspect steering wheel
          • Steering Wheel deformity= SERIOUS injury
  • 9. Pneumothorax Hemothorax
  • 10. Rapid Trauma Assessment
    • What
      • Rapid head-to-toe assessment of pt by palpation
      • DCAP-BTLS
    • Who
      • ALL pt with significant MOI
    • Why
      • Assess for life threatening injuries
    • How
      • Responsive= Seek symptoms before, during, after assessment
      • Unresponsive= Rely on signs before, during, after assessment
  • 11. DCAP-BTLS
    • Deformity
      • “ Structural distortion/bend that alters the normal appearance
      • of the body/body part”
        • Broken bones, soft tissue swelling, etc.
        • Crepitus
          • Grating/crunching sound as one bone fragment rubs against another
        • Subcutaneous Emphysema
          • Air beneath the skin
  • 12.
          • Subcutaneous Emphysema
    Whats this from?
  • 13. DCAP-BTLS
    • Contusions
      • “ Injury to body part without break in the skin”
      • Blunt force trauma compresses underlying vessels
        • Vessels become “leaky” and rupture
      • Hematoma
        • Blood collection under the skin
  • 14. DCAP-BTLS
    • Abrasions
      • “ Scraping of the surface of the skin/mucous membrane”
      • Superficial capillaries break = Oozing
      • Painful Blood
  • 15. DCAP-BTLS
    • Punctures/Penetrations
      • “ Sharp instrument driven through the outer layer of skin”
      • VERY deceiving
        • Small puncture can go VERY deep
  • 16. DCAP-BTLS
    • Burns
    • Sources
      • Thermal – Electrical - Chemical
    • Types
      • Superficial (1 st degree)
        • Upper level of the skin (epidermis)
        • Redness and pain
          • Sunburn
      • Partial Thickness (2 nd degree)
        • Upper and lower level of skin (Epidermis/Dermis)
        • Blistering w/ w/o redness of skin
        • VERY painful
      • Full Thickness (3 rd degree)
        • Extension through upper and lower layers of skin
        • Black/charred red, Yellow/Brown, Dark red, White/Translucent
        • Little pain, pain from associated 1 st and 2 nd degree burns
  • 17.  
  • 18.  
  • 19.  
  • 20. DCAP-BTLS
    • Tenderness
      • “ Pain elicited upon palpation”
  • 21. DCAP-BTLS
    • Lacerations
      • “ Tearing of the skin or surface tissues”
      • Blunt tearing forces
        • Increases collateral tissue damage
      • Sharp objects
        • Minimize collateral tissue damage
  • 22. Sharp Object Blunt Trauma
  • 23.  
  • 24. DCAP-BTLS
    • Swelling (edema)
      • “ Abnormal enlargement of a body part/organ”
      • Caused by increased volume of fluid
        • In Blood vessels
        • Between cells
    Pitting Edema
  • 25. Rapid Trauma Assessment
    • Head-to-to Exam
    • VISUALIZE and PALPATE EVERYTHING!!!
      • Apply DCAP-BTLS
    • SAMPLE HX
    • BASELINE VITALS
  • 26. Rapid Trauma Assessment Head
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Battle’s Signs
      • Bruising immediately behind the ears
      • Suggestive of basal skull fracture
    • Raccoon eyes
      • Bilateral black eyes
      • Suggestive of a basal skull fracture
    • Halo test
      • If fluid is present draining out of nose/ears
      • Collect small sample with gauze pad
      • If CSF is present in the blood it will separate out
      • A halo is created
        • Blood in the center
        • CSF in the periphery
  • 27. Raccoon Eyes Battle’s Signs
  • 28. Rapid Trauma Assessment Neck
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
      • C-Spine “Step Off”
    • Jugular Vein Distention
      • Indicates increased venous pressure
      • Assessed at 45 O
    • Trachea
      • Midline
      • Deviation…
    • Subcutaneous Emphysema
    • APPLY C-COLLAR!!!!!!!!!!!!!!!
  • 29. JVD
  • 30. Rapid Trauma Assessment Chest
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Paradoxical Motion
      • Movement of part of the chest wall that is opposite that of the rest of the chest
        • Flail Segment
    • Breath sounds
      • Mid clavicular lines bilaterally
      • Mid axillary lines bilaterally
        • Present or Absent
        • Equal or diminished
  • 31.  
  • 32.  
  • 33. Rapid Trauma Assessment Abdomen
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Rebound Tenderness
    • Distention
    • Resistance
      • Firm
      • Tender
      • Soft
  • 34. Rapid Trauma Assessment Pelvis
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Stability
      • If no pain
      • Gently compress pelvis posteriorly and medially
    • Priapism
      • Painful erection of the penis indicative of spinal injury
      • Loss of sympathetic tone
  • 35. Rapid Trauma Assessment Lower Extremities
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Work bilaterally at the same time
      • Makes comparison easy
      • 1 L of blood from femur Fx
        • ONLY 1-2 Cm swelling
    • Start at top and work your way down
    • Palpate entirely around the part
    • Assess for PMS!!!!!!!!
      • Pulse
      • Motor
      • Sensation
  • 36. Rapid Trauma Assessment Upper Extremities
    • Inspect/Palpate
      • DCAP-BTLS
      • Crepitation
    • Work bilaterally at the same time
    • Start at clavicles/shoulder and work down
    • Palpate entirely around the part
      • Makes comparison easy
    • Assess for PMS!!!!!!!!
      • Pulse
      • Motor
      • Sensation
  • 37. Rapid Trauma Assessment Posterior
    • Use C-Spine Control!!!!
    • Log-roll pt to lateral position and inspect for
      • DCAP-BTLS
      • Crepitation
      • Vertebral “step offs”
    • !!!DON’T FORGET THE PT HAS A BACK!!!!
  • 38. Focused Trauma Assessment
    • What
      • Focused assessment of injured area
      • Lead by the MOI
    • Who
      • Pt with non significant MOI
    • Why
      • Assess specific area of injury
    • How
      • Assess for DCAP-BTLS at site of injury
      • Assess baseline vitals
      • Obtain SAMPLE history
  • 39.