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Alexander ch34 lecture
1.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Advanced EMT A Clinical-Reasoning Approach, 2nd Edition Chapter 34 Mechanisms of Injury, Trauma Assessment, and Trauma Triage Criteria
2.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Applies fundamental knowledge to provide basic and selected advanced emergency care and transportation based on assessment findings for an acutely injured patient. • Pathophysiology, assessment, and management of the trauma patient, including trauma scoring, rapid transport and destination issues, and transport mode. Advanced EMT Education Standards
3.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. 1. Define key terms introduced in this chapter. 2. Describe the purpose and goals of trauma patient assessment. 3. Describe the components of the trauma patient assessment process. 4. Discuss the decisions that must be made during the trauma patient assessment process. 5. Explain the importance of various decision-making and problem-solving approaches in the trauma patient assessment and patient care processes. Objectives
4.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-1 Because injury can occur to anyone at any time, you must be prepared to respond and properly manage trauma patients. (© Edward T. Dickinson, MD)
5.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. • Trauma is injury to the body resulting from external forces. • Traumatic injury affects people of all age groups and can occur in any environment at any time. • Be prepared to respond to and properly assess and manage trauma patients. Introduction
6.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Think About It • What can the information provided so far tell Mac and Courtney about the potential severity of the patient’s injuries? • What should Mac and Courtney include in their initial plans for approaching the scene and assessing the patient?
7.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-3 The law of inertia: A body in motion remains in motion and a body at rest remains at rest unless acted upon by an outside force.
8.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (1 of 6) • Kinetics – Branch of physics ▪ How objects in motion are affected by outside forces; how energy distributed when objects collide – Newton’s law of inertia ▪ A body in motion will remain in motion; body at rest will remain at rest unless acted upon by outside force.
9.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (2 of 6) • Kinetics (continued) – Law of conservation of energy ▪ Energy can neither be created nor destroyed; can change from one form to another. – Kinetic energy ▪ Function of mass (weight) and velocity (speed) – Newton’s second law of motion ▪ Force = mass × acceleration or deceleration
10.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (3 of 6) • Classifying trauma – Blunt trauma ▪ Direct injury ▪ Indirect energy – Penetrating trauma ▪ Stab or bullet wound ▪ As an object passes through tissues, energy is dispersed to surrounding tissues, creating temporary cavity and additional internal injury.
11.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-4 As an object passes through the tissues [(A) and (C)], a permanent cavity is created. As the object continues, energy is dispersed to the surrounding tissues (B), creating a temporary cavity (cavitation) and additional internal injury.
12.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-5 The cone of injury provides an idea of how much internal damage may have occurred through movement of the object within the tissues. For this reason, you must identify the object that has caused the patient’s injury.
13.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (4 of 6) • Classifying trauma (continued) – Low-velocity penetrating injuries ▪ Created by hand-driven objects such as stick, ice pick, or knife ▪ Energy involved not as significant ▪ Important to know the length and width of object to determine the potential for injuries
14.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (5 of 6) • Classifying trauma (continued) – Medium-velocity weapons ▪ Handguns and smaller-caliber rifles ▪ Produce enough energy to cause injury beyond immediate pathway of projectile – High-velocity injuries ▪ Caused by high-velocity rifles ▪ Massive direct and indirect injuries
15.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Kinematics of Trauma (6 of 6) • Classifying trauma (continued) – Attempt to determine caliber of weapon that created injury. ▪ Distance between weapon when fired and patient – Identify both entrance and exit wounds. ▪ Idea of what underlying body structures injured
16.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-6 You must not approach a scene unless it is safe to do so. If a scene is not safe upon arrival, you must call for appropriate additional resources to mitigate the hazards prior to approaching the scene. (© Mark C. Ide / Science Source)
17.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient • Scene size-up – Standard Precautions – Ensure that the scene is safe. – Identify number and location of injured. – Assess mechanism of injury (MOI). – Consider the need for additional resources. – If there are hazards at the scene, do not approach.
18.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (2 of 39) • Mechanism of injury (MOI) – Forces and energy that cause injury – Important to identify forces sustained – Each MOI has a predictable pattern of potential injuries associated with it. – Allows you to formulate list of potential injuries based solely on MOI
19.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-7 (1 of 3) (A) Three collisions occur with a rapid-deceleration MOI: (A) The vehicle collides with an object.
20.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-7 (2 of 3) (B) Three collisions occur with a rapid-deceleration MOI: (B) The driver collides with the steering wheel.
21.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-7 (3 of 3) (C) Three collisions occur with a rapid-deceleration MOI: (C) The organs collide with the inside of the body.
22.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (3 of 39) • Motor vehicle crashes (MVCs) – Vehicle collides with object or another vehicle – Patient inside vehicle forced to decelerate by restraint systems or collides with interior of vehicle – Internal organs collide with one another and the inside of the body
23.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (4 of 39) • Motor vehicle crashes (MVCs) (continued) – Collisions of internal organs ▪ Bruising, lacerations, tearing ▪ Can lead to massive internal bleeding not visible on external examination ▪ Rely on assessment and MOI and indications of bleeding: – Pale, diaphoretic skin – Abnormal vital signs
24.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-8 (A) (B) (A) In a frontal impact collision, the vehicle collides with another object, causing damage to the front of the vehicle. (B) In a frontal impact collision, the occupant continues traveling at the same speed after the initial impact. (© Mark C. Ide / Science Source)
25.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (5 of 39) • Motor vehicle crashes (MVCs) (continued) – Five categories of impact ▪ Frontal ▪ Rear ▪ Lateral ▪ Rotational ▪ Rollover
26.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (6 of 39) • Frontal impact – Head-on collision – Two possible paths ▪ Up and over ▪ Down and under
27.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (7 of 39) • Frontal impact—up and over – Patient collides with steering wheel. – Head moves upward toward windshield. – Chest, head, neck, abdominal trauma, partial ejection through windshield
28.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-9 It is important to consider the predictable injuries of the head, neck, chest, and abdomen associated with a patient’s up-and-over pathway.
29.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (8 of 39) • Frontal impact—down and under – Patient collides with bottom of steering wheel and, in some cases, legs collide with dashboard. – Chest, abdominal, lower extremity injuries – Often lower legs, ankles, and feet are forced into the floorboard and pedals, creating injury.
30.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-10 It is important to consider the predictable injuries of the abdomen, hips, spine, and lower extremities associated with a patient’s down-and-under pathway.
31.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-11 You should look for damage to the vehicle to predict potential injury to the patient. Starring of the windshield indicates possible head injury to the patient.
32.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (9 of 39) • Frontal impact MVCs—predicting potential significant injury – More than 18 inches of damage to car – Starring and shattering of windshield – Bending of steering wheel – Damage to dashboard
33.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (10 of 39) • Frontal impact MVCs – Chest ▪ Internal bleeding ▪ Compression, shearing, or injury of heart and lungs ▪ Air pressure causing rupture of lung tissue – Abdomen ▪ Compression and shearing injury ▪ Liver and spleen can be injured, leading to massive internal bleeding and death
34.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (11 of 39) • Frontal impact MVCs (continued) – Head ▪ Range from mild lacerations to massive skull fractures ▪ Massive fractures ▪ Direct injury to brain ▪ Indirect injury to neck
35.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-12 (1 of 2) (A) (A) Rear impact. A rear impact MOI results in rapid-acceleration injuries such as whiplash, or hyperextension injuries. (© Mark C. Ide / Science Source)
36.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-12 (2 of 2) (B) Following the acceleration, the occupant decelerates, moving forward and causing injury to the head and chest. (B)
37.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (12 of 39) • Rear impact MVCs – Vehicle is struck from behind, driving vehicle forward. – Acceleration of vehicle causes acceleration injuries. – Whiplash: ▪ Hyperextension can lead to serious injury of soft tissues, spine, spinal cord.
38.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-13 (1 of 2) (A) (A) Lateral impact. (© Mark C. Ide / Science Source)
39.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-13 (2 of 2) (B) (B) In a lateral impact MOI, you must consider the potential for injury to the side of the patient that sustained the energy from impact.
40.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (13 of 39) • Lateral impact MVCs – Vehicle is struck on side (“T-bone” collision). – Determine if intrusion into passenger compartment of vehicle occurred and what location. – Injuries: ▪ Fractured extremities on side of impact ▪ Lateral chest trauma ▪ Hip fractures ▪ Head and neck
41.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-14 A rotational impact occurs when a lateral impact causes the patient’s vehicle to rotate or spin. This rotation results in twisting forces to the patient. (© Ed Effron)
42.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (14 of 39) • Rotational impact MVC – Causes vehicle to rotate or spin; occurs at either front or rear fender locations. – Patient subjected to twisting forces. ▪ Can lead to significant injury (neck and internal organs).
43.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-15 (1 of 2) (A) (A) Rollover impact. (© Daniel Limmer)
44.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-15 (2 of 2) (B) (B) A rollover MVC subjects the patient to forces of every kind and can lead to Significant patient injury.
45.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (15 of 39) • Rollover MVCs – Subject patient to forces of every kind; can lead to significant injury. – Unrestrained individuals inside vehicle may be ejected from vehicle. – Patients who have been ejected usually sustain serious injury or death.
46.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-16 Adults tend to turn away from an approaching vehicle, whereas children tend to turn and face directly toward it. (© Mark C. Ide / Science Source)
47.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (16 of 39) • Pedestrian–vehicle collisions – Speed of vehicle – Parts of patient’s body struck – Distance patient thrown following impact – Parts of the body that struck ground – Type of surface patient landed on
48.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (17 of 39) • Pedestrian–vehicle collisions (continued) – When person is about to be struck: ▪ Tends to turn his back to coming impact, absorbing it either on lateral or posterior side of body – As vehicle impacts, the person is: ▪ Lifted off his feet, and forward movement of vehicle causes him to impact windshield of vehicle
49.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (18 of 39) • Pedestrian–vehicle collisions (continued) – If speed of vehicle substantial: ▪ Person will travel completely over vehicle. – If driver decelerates by applying brakes: ▪ Person will roll off hood of car and strike ground, causing additional injury.
50.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-17 Motorcycle collisions can result in multiple impacts that injure the rider. (© CW McKean/Syracuse Newspapers/The Image Works)
51.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (19 of 39) • Motorcycle crashes – Driver of motorcycle is exposed. ▪ More risk for injury than driver of automobile – Not wearing helmet ▪ Greater risk of sustaining head injury, increasing morbidity and mortality – Head-on motorcycle collision ▪ Rider is thrown into and over handlebars; continues until he comes to rest after striking ground.
52.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (20 of 39) • Motorcycle crashes (continued) – Lateral impact motorcycle collision ▪ Rider is struck by vehicle, sustaining injury to leg on side of impact. ▪ After impact, rider loses control and crashes. – Ejection of motorcyclist ▪ Rider is separated from motorcycle. – When helmet isn’t worn, likelihood of significant head trauma is much higher.
53.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-18 Direct injury occurs with contact with the ground, and indirect injury occurs as energy is transferred to other parts of the body.
54.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (21 of 39) • Falls – Height of fall – Body part that hit landing surface first – Surface fallen onto – Direct injury ▪ Patient’s body contacts ground – Indirect injury ▪ Energy continues to be absorbed by body; additional injury
55.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (22 of 39) • Blast injuries – Result of explosions from natural gas, fireworks, improvised explosive devices (IEDs) – Ensure scene is safe prior to entering. – Five phases of injury: ▪ Blast injury ▪ Secondary blast injury ▪ Tertiary blast injury ▪ Quarternary blast injury ▪ Quinary blast injury
56.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (23 of 39) • Blast injuries (continued) – Primary blast injury ▪ Pressure wave from explosion; directly related to force of explosion – Secondary blast injury ▪ Debris thrown from explosion as result of pressure wave
57.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (24 of 39) • Blast injuries (continued) – Tertiary blast injury ▪ Pressure wave and debris hit patient; thrown away from explosion – Quaternary blast injury ▪ Environmental conditions following explosion – Quinary blast injury ▪ Hyperinflammatory state caused by exposure to contaminants from the blast
58.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (25 of 39) • Significant mechanism of injury (MOI) – Consider MOI of patient to determine if life-threatening injury exists. ▪ Ejection ▪ Death in the same vehicle ▪ Vehicle telemetry consistent with high risk ▪ Pedestrian struck when vehicle was going faster than 20 mph ▪ Fall >20 feet ▪ Motorcycle crash >20 mph ▪ Penetrating trauma to head, neck, torso, or proximal extremity ▪ Amputation proximal to wrist or ankle
59.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (26 of 39) • Significant mechanism of injury (MOI) (continued) – Maintain a high index of suspicion if significant MOI is present. – Transport to facility with surgical services.
60.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Table 34-1 Mechanisms Indicating High Potential for Significant Injury Maintain a high index of suspicion for each of the following significant mechanisms of injury: • Ejection from a vehicle • Death of someone in the same vehicle • Rollover MVC • High-speed collisions (>40 mph) • Pedestrian struck by a vehicle • Falls of >20 feet (>10 feet for children) • Motorcycle and rider separation • Penetrating trauma to the head, neck, torso, or proximal extremity • Significant blunt trauma to the head, neck, or torso
61.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (27 of 39) • Nonsignificant mechanism of injury (MOI) – Less-severe injuries also require EMS care. – Your role: ▪ Assess patient. ▪ Treat and package. ▪ Provide transport to appropriate facility.
62.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Think About It • What pattern of injuries should Mac and Courtney anticipate? • How should they begin their assessment and management?
63.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (28 of 39) • Primary assessment – Identify immediate life threats and treat. – Use systematic approach. – Perform head-to-toe exam. – Trauma patients have gruesome injuries that can be distracting. ▪ Do not allow injuries to distract you from performing systematic primary assessment.
64.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-19 When a trauma patient has the potential for spine injury, manually stabilize his head and neck to restrict motion as soon as you make contact with him.
65.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (29 of 39) • Primary assessment (continued) – Manual stabilization of head and neck when: ▪ Forces have been applied to head, neck, or back ▪ Neurologic deficits of extremities are present ▪ Patient has altered mental status – Place hands on both sides of head and hold in neutral inline position.
66.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (30 of 39) • Primary assessment—airway – Assess airway; if blood, vomit, fluids in airway, clear by suctioning. – Determine if airway patent; look, listen, feel for breathing. – Abnormal respiratory sounds such as gurgling, snoring, or stridor are indicative of a partially obstructed airway.
67.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (31 of 39) • Primary assessment—airway (continued) – Unconscious or decreased level of responsiveness ▪ Look, listen, and feel for breathing. ▪ Use modified jaw-thrust . – Use head-tilt/chin-lift maneuver if unsuccessful. ▪ Open airway and insert a nasal or oral adjunct to maintain airway.
68.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (32 of 39) • Primary assessment—breathing – If breathing adequate: ▪ Apply oxygen to maintain SpO2 of 95% or higher. – If breathing not adequate: ▪ Ventilate using bag-valve mask with high-flow oxygen. – If lung sounds diminished or absent on one side of chest, pneumothorax or hemothorax may be present.
69.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (33 of 39) • Primary assessment—circulation – Pulse check, skin condition, blood sweep – Assess pulse for rate, rhythm, quality. – Skin cool, clammy, diaphoretic: signs of shock – Perform blood sweep: ▪ Control life-threatening bleeding immediately.
70.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (34 of 39) • Primary assessment—disability – Patient’s level of responsiveness – Use AVPU mnemonic. – Determine Glasgow Coma Scale (GCS) score.
71.
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2012 Pearson Education, Inc. All Rights Reserved. Table 34-2 Glasgow Coma Scale EYE OPENING VERBAL RESPONSE MOTOR RESPONSE Points Points Points Spontaneous 4 Oriented 5 Obeys commands 6 To voice 3 Confused 4 Localizes pain 5 To pain 2 Inappropriate words 3 Withdraws 4 None 1 None 1 Abnormal flexion 3 Abnormal extension 2 None 1
72.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (35 of 39) • Primary assessment—expose – Expose critical trauma patients to prepare for rapid trauma exam. – Protect patient’s modesty; keep patient warm. – You cannot treat what you cannot see.
73.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (36 of 39) • Secondary assessment – Rapid trauma exam for critical patients and those with significant MOI – Baseline vital signs – Medical history – Either focused or head-to-toe exam, depending on patient’s MOI, complaints, overall condition – Rapid trauma exam: quick visualization and palpation of vital areas of body to identify life-threatening injuries What does the DCAP-BTLS mnemonic stand for?
74.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (37 of 39) • Secondary assessment (continued) – Rapid trauma assessment ▪ Head ▪ Neck ▪ Chest ▪ Abdomen ▪ Pelvis ▪ Posterior ▪ Extremities
75.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (38 of 39) • Secondary assessment (continued) – Baseline vital signs: respiratory rate, pulse rate, blood pressure – Subsequent vital signs compared to baseline vital signs allows you to identify trends. – Obtain patient’s history. What does the SAMPLE mnemonic stand for?
76.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (39 of 39) • Critical trauma patients – Glasgow Coma Scale less than 14 – Systolic blood pressure less than 90 mmHg – Respiratory rate less than 12 or greater than 29 (less than 20 in infant under 1 year of age) – Goal: treat and package; begin transport
77.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (1 of 3) • Secondary assessment (continued) – Focused trauma exam ▪ Isolated injury without significant MOIs – Head-to-toe exam ▪ Identify all injuries; use DCAP-BTLS mnemonic.
78.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (1 of 13) Head-to-Toe Assessment 1. Run your gloved hands over the scalp and through the hair. Note any blood on your gloves.
79.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (2 of 13) Head-to-Toe Assessment 2. Palpate the face, forehead, and jaw.
80.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (3 of 13) Head-to-Toe Assessment 3. Observe the pupils using an appropriate light source.
81.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (4 of 13) Head-to-Toe Assessment 4. Observe for drainage of blood or cerebrospinal fluid, flaring of nostrils, and damage to teeth. Look behind the ears for bruising (Battle’s sign).
82.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (5 of 13) Head-to-Toe Assessment 5. Observe for JVD and run your thumb and forefinger along both sides of the trachea to confirm proper alignment. Note any retractions above the clavicles.
83.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (6 of 13) Head-to-Toe Assessment 6. Palpate the chest with both hands, feeling for crepitus or subcutaneous emphysema, then listen for equal breath sounds and observe for paradoxical movement of the chest.
84.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (7 of 13) Head-to-Toe Assessment 7. Palpate each quadrant of the abdomen with both hands. Observe the patient’s face for signs of grimacing, and note body language for evidence of guarding.
85.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (8 of 13) Head-to-Toe Assessment 8. Palpate both sides of the pelvis gently with both hands. Press downward and outward gently. Observe for signs of wetness that may be blood or urine.
86.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (9 of 13) Head-to-Toe Assessment 9. Palpate each leg with both hands and assess distal pulses and sensation. Have the patient push and pull against the resistance of your hands to test for motor function.
87.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (10 of 13) Head-to-Toe Assessment 10. Palpate each arm with both hands, and assess distal pulses and sensation. Have the patient squeeze both hands with his simultaneously to test for motor function.
88.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (11 of 13) Head-to-Toe Assessment 11. Palpate as much of the back as you can with both hands, feeling for soft spots (paradoxical movement) and crepitus (subcutaneous emphysema or rib fractures).
89.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (12 of 13) Head-to-Toe Assessment 12. Use both hands to perform the grip test.
90.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Scan 34-1 (13 of 13) Head-to-Toe Assessment 13. Perform the foot-flex test against both feet.
91.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (2 of 3) • For critical patients – Reassess vital signs and interventions every 5 minutes. • For noncritical patients – Reassess every 15 minutes. • Transport patient to most appropriate facility. • Mode of transport – Method used to transport; ground or air
92.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Figure 34-22 You must determine the most appropriate mode of transport for the patient.
93.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Assessment of the Trauma Patient (3 of 3) • Air transport – Patient’s condition – Estimated time of arrival (ETA) of aircraft – Weather conditions – Ground transport time – Location of potential landing zones • Specialty care hospitals provide specific services.
94.
Copyright © 2017,
2012 Pearson Education, Inc. All Rights Reserved. Chapter Summary • Scene of critical trauma patient is hectic. • Remain focused and organized; systematic assessment, treatment, packaging; make decisions about transport. • Failure to manage emergency in efficient manner can lead to increase in morbidity and death. • Goal: minimize scene times; begin transporting patient to nearest appropriate medical facility.
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