Focused History and Physical Exam- Trauma Pt.
Focused History and Physical Exam- Trauma Pt. <ul><ul><li>MOI Guides physical exam </li></ul></ul><ul><li>Significant MOI ...
Significant MOIs <ul><li>Significant MOI </li></ul><ul><ul><li>Ejection from a vehicle  </li></ul></ul><ul><ul><li>Death i...
Special Populations & MOI  <ul><li>Infants/Peds </li></ul><ul><ul><li>Significant MOI </li></ul></ul><ul><ul><ul><li>Falls...
 
 
Thoracic Stab Wound Abdominal Stab Wound
Hidden Injuries <ul><li>Safety devices cant prevent everything </li></ul><ul><li>If they had one on it does not exclude al...
Pneumothorax Hemothorax
Rapid Trauma Assessment <ul><li>What </li></ul><ul><ul><li>Rapid head-to-toe assessment of pt by palpation </li></ul></ul>...
DCAP-BTLS  <ul><li>Deformity  </li></ul><ul><ul><li>“ Structural distortion/bend that alters the normal appearance </li></...
<ul><ul><ul><ul><li>Subcutaneous Emphysema  </li></ul></ul></ul></ul>Whats this from?
DCAP-BTLS <ul><li>Contusions </li></ul><ul><ul><li>“ Injury to body part without break in the skin”  </li></ul></ul><ul><u...
DCAP-BTLS <ul><li>Abrasions </li></ul><ul><ul><li>“ Scraping of the surface of the skin/mucous membrane” </li></ul></ul><u...
DCAP-BTLS <ul><li>Punctures/Penetrations </li></ul><ul><ul><li>“ Sharp instrument driven through the outer layer of skin” ...
DCAP-BTLS <ul><li>Burns </li></ul><ul><li>Sources </li></ul><ul><ul><li>Thermal – Electrical - Chemical </li></ul></ul><ul...
 
 
 
DCAP-BTLS <ul><li>Tenderness </li></ul><ul><ul><li>“ Pain elicited upon palpation” </li></ul></ul>
DCAP-BTLS <ul><li>Lacerations </li></ul><ul><ul><li>“ Tearing of the skin or surface tissues” </li></ul></ul><ul><ul><li>B...
Sharp Object  Blunt Trauma
 
DCAP-BTLS <ul><li>Swelling (edema) </li></ul><ul><ul><li>“ Abnormal enlargement of a body part/organ” </li></ul></ul><ul><...
Rapid Trauma Assessment <ul><li>Head-to-to Exam </li></ul><ul><li>VISUALIZE  and  PALPATE EVERYTHING!!! </li></ul><ul><ul>...
Rapid Trauma Assessment Head <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul><li>Crepitati...
Raccoon Eyes Battle’s Signs
Rapid Trauma Assessment Neck <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul><li>Crepitati...
JVD
Rapid Trauma Assessment Chest <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul><li>Crepitat...
 
 
Rapid Trauma Assessment Abdomen <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul><li>Crepit...
Rapid Trauma Assessment Pelvis <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul><li>Crepita...
Rapid Trauma Assessment Lower Extremities  <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul...
Rapid Trauma Assessment Upper Extremities <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS  </li></ul></ul><ul><ul>...
Rapid Trauma Assessment Posterior  <ul><li>Use C-Spine Control!!!! </li></ul><ul><li>Log-roll pt to lateral position and i...
Focused  Trauma Assessment <ul><li>What </li></ul><ul><ul><li>Focused assessment of injured area </li></ul></ul><ul><ul><l...
 
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12)Focused History And Physical Exam Trauma Pt

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12)Focused History And Physical Exam Trauma Pt

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

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