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14)Detailed Assessment

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14)Detailed Assessment

  1. 1. Detailed Assessment
  2. 2. Detailed Assessment <ul><li>What: </li></ul><ul><ul><li>Deliberate head-to-toe assessment </li></ul></ul><ul><ul><li>Encompasses ALL aspects of physical exam </li></ul></ul><ul><ul><li>Seeks information not previously obtained </li></ul></ul><ul><li>Why: </li></ul><ul><ul><li>Assess secondary injuries </li></ul></ul><ul><li>When: </li></ul><ul><ul><li>After critical decisions and treatment have been made </li></ul></ul><ul><li>Who: </li></ul><ul><ul><li>Medical pt based on NOI </li></ul></ul><ul><ul><li>Unresponsive pt (med/trauma) </li></ul></ul><ul><ul><ul><li>Rule in/out trauma </li></ul></ul></ul><ul><ul><li>Trauma pt –Injury specific </li></ul></ul><ul><ul><ul><li>i.e. baseball player struck in eye- exam eyes, ears, nose, mouth, etc. </li></ul></ul></ul>
  3. 3. Detailed Assessment Head <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS </li></ul></ul><ul><ul><li>Crepitation </li></ul></ul>
  4. 4. Detailed Assessment Face <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>
  5. 5. Detailed Assessment Ears <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS </li></ul></ul><ul><li>Drainage </li></ul><ul><ul><li>Apply loose dressing </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><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>
  6. 6. Detailed Assessment Eyes <ul><li>Inspect </li></ul><ul><ul><li>DCAP-BTLS </li></ul></ul><ul><li>Discoloration </li></ul><ul><li>Unequal pupils </li></ul><ul><li>Foreign material </li></ul><ul><li>Blood in anterior chamber </li></ul>
  7. 7. Blood in anterior chamber Foreign Body Jaundice Constricted Unequal Dilated
  8. 8. Detailed Assessment Nose <ul><li>Inspect/Palpate </li></ul><ul><ul><li>DCAP-BTLS </li></ul></ul><ul><li>Drainage </li></ul><ul><li>Bleeding </li></ul>
  9. 9. Detailed Assessment Mouth <ul><li>DCAP-BTLS </li></ul><ul><li>Drainage </li></ul><ul><li>Bleeding </li></ul><ul><li>Teeth </li></ul><ul><li>Obstructions </li></ul><ul><li>Swollen/lacerated tongue </li></ul><ul><ul><li>Seizure? </li></ul></ul><ul><li>Odors </li></ul><ul><ul><li>DKA? </li></ul></ul><ul><li>Discoloration </li></ul>
  10. 10. Detailed 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>
  11. 11. JVD
  12. 12. Detailed 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><li>Present or Absent </li></ul></ul><ul><ul><li>Equal or diminished </li></ul></ul>
  13. 13. Detailed 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>
  14. 14. 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>
  15. 15. Rapid Trauma Assessment 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>
  16. 16. 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>
  17. 17. Detailed Assessment <ul><li>Treat minor injuries found. </li></ul><ul><li>Reassess vitals!!!!!!!! </li></ul>

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