ASSESSMENT AND MANAGEMENT OF

THE TRAUMA PATIENT

Instructor Name:

Title:

Unit:

OVERVIEW

• SCENE SIZE-UP

• TRANSPORT DECISION AND CRITICAL INTERVENTIONS

• DETAILED EXAM

• ONGOING EXAM

SCENE SIZE-UP

• BSI DECISION

• SCENE SAFETY

• TOTAL NUMBER OF PATIENTS

• ESSENTIAL EQUIPMENT

• ARE ADDITIONAL RESOURCES NEEDED

• MECHANISM OF INJURY

                                     

    

What is Trauma?

A serious injury or shock to the body by violence or accident!

Trauma Assessment is a Basic life support

skill!

Touching the patient is a must to find possible

injuries!

What are we looking for?

• Life threats that are going to kill the patient right now!

• Any obvious injuries that the patient has

• Any underlying injuries the patient may have we can’t see

• Changes that may occur during transport

How fast do patient’s die?

Immediate(50%) minutesto one hour

Early (30%)First 4 hrs

Late (20%) 2 to5 weeks

Now let’s take a look at how the assessment

should go!

Scene size-up

This is the overall picture of the scene to ensure the safest environment for yourself, your crew, other responding personnel, patient, and bystanders in that order.

Scene size-up

• BSI (body substance isolation)• Scene safety• Number of victims• Other help or equipment needed• Mechanism of injury

Mechanism of Injury

• Predictable pattern of injuries caused by forces applied to the body

• Helps you key in on possible injuries

Initial assessment

• General impression- your gut feeling on patient status and priority of transport

• LOC- AVPU on patient with simultaneous initiation of c-spine immobilization

• Airway- open/clear if not fix it• Breathing- rate/quality• interventions to airway- oxygen by NRB or BVM• Circulation- compare radial vs. carotid pulses,

skin color/temp/condition• Control any major bleeding!

Decisions, decisions, decisions

• Load and Go or Stay and play• Rapid trauma survey • Focused trauma survey

Rapid Trauma assessment

• Should take less than two minutes to perform

• A quick scan of whole body• Identifies any life threats• Used to mentally note injuries to fix later

DCAP-BLS-TIC

• Deformities• Contusions• Abrasions• Punctures/penetrations• Burns• Lacerations• Swelling• Tenderness• Instability• crepitation

HEAD• Palpate the head looking for DCAP-BLS-

TIC• Examine the facial bones• Look at ears , nose, and mouth for any

fluids coming from them• Check for Battle signs or raccoon eyes

Neck

• Visualize neck for DCAp-bls-tic• Check neck for tracheal deviation• Check neck for Jugular vein

distention• Palpate the back of the neck • Consider applying the c-collar

Chest• Visualize chest for DCAP-bls-tic• Listen to breath sounds(this is a bls

skill)• Palpate the chest• IF a open wound or flail chest is

found have a partner place a gloved hand over area till you finish rapid trauma survey

Abdomen

• Visualize the abdomen for dcap-bls-tic• Palpate abdomen for rigidity, guarding, or

tenderness• If patient alert and tells you where pain is

feel that area last

Pelvis• Palpate the pelvis for dcap-bls-tic• It is a in and down motion

•Do not rock the pelvis• If you find a unstable pelvis do not

mess with it again

Lower extremities

• Visualize lower extremities for dcap-bls-tic

• Palpate down one leg at a time• Check for pulse, motor, sensory

function to both feet• Check for capillary refill

Upper extremities

• Visualize upper extremities for dcap-bls-tic

• Palpate both arms • Feel for pulse, motor, and sensory• Check capillary refill

Back

• Log roll the patient with c-spine stabilization

• Visualize back for dcap-bls-tic• Palpate back from neck to legs

Secure patient to board

• Secure body first• Then secure head• Reassess PMS after moving patient

•Securing head first or not securing body could be a major problem if patient becomes sick and you have to roll patient to maintain airway!

Attempt to obtain sample history

• Signs/symptoms• Allergies• Medicines including OTC and herbal• Pertinent past medical history• Last oral intake not just eating• Events leading to trauma

Now the patient is in the ambulance enroute to the

hospital!

Baseline Vitals

• Pulse• Respirations• Blood pressure• O2 sat• Skin color/condition

Neurological exam

• LOC• Pupils• Motor• sensory

Detailed exam

• Do a slower exam of body• Touch the whole body looking

for injuries• Fix problems as you find them • Fix problems that you noted in

rapid trauma assessment• Looking for dcap-bls-tic again

Maintain body temperature during exam and transport

PERFORM ONGOING ASSESSMENT

• PERFORM REASSESSMENT OF ABC’S

• REASSESS VITALS EVERY THREE TO FIVE MINUTES

• REASSESS INTERVENTIONS AND EFFECTIVENESS

Give oral report

• Give short concise report• Use the mint pneumonic

– Mechanism of injury– Injuries from head to toe– Neurological exam including gcs score– Treatments performed and vital signs

Transfer patient out of your care!

PITFALLS• Approaching the patient before performing

a Scene Size-Up• Trying to do too much on-scene

– Attempting to “stabilize” the patient in the field

SUMMARY• Scene Size-Up• BTLS Primary Survey

– Initial Assessment

– Rapid Trauma Survey or Focused Exam

• Critical interventions and transport decision

• Detailed Exam• Ongoing Exam

We are finished now

• Question? • Comments• Snide remarks• If not thank you

QUESTIONS?