assessment of the trauma patient. focused history and physical exam for the trama patient
TRANSCRIPT
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Assessment of the Trauma Patient
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Focused History and Physical Exam for the Trama Patient
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No significant mechanism of injury
Focus assessment on just the areas of injury or compliant.
Includes
Physical Exam
VS
SAMPLE
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D C A P B T L Se o b u u e a wf n r n r n c eo t a c n d e lm u s t s e r li s I u r a it I o r n t ni o n e e I ge n s s s os s s n
s
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Apply a cervical collar
during the rapid trauma assessment
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Trauma patient with a significant mechanism of injury
Remember with children same type of injury may take less force.
Continue spinal immobilization
Reconsider transport decision
Reassess MS
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Perform a Rapid Trauma Assessment
Inspect
Palpate
Auscultate
Smell
From head-to-toe
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Jugular vein distension
Paradoxical motion
Flail chest
Crepitation
Subcutaneous Emphysema
Pulsating mass
Pelvis- Priapism
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PMS PMS
PMS PMS
PMS
PMS PMS PMS
PMS
PMS PMS PMS
PMS PMS
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Reconsider mechanism of injury
Determine chief complaint
Perform a focused physical exam
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Expose
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Mechanism of Injury
Index of suspicion
Law of inertia: A object in motion stays in motion until acted upon by another force
Three collisions: First; vehicle strikes something
Second; Victim strikes something
on impact
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Third collision; organs strike
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Examples:
Head-on collision:
Up and over injury
up and over the steering wheel
Down and under injurydown and under the steering wheel
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Rear-end collisionHead and neck injury
Side impact collisionSkeletal and internal injuries
RolloverPossibility of ejection
Rotational ImpactObserve damage to the windshield, steering wheel,
dash and pedals
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Motorcycles and ATVs
Helmet?
Suspect any and all types of injuries
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Falls
Height of fall
three times patient height is severe
Surface they landed on
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Penetrating TraumaShooting; stabbing
Velocity: Speed of the objectLow velocity
StabbingInjury usually isolated to area penetrated
multiple woundsdamage to internal organs
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Medium-velocity
Handguns and shotguns
Arrows
High velocity
High powered rifles
Assault rifles
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Bullets cause damage in two ways:
Damage directly from the bullet itself
Cavitation
pressure wave
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Blunt Force Trauma
maintain a high index of suspicion
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Assessment of the Medical Patient
ResponsiveFour parts
History of present illnessFocused physical exam
OPQRSTSAMPLE
Baseline VSPrior historyDCAPBTLS
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UnresponsivePatient history from family, bystanders etc.Rapid assessment
Abd: distension, firmness, rigidityPelvis: Incontinence of urine, feces
ID braceletsBaseline VSConsider need for ALSHistory of present illness and SAMPLE
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History of present illness and SAMPLE
Patient’s name
What happened
what did family/bystander see
Did patient complain of anything prior
Know illness
Medications