trauma assessment
DESCRIPTION
TRAUMA ASSESSMENT. Emergency Medical Technician - Basic. Scene Size-Up. Safety Yourself Your partner Other responders Bystanders Patient. Scene Size-Up. Scene Location? Appearance? Where is patient? What is condition of vehicle? Were seatbelts used? - PowerPoint PPT PresentationTRANSCRIPT
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TRAUMA ASSESSMENT
Emergency Medical Technician - Basic
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Scene Size-Up Safety
– Yourself– Your partner– Other responders– Bystanders– Patient
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Scene Size-Up Scene
– Location?– Appearance?– Where is patient?– What is condition of vehicle?– Were seatbelts used?– Mechanism of Injury? Amount of force?
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Scene Size-Up Situation
– Additional support?– Critical vs. Non-critical patient?
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Initial Assessment Find life threats If life-threat is present, CORRECT IT! If you can’t correct it:
– Oxygenate– Ventilate– TRANSPORT
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Initial Assessment With critical trauma you may never get
past the initial assessment Most obvious or dramatic injury usually
isn’t what’s killing the patient Listen to patient’s chief complaint
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Initial Assessment Airway with C-Spine Control
– Manual stabilization of C-Spine– Noisy breathing = Obstructed breathing– But all obstructed breathing is NOT noisy– Assume airway problems with:
» Decreased LOC» Head, face, neck, thorax trauma
OPEN - CLEAR - MAINTAIN
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Initial Assessment Breathing
– Is patient breathing– Is patient moving air adequately?– Is O2 getting to blood
LOOK - LISTEN - FEEL
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Initial Assessment Breathing
– Give O2 immediately if: » Change in LOC» Possible shock» Possible severe
hemorrhage
» Chest pain» Chest Trauma» Dyspnea» Respiratory Distress
If you think about giving O2, GIVE IT!
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Initial Assessment Breathing
– Assist ventilations if:» Rate is <12» Rate is >24» Decreased tidal volume» Increased respiratory effort
If you can’t tell if ventilations are adequate, THEY AREN’T!
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Initial Assessment Breathing
– If breathing is compromised:» Expose» Palpate» Auscultate
Try to find, correct cause
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Initial Assessment Circulation
– Is heart beating?– Is patient perfusing?– Serious external hemorrhage ?
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Initial Assessment Circulation
– Pulses present?» Radial => BP > 80 systolic» Femoral => BP > 70 systolic» Carotid => BP > 60 systolic
– Skin color, temperature» Cool» Pale» Moist
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Initial Assessment Circulation
– If circulation is compromised:» Expose» Palpate» Auscultate
Try to find, correct cause
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Initial Assessment Circulation
– If carotid pulse absent:» Extricate» CPR» MAST» Transport
Fewer than 1% of blunt trauma victims in cardiac arrest survive
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Initial Assessment Disability
– Level of consciousness = Best indicator of brain perfusion
– Pupils--Eyes are windows of CNS– Decreased LOC
» Head injury» Hypoxia» Hypoglycemia» Shock
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Initial Assessment Level of Consciousness (LOC)
– A - Alert– V - Verbal– P - Painful– U - Unresponsive
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Initial Assessment Decreased LOC + Unequal Pupils = Epidural
or Subdural Hematoma Until Proven Otherwise
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Initial Assessment Expose, Examine
– You can’t treat what you don’t find– Remove clothing from critical patients ASAP– But do NOT delay resuscitation to remove
clothing– Cover patient with blanket after exam is
complete
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Initial Assessment Vitals signs are not necessary to determine whether
patient is critical Regardless of your findings
If the patient looks sick, he is sick
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Initial Resuscitation Treat as you go! Aggressively correct hypoxia, hypovolemia
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Initial Resuscitation Immobilize C-spine Maintain airway Oxygenate Rapid extrication to
long board Assist ventilations
Expose MAST (PASG) Transport Reassess - Report
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Initial Resuscitation
Minimum Time On Scene Maximum Treatment in Route
Critical Trauma Goals
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History, Physical Exam
You will get to this with MOST trauma patients Perform only after:
– Initial assessment is completed, and– All life-threats are corrected
Do NOT hold critical trauma in field for secondary history, physical exam
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History, Physical Exam
Significant mechanism of injury, multiple injuries, possible unknown injuries?– Rapid head-to-toe assessment– Baseline vital signs– SAMPLE history
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History, Physical Exam NO significant mechanism of injury, isolated
trauma only– Focused assessment of injury site– Baseline vital signs– SAMPLE History
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Head to Toe Exam Organized, systematic Superior to Inferior Proximal to Distal Look - Listen - Feel - Smell
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Head to Toe Exam Extremity assessment must include:
– Pulse – Skin color, temperature– Capillary refill– Motor, sensory function
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Focused Exam Isolated Injury No significant mechanism of Injury Head-to-toe not necessary since other
injuries unlikely
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Focused Exam Assess isolated injury only Be prepared to perform head-to-toe
exam if other injuries identified Be prepared to manage as critical
trauma patient if condition deteriorates
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Baseline Vital Signs Pulse
– Rate» Rapid» Slow
– Rhythm» Regular» Irregular
– Quality» Weak (Thready)» Full» Bounding
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Baseline Vital Signs Respirations
– Rate» Inadequate» <10 or >24
– Rhythm» Regular» Irregular
– Quality» Shallow» Full» Deep» Labored
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Baseline Vital Signs Blood Pressure
– Hypotensive?– Hypertensive?– Narrow pulse pressure?– Wide pulse pressure?
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Baseline Vital Signs Pupils
– Dilated?– Unequal?– Reaction to light
» Normal?» Sluggish?» Unequal?» Unresponsive?
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Baseline Vital Signs Skin
– Color– Temperature– Moisture– Turgor– Capillary refill
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SAMPLE History Signs, Symptoms
– Signs» Objective findings» What you perceive
– Symptoms» Subjective» What patient experiences
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SAMPLE History Allergies
– ANY Allergies?» Don’t focus only on allergies to medication» All allergies could be significant
– What are they?– Are you being treated for this condition?
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SAMPLE History Medications
– Do you take any medications?– What are they?– Are you taking them as prescribed?– Are you taking any over-the-counter meds?– May we see the medications?
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SAMPLE History Past, Pertinent Medical History
– Have you had any recent illnesses?– Have you been receiving medical care for any
conditions?
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SAMPLE History Last oral intake
– Last food or drink Events leading up to incident