Patient AssessmentPatient Assessment

TraumaTrauma

Scene Size-UpScene Size-UpAn assessment of the scene and surroundings that will provide valuable information to the EMT

1.1. Personal Protective Equipment/Body Personal Protective Equipment/Body Substance IsolationSubstance Isolation

PPE for BSIPPE for BSI

2.2. Scene SafetyScene Safety FireFire HAZMATHAZMAT Car AccidentsCar Accidents Domestic Violence – Domestic Violence –

shootings/stabbings/assaultsshootings/stabbings/assaults

YOUR SAFETY COMES YOUR SAFETY COMES FIRSTFIRST!!!!!!!!

3.3. Number of PatientsNumber of Patients TriageTriage – French meaning “to sort” – French meaning “to sort” TriageTriage officer does not treat patients – officer does not treat patients –

just tags themjust tags them Cardiac arrestCardiac arrest patients considered low patients considered low

triage because they are already deadtriage because they are already dead

4.4. Need for Need for Additional ResourcesAdditional Resources Multiple patients = more respondersMultiple patients = more responders ALS back-upALS back-up Police/Fire Dept.Police/Fire Dept.

5.5. Mechanism of InjuryMechanism of Injury or or Nature of Nature of IllnessIllness

Medical – Medical – 90% of all calls90% of all calls Trauma – Trauma – 10% of all calls10% of all calls

What is causing the problem?What is causing the problem?

What does that tell you?What does that tell you?

Car CrashesCar CrashesWhere were they Where were they sittingsitting? ?

Were they wearing a Were they wearing a seat beltseat belt??

1.1. Head-on collisionHead-on collisionTypes of injuries:Types of injuries: HipHip Knee & legKnee & leg Head & neckHead & neck ChestChest Abdominal injuriesAbdominal injuries

Head-on CollisionHead-on Collision

2. Rear-end collision2. Rear-end collisionTypes of InjuriesTypes of Injuries

Head & neckHead & neck Chest injuriesChest injuries3. Side-impact collision3. Side-impact collision

Types of InjuriesTypes of Injuries Head & neckHead & neck ChestChest AbdomenAbdomen PelvisPelvis ThighsThighs

Rear-end CollisionRear-end Collision

Side-impact CollisionSide-impact Collision

Penetrating traumaPenetrating trauma – passes through the – passes through the skin and/or body tissuesskin and/or body tissues

Low velocityLow velocity– Propelled by hand – ex. Propelled by hand – ex. KnivesKnives– Injury limited to Injury limited to area penetratedarea penetrated

Medium velocityMedium velocity– Handguns or shotgunsHandguns or shotguns

High velocityHigh velocity– High powered assault rifleHigh powered assault rifle

Blunt force traumaBlunt force trauma – blow that does not – blow that does not break the skinbreak the skin but causes injury but causes injury

Steering wheelSteering wheel, , baseball batbaseball bat

Nature of IllnessNature of Illness Sources of Information are:Sources of Information are:

– PatientPatient– Family members or bystandersFamily members or bystanders– Information found at the sceneInformation found at the scene

Significant Mechanism of InjurySignificant Mechanism of Injury Ejection from the vehicleEjection from the vehicle DeathDeath in same passenger compartment in same passenger compartment Fall of more than Fall of more than 15ft or 3 times the patient’s 15ft or 3 times the patient’s

heightheight RolloverRollover High speedHigh speed vehicle collision vehicle collision Vehicle-pedestrianVehicle-pedestrian collision collision MotorcycleMotorcycle UnresponsiveUnresponsive or or altered mental statusaltered mental status (AMS) (AMS)

due to the incident due to the incident Penetration of Penetration of headhead, , chestchest, , abdomenabdomen

Significant Significant Mechanism of InjuryMechanism of Injury

specifically for specifically for childrenchildren Falls more than 10ft.Falls more than 10ft. Bicycle collisionBicycle collision Vehicle in medium speed collisionVehicle in medium speed collision

Initial AssessmentInitial Assessment(Quick Look)(Quick Look)

The purpose of the The purpose of the initial assessment is to initial assessment is to identifyidentify and and treattreat any any life threatening life threatening conditions.conditions.

Initial AssessmentInitial Assessment

Consider Consider C-spine stabilizationC-spine stabilization – have – have your partner stabilize the head if your partner stabilize the head if sufficient manpower available.sufficient manpower available.

General impressionGeneral impression of the patient: of the patient: – How are they How are they layinglaying– Skin colorSkin color– RespirationsRespirations– Any Any bloodblood??

Initial AssessmentInitial Assessment Assess patient’s mental status Assess patient’s mental status

(AVPU)(AVPU)– AlertAlert– VerbalVerbal– PainfulPainful– UnresponsiveUnresponsive

Ask questions such as:Ask questions such as:

* * What is your nameWhat is your name??

* * Where are youWhere are you??

* * What day is itWhat day is it??

ABC’sABC’sTREAT AS YOU TREAT AS YOU

GO!!!GO!!!

Initial AssessmentInitial Assessment Assess patient’s Assess patient’s AIRWAYAIRWAY status and status and

maintain airwaymaintain airway..– In unresponsive patients In unresponsive patients alwaysalways do a do a jaw jaw

thrustthrust..

Initial AssessmentInitial Assessment Assess patient’s Assess patient’s BREATHINGBREATHING – look, listen and – look, listen and

feel.feel.– RespirationsRespirations

QualityQuality– Bilateral Bilateral chest expansionchest expansion– Sucking chest woundSucking chest wound– Flail chest Flail chest – – 3 or more3 or more ribs broke in ribs broke in 2 or 2 or

moremore places. The pt. will have places. The pt. will have paradoxicalparadoxical chest movement.chest movement.

******INITIATE APPROPRIATE OXYGEN INITIATE APPROPRIATE OXYGEN THERAPY AND ASSURE ADEQUATE THERAPY AND ASSURE ADEQUATE VENTIALATIONVENTIALATION******

Initial AssessmentInitial Assessment Assess patient Assess patient CIRCULATIONCIRCULATION

– Pulse – Pulse – radialradial most reliable distal pulse in an most reliable distal pulse in an adult. adult. BrachialBrachial in a child. in a child.QualityQuality

– Control Control major bleedingmajor bleeding – pat down the body. – pat down the body. Bright redBright red blood (arterial) is an emergency blood (arterial) is an emergency situation and requires situation and requires immediate attentionimmediate attention..

– Skin Skin colorcolor, , temperaturetemperature and condition and condition– PerfusionPerfusion

Capillary Refill Capillary Refill (INFANTS AND CHILDREN (INFANTS AND CHILDREN ONLY – up to age 5) ONLY – up to age 5) <2 seconds<2 seconds is normal is normal

ABC’s should ABC’s should take 60 – 90 take 60 – 90 seconds!!!!seconds!!!!

Initial AssessmentInitial Assessment Identify priority patients and make Identify priority patients and make

transport decisiontransport decision– CUPSCUPS

CCriticalritical – CPR/arrest patient – CPR/arrest patient

UUnstablenstable patient patient

PPotentially Unstableotentially Unstable patient patient

SStabletable patient patient

Rapid Trauma AssessmentRapid Trauma Assessmentvs.vs.

Detailed Physical ExamDetailed Physical Exam Rapid trauma assessment should be Rapid trauma assessment should be

performed on patients with performed on patients with significant significant mechanism of injurymechanism of injury to determine life to determine life threatening injuries.threatening injuries.

Important in order to:Important in order to:– Make Make CUPSCUPS determination determination– Consider Consider ALS interceptALS intercept– Consider Consider platinum ten minutesplatinum ten minutes and and golden golden

hourhour

Focus History & Physical ExamFocus History & Physical Exam

Reconsider mechanism of injuryReconsider mechanism of injury– Trauma protocolsTrauma protocols– Consider Consider hidden injurieshidden injuries due to due to

mechanism of injury.mechanism of injury.

Perform Rapid Trauma Perform Rapid Trauma AssessmentAssessment

DCAP-BTLSDCAP-BTLS– DDeformitieseformities

– CContusionsontusions

– AAbrasionsbrasions

– PPunctures/penetrationsunctures/penetrations

– BBurnsurns

– TTendernessenderness

– LLacerationsacerations

– SSwellingwelling

DeformitiesDeformities

ContusionsContusions

AbrasionsAbrasions

Punctures/penetrationsPunctures/penetrations

BurnsBurns

TendernessTenderness

LacerationsLacerations

SwellingSwelling

Focus History & Physical ExamFocus History & Physical Exam

1. Assess the 1. Assess the HeadHead

2. Assess 2. Assess NeckNecka.a. Jugular venous distention (Jugular venous distention (JVDJVD) – Flat ) – Flat

veins in a supine trauma patient can be veins in a supine trauma patient can be an indication of an indication of blood lossblood loss..

b.b. Tracheal deviation-moves to Tracheal deviation-moves to

uninjureduninjured lung side lung side

c.c. Stoma/tracheostomyStoma/tracheostomy

** Apply Cervical Collar**** Apply Cervical Collar**

3. Assess the 3. Assess the ChestChest – – crepituscrepitus (bone ends (bone ends rubbing together)rubbing together)

a. listen for breath sounds – high on a. listen for breath sounds – high on both sides. both sides. Under arm pitsUnder arm pits

b. check for equal chest rise and b. check for equal chest rise and expansion – expansion – paradoxical breathingparadoxical breathing

4. Assess Abdomen4. Assess Abdomen

a. Palpate all a. Palpate all 4 quadrants4 quadrants – press – press gently hand over hand. gently hand over hand. Do spot Do spot where the pain is lastwhere the pain is last..

b. Do they have a colostomy or b. Do they have a colostomy or ileostomy?ileostomy?

5. Assess the 5. Assess the PelvisPelvis– If no pain is noted, press gently in and If no pain is noted, press gently in and

down on the wings. down on the wings. DO NOTDO NOT log roll log roll someone with a someone with a suspected pelvic suspected pelvic injuryinjury..

– Assess males for Assess males for priapismpriapism6. Assess the 6. Assess the Lower ExtremitiesLower Extremities

– Check pulsesCheck pulses– Check neurological function – Check neurological function – PMSPMS

PPulseulseMMovementovementSSensationensation

7. Assess the 7. Assess the Upper ExtremitiesUpper Extremities– Check pulsesCheck pulses– Check neurological function - Check neurological function - PMSPMS

PPulseulseMMovementovementSSensationensation

8. Assess the 8. Assess the Back & ButtocksBack & Buttocks– Do this when you log roll the patient Do this when you log roll the patient

to place them on the long boardto place them on the long board

Focus History & Physical ExamFocus History & Physical ExamObtain a Baseline Set of Vital SignsObtain a Baseline Set of Vital Signs

1. 1. RespirationsRespirations

a. Quality & Quantity – shallow? a. Quality & Quantity – shallow? Labored? Deep? Labored? Deep? <10 or >29 BVM<10 or >29 BVM

2. 2. PulsePulse

a. Quality & Quantity – normal a. Quality & Quantity – normal 60-10060-100

b. Bradycardia: b. Bradycardia: pulse under 60pulse under 60

c. Tachycardia: c. Tachycardia: pulse over 100pulse over 100

3. 3. Blood PressureBlood Pressure – – 120/80120/80

Obtain the SAMPLE HistoryObtain the SAMPLE HistoryYou should try to complete this You should try to complete this earlyearly on in case on in case

the patient goes the patient goes unconsciousunconscious1.1. SSigns and symptomsigns and symptoms

*sign – *sign – something you can seesomething you can see **symptom – symptom – something a patient feels or tells yousomething a patient feels or tells you

2.2. AAllergiesllergies – to medications or latex – to medications or latex

3.3. MMedicationsedications (presently taking) (presently taking)

prescription or over the counterprescription or over the counter

4.4. PPast Medical Historyast Medical History

5.5. LLast oral intakeast oral intake

6.6. EEvents leading up to the present problemvents leading up to the present problem

Detailed Physical ExamDetailed Physical Exam Depending on the Depending on the seriousnessseriousness of the of the

patient’s injuries, you may patient’s injuries, you may nevernever have the opportunity to complete a have the opportunity to complete a detailed physical exam.detailed physical exam.

If, during your assessment, you If, during your assessment, you notice a change in the patient’s notice a change in the patient’s condition, condition, STOPSTOP and go back to the and go back to the initial assessmentinitial assessment..

Detailed Physical ExamDetailed Physical Exam Use “DCAP-BTLS”Use “DCAP-BTLS” Assess the HeadAssess the Head

– Inspect & palpate the Inspect & palpate the scalp and earsscalp and ears– Assess the Assess the eyeseyes – – unequalunequal pupils = pupils =

head/brain injuryhead/brain injury..– Assess the facial area including the Assess the facial area including the mouth mouth

and noseand nose Assess the NeckAssess the Neck

– Inspect and palpate the neckInspect and palpate the neck– Assess for Assess for JVDJVD– Assess for Assess for tracheal deviationtracheal deviation

Assess the ChestAssess the Chest– Inspect – watch the Inspect – watch the chest risechest rise– Palpate – check for Palpate – check for equal expansionequal expansion– AuscultateAuscultate – listen to ALL 4 quadrants – listen to ALL 4 quadrants

Assess the Abdomen & PelvisAssess the Abdomen & Pelvis– Assess all Assess all 4 quadrants4 quadrants of the ABD of the ABD– Assess the pelvisAssess the pelvis– Verbalize assessment of Verbalize assessment of

genitalia/perineum as neededgenitalia/perineum as needed

Assess the ExtremitiesAssess the Extremities– Inspect & palpateInspect & palpate– Check neurological function (Check neurological function (PMSPMS) and ) and

distal circulationdistal circulation Assess the BackAssess the Back

– This may have already been done when This may have already been done when the pt. was the pt. was placed on the backboardplaced on the backboard

Ongoing AssessmentOngoing Assessment(verbalized)(verbalized)

Repeat Initial AssessmentRepeat Initial Assessment– StableStable patient patient every 15 minutesevery 15 minutes– UnstableUnstable patient patient every 5 minutesevery 5 minutes

Repeat Repeat Vital SignsVital Signs Repeats Repeats Focused AssessmentFocused Assessment

1.1. Reassesses mental statusReassesses mental status2.2. Maintain open airwayMaintain open airway3.3. Reassess breathingReassess breathing4.4. Reassess pulseReassess pulse5.5. Monitor skin color & temperatureMonitor skin color & temperature6.6. Re-establish patient priorityRe-establish patient priority