Principles of Patient Assessment in EMS. Detailed Physical Examination.

Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

Detailed Physical Detailed Physical ExaminationExamination

IntroductionIntroduction The detailed physical exam (DPE) is a The detailed physical exam (DPE) is a

complete head-to-toe exam for the complete head-to-toe exam for the non-life or limb-threatening non-life or limb-threatening conditions.conditions.

The DPE is performed on trauma The DPE is performed on trauma patients with a significant MOI.patients with a significant MOI.

The DPE is usually completed during The DPE is usually completed during transport unless there is a delay. transport unless there is a delay.

Detailed Physical ExamDetailed Physical Exam For most patients assess in a head-For most patients assess in a head-

to-toe direction.to-toe direction. For young children the toe-to-head For young children the toe-to-head

approach is used to decrease fear approach is used to decrease fear and anxiety.and anxiety.

Soft tissue injuries discovered are Soft tissue injuries discovered are classified as “opened” or “closed.”classified as “opened” or “closed.”

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Closed Soft Tissue InjuriesClosed Soft Tissue Injuries ContusionContusion HematomaHematoma Crush injuriesCrush injuries


Open Soft Tissue InjuriesOpen Soft Tissue Injuries AbrasionAbrasion AvulsionsAvulsions IncisionsIncisions LacerationsLacerations Punctures/penetrationsPunctures/penetrations AmputationsAmputations Impaled objectsImpaled objects Major artery lacerationsMajor artery lacerations Crush injuriesCrush injuries© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examine the Following Examine the Following Areas:Areas:

HeadHead Assess for DCAP-BTLS and crepitusAssess for DCAP-BTLS and crepitus Common injuries are contusions and Common injuries are contusions and

lacerations, which bleed profuselylacerations, which bleed profusely FaceFace

Assess for DCAP-BTLS, crepitation and Assess for DCAP-BTLS, crepitation and symmetrysymmetry

Palpate facial bones for stabilityPalpate facial bones for stability Vision problems can result from Vision problems can result from

instabilityinstability© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.


EyesEyes Assess for DCAP-BTLS, pupil response, Assess for DCAP-BTLS, pupil response,

and eye movementand eye movement Note any discoloration in the anterior Note any discoloration in the anterior

chamber and around the eye (Raccoon’s chamber and around the eye (Raccoon’s eye)eye)

NoseNose Assess for DCAP-BTLS, and fluid drainageAssess for DCAP-BTLS, and fluid drainage Drainage may include blood or CSFDrainage may include blood or CSF For patients that are immobilized, For patients that are immobilized,

drainage may become an airway drainage may become an airway obstructionobstruction



EarsEars Assess for DCAP-BTLS and fluid drainageAssess for DCAP-BTLS and fluid drainage Allow fluids to drainAllow fluids to drain

MouthMouth Assess for DCAP-BTLS, crepitation, loose Assess for DCAP-BTLS, crepitation, loose

or broken teeth, swelling or laceration of or broken teeth, swelling or laceration of the tongue or throat, unusual odors, the tongue or throat, unusual odors, discoloration, and drainagediscoloration, and drainage

Assess need for suction or airway Assess need for suction or airway adjunctsadjuncts



NeckNeck Assess for DCAP-BTLS, crepitation and JVDAssess for DCAP-BTLS, crepitation and JVD May be necessary to open c-collar to assess, May be necessary to open c-collar to assess,

maintain manual stabilizationmaintain manual stabilization ChestChest

Assess for DCAP-BTLS, crepitation, symmetry Assess for DCAP-BTLS, crepitation, symmetry and paradoxical motionand paradoxical motion

Listen to breath soundsListen to breath sounds Note any scarsNote any scars Apply chest compression to reveal rib fracturesApply chest compression to reveal rib fractures



AbdomenAbdomen Assess for DCAP-BTLS, guarding, rigidity, Assess for DCAP-BTLS, guarding, rigidity,

masses/bulging (pulsing or firm) or masses/bulging (pulsing or firm) or distensiondistension

Prior to palpation, listen for absence of Prior to palpation, listen for absence of bowel sounds (if feasible)bowel sounds (if feasible)

Ask the patient about distension or bloatingAsk the patient about distension or bloating Do not touch any massesDo not touch any masses Note any scarsNote any scars Consider females of child bearing age to be Consider females of child bearing age to be

pregnantpregnant© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.


PelvisPelvis Assess for DCAP-BTLS, crepitus, and Assess for DCAP-BTLS, crepitus, and

stabilitystability Apply pressure on pelvic ring and pubic Apply pressure on pelvic ring and pubic

synthesissynthesis Reconsider the MOI for possible pelvic Reconsider the MOI for possible pelvic

injuryinjury PosteriorPosterior

Assess back and buttocks for DCAP-BTLS Assess back and buttocks for DCAP-BTLS and crepitationand crepitation

When patient is on a long board prior to When patient is on a long board prior to the exam, use fingers to reach underthe exam, use fingers to reach under



ExtremitiesExtremities Assess for DCAP-BTLS and distal PMSAssess for DCAP-BTLS and distal PMS Compare side to side and assess for Compare side to side and assess for

strength and reflexesstrength and reflexes Assess the range of motion (ROM)Assess the range of motion (ROM) With major degloving injury or With major degloving injury or

amputation assess for bleedingamputation assess for bleeding Crush injuries have the potential for Crush injuries have the potential for

immediate complications when crush is immediate complications when crush is a lengthy timea lengthy time


Priority Determines CarePriority Determines Care

The DPE is conducted:The DPE is conducted: Only if time permitsOnly if time permits Usually enroute to the hospitalUsually enroute to the hospital

When the patient’s condition is When the patient’s condition is critical the priority should be:critical the priority should be: Necessary interventionsNecessary interventions Serial initial assessmentsSerial initial assessments TransportTransport


ConclusionConclusion

The DPE is a thorough head-to-toe The DPE is a thorough head-to-toe exam of the trauma patient who has exam of the trauma patient who has significant MOI.significant MOI.

The approach differs for children (toe-The approach differs for children (toe-to-head).to-head).

The DPE is completed enroute to the The DPE is completed enroute to the hospital if time and personnel permit.hospital if time and personnel permit.

Report all findings to the next care Report all findings to the next care giver and carefully document your giver and carefully document your findings.findings.

Principles of Patient Assessment in EMS. Detailed Physical Examination.

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