Focused History and Physical Examination for Trauma Patients CHAPTER 10

Do a rapid assessment for multisystem injuries.

Mechanism of Injury

High-risk Mechanisms  Ejection from a vehicle  Same passenger compartment where another died  Fall of more than 20 feet  Greater than 10 feet (or twice patient’s height) for infants & children  Vehicle roll-over

High-risk Mechanisms continued  High-speed collision  Vehicle-pedestrian collision  Motorcycle crash  Unresponsive or altered mental status  Penetrating trauma to head, chest or abdomen

Kinematics of Trauma

Kinematics: In trauma, the process of surveying an accident scene to determine injuries that may have resulted from forces involving motion. It is based on the fundamental laws of physics.

Motor vehicle collisions can produce tremendous forces.

Motor Vehicle Collisions  Head-on or frontal impact  Down and under  Up and over  Rear impact  Lateral or side impact  Rollover  Rotational impact

Down-and-Under Injury

Up-and-Over Injury

Lateral impacts can affect the chest, pelvis and cervical spine.

Other Collisions  Motorcycle  Head-on collision  Angular-impact collision  Ejection-impact collision  Vehicle-pedestrian  Adult  Pediatric  Falls

Adults struck by vehicles tend to sustain lower extremity injuries.

Children struck by vehicles tend to sustain chest and abdominal trauma.

Organ Injuries

Shear injury: Damage to body organs that occurs as a result of a sudden change of speed (during acceleration or deceleration). Can result from any type of impact.

The aorta is subject to shear injuries.

Compression injury: Damage to body organs that occurs as a result of a compression-type force.

Restraints such as seat belts and airbags are associated with injuries when not used properly.

An improperly positioned lap belt can result in abdominal injuries.

Penetrating Injuries

Categories of Energy Capacity  Low-energy weapons  Knife, ice pick  Medium-energy weapons  Handgun, bow and arrow  High-energy weapons  Assault weapons, hunting rifles

With a GSW, look for an exit wound also.

Patients involved in an incident with significant mechanism, may initially APPEAR TO BE STABLE.

Evaluating Patients with Serious Injuries or Mechanisms of Injury

Perform rapid trauma assessment of:  Unresponsive patients  Trauma with significant mechanism  Multisystem trauma

EMTs who work in a multi-tiered response system should request ALS immediately, or rendezvous with responding ALS.

If ALS is not available immediately, consider a helicopter.

Assume that unresponsive & head-injured patients have spinal injuries.

Performing the Rapid Trauma Assessment

DCAP - BTLS Acronym D - Deformities C - Contusions A - Abrasions P - Penetrations or punctures B - Burns T - Tenderness L - Lacerations S - Swelling

Assess the skull for deformities.

Assess the neck.

Jugular vein distention: An abnormal enlargement of the veins on the side of the neck in the sitting patient. May signify increased pressure in the circulatory system from a crush injury to the chest or abdomen.

Jugular Vein Distention (JVD)

Apply a cervical spine immobilization device after assessing the neck.

Inspect the chest for DCAP - BTLS

Paradoxical motion: Movement of part of the chest wall in the opposite direction from the rest of the chest wall during respiratory efforts. Indicates a section of the chest wall has broken loose.

Crepitus: A crackling sound or sensation that indicates air under the skin; more easily palpated than seen. Crepitus also refers to the grating sound and sensation produced by broken bone ends.

Listen forbreath soundsat four points. Listen for breath sounds at four points. Midaxillary Line Midclavicular Line

Determine if the abdomen is FIRM, SOFT, or DISTENDED

Gently press on the abdomen.

abdominal quadrants. Assess each of the four abdominal quadrants. RightLower LeftLower Left Upper RightUpper

Swelling, bruising, distention or a firm abdomen may indicate a serious abdominal injury!

Assess pelvic stability - flexion.

Assess pelvic stability - compression.

Palpate the lower extremities.

Note the presence or absence of pedal pulses.

To determine motor function, ask the patient to wiggle their toes.

Determine sensation.

Palpate the upper extremities.

Inspect and palpate the back.

While one EMT completes the focused physical exam, another can obtain baseline vital signs.

Evaluating Patients with No Significant Mechanism of Injury

A patient with a minor isolated injury may not need a complete trauma assessment.

SUMMARY Mechanism of Injury Mechanism of Injury Evaluating Patients with Serious Injuries or Mechanisms of Injury Evaluating Patients with Serious Injuries or Mechanisms of Injury Evaluating Patients with No Significant Mechanism of Injury Evaluating Patients with No Significant Mechanism of Injury