Focused History and Physical Examination of the

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Presentation transcript:

Focused History and Physical Examination of the Chapter 10 Focused History and Physical Examination of the Trauma Patient

Case History You respond to a 35-year-old male who has been in a front-end, high-speed collision. He was the driver of the car and there is a deformed steering wheel. You take the appropriate BSI precautions and ensure that the scene is safe, perform your initial assessment, and begin your physical examination and history.

Reconsider Mechanism of Injury Ejection from vehicle Death in same passenger compartment Falls > 20 feet Rollover of vehicle High-speed vehicle collision

Reconsider Mechanism of Injury Vehicle-pedestrian collision Motorcycle crash Unresponsive or altered mental status Penetrations of the head, chest, or abdomen Type of instrument in blunt trauma

Hidden Injuries Seat belts and airbags can prevent death/injury. Patients who use safety devices may still have serious injuries. Shearing forces Shoulder belt Lap belt

Hidden Injuries Airbags may not be effective without use of a seat belt. Lift airbag and look at the steering wheel for deformity

Infant and Child Considerations Falls >10 feet Bicycle collision Vehicle in medium-speed collision

Elderly Subject to injury with a lesser mechanism Carefully evaluate for bone injury, even with minor mechanisms. May have a different response to an injury than younger adults Do not compensate as well for serious injury Tend to decompensate (become worse) more quickly May be taking medications that affect vital signs

Rapid Trauma Assessment Performed on patients with significant mechanism of injury to determine life-threatening injuries In the responsive patient, symptoms should be sought before and during the trauma assessment. Maintain spinal stabilization. Consider ALS request. Reconsider transport decision.

Assess Mental Status AVPU Alert Verbal stimuli Painful stimuli Unresponsive

Inspect and Palpate DCAP/BTLS Deformities Contusions Abrasions Punctures/penetrations Burns Tenderness Lacerations Swelling

Rapid Trauma Assessment Head DCAP/BTLS Crepitation Careful palpation to avoid injury to brain Assume cervical spine injury with blunt head trauma

Rapid Trauma Assessment Neck DCAP/BTLS Crepitation Subcutaneous emphysema Jugular venous distention Tracheal shift Apply CSID

Rapid Trauma Assessment Chest DCAP/BTLS Breath sounds Paradoxical breathing

Rapid Trauma Assessment Abdomen DCAP/BTLS Firm vs. soft Distended

Rapid Trauma Assessment Pelvis DCAP/BTLS Crepitation Tenderness Motion

Rapid Trauma Assessment Lower Extremities DCAP/BTLS Distal pulse

Rapid Trauma Assessment Lower Extremities Sensation Motor function

Rapid Trauma Assessment Upper Extremities DCAP/BTLS Distal pulse

Rapid Trauma Assessment Upper Extremities Sensation Motor function

Rapid Trauma Assessment Back DCAP/BTLS Look for exit wounds with penetrating trauma

Assess Baseline Vital Signs Pulse Respirations Blood pressure Temperature

Assess SAMPLE History Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to the incident

Patients with No Significant Mechanism of Injury Perform focused history. Perform focused assessment on the specific injury site. Assess baseline vital signs. Assess SAMPLE history.

Summary Reconsider the mechanism of injury. Perform rapid trauma assessment. Check for signs of injury (DCAP/BTLS) in all body regions. Maintain spinal stabilization. After assessing the head and neck, apply a cervical collar. Log roll the patient to assess the posterior body. Assess baseline vital signs. Collect a SAMPLE history. For patients with no significant mechanism of injury, physical examination should be focused on the injured body part.