Assessment of the Trauma Patient

Focused History and Physical Exam for the Trama Patient

No significant mechanism of injury Focus assessment on just the areas of injury or compliant. Includes Physical Exam VS SAMPLE

D C A P B T L S e o b u u e a w f n r n r n c e o t a c n d e l m u s t s e r l i s I u r a i t I o r n t n i o n e e I g e n s s s o s s s n s

Apply a cervical collar during the rapid trauma assessment

Trauma patient with a significant mechanism of injury Remember with children same type of injury may take less force. Continue spinal immobilization Reconsider transport decision Reassess MS

Perform a Rapid Trauma Assessment Inspect Palpate Auscultate Smell From head-to-toe

Jugular vein distension Paradoxical motion Flail chest Crepitation Subcutaneous Emphysema Pulsating mass Pelvis- Priapism

PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS

Reconsider mechanism of injury Determine chief complaint Perform a focused physical exam

Expose

Mechanism of Injury Index of suspicion Law of inertia: A object in motion stays in motion until acted upon by another force Three collisions: First; vehicle strikes something Second; Victim strikes something on impact

Third collision; organs strike

up and over the steering wheel Down and under injury Examples: Head-on collision: Up and over injury up and over the steering wheel Down and under injury down and under the steering wheel

Rear-end collision Head and neck injury Side impact collision Skeletal and internal injuries Rollover Possibility of ejection Rotational Impact Observe damage to the windshield, steering wheel, dash and pedals

Motorcycles and ATVs Helmet? Suspect any and all types of injuries

Falls Height of fall three times patient height is severe Surface they landed on

Penetrating Trauma Shooting; stabbing Velocity: Speed of the object Low velocity Stabbing Injury usually isolated to area penetrated multiple wounds damage to internal organs

Medium-velocity Handguns and shotguns Arrows High velocity High powered rifles Assault rifles

Bullets cause damage in two ways: Damage directly from the bullet itself Cavitation pressure wave

Blunt Force Trauma maintain a high index of suspicion

Assessment of the Medical Patient Responsive Four parts History of present illness Focused physical exam OPQRST SAMPLE Baseline VS Prior history DCAPBTLS

Unresponsive Patient history from family, bystanders etc. Rapid assessment Abd: distension, firmness, rigidity Pelvis: Incontinence of urine, feces ID bracelets Baseline VS Consider need for ALS History of present illness and SAMPLE

History of present illness and SAMPLE Patient’s name What happened what did family/bystander see Did patient complain of anything prior Know illness Medications