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

2. 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.

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

4. 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

5. 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

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

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

8. 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

9. 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.

10. Assess Mental Status AVPU
Alert
Verbal stimuli
Painful stimuli
Unresponsive

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

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

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

14. Rapid Trauma Assessment
Chest
DCAP/BTLS
Breath sounds
Paradoxical breathing

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

16. Rapid Trauma Assessment
Pelvis
DCAP/BTLS
Crepitation
Tenderness
Motion

17. Rapid Trauma Assessment
Lower Extremities
DCAP/BTLS
Distal pulse

18. Rapid Trauma Assessment
Lower Extremities
Sensation
Motor function

19. Rapid Trauma Assessment
Upper Extremities
DCAP/BTLS
Distal pulse

20. Rapid Trauma Assessment
Upper Extremities
Sensation
Motor function

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

22. Assess Baseline Vital Signs
Pulse
Respirations
Blood pressure
Temperature

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

24. 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.

25. 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.