1. 1 TRAUMA ASSESSMENT Emergency Medical Technician - Basic

2. 2 Scene Size-Up l Safety –Yourself –Your partner –Other responders –Bystanders –Patient

3. 3 Scene Size-Up l Scene –Location? –Appearance? –Where is patient? –What is condition of vehicle? –Were seatbelts used? –Mechanism of Injury? Amount of force?

4. 4 Scene Size-Up l Situation –Additional support? –Critical vs. Non-critical patient?

5. 5 Initial Assessment l Find life threats l If life-threat is present, CORRECT IT! l If you can’t correct it: –Oxygenate –Ventilate –TRANSPORT

6. 6 Initial Assessment l With critical trauma you may never get past the initial assessment l Most obvious or dramatic injury usually isn’t what’s killing the patient l Listen to patient’s chief complaint

7. 7 Initial Assessment l Airway with C-Spine Control –Manual stabilization of C-Spine –Noisy breathing = Obstructed breathing –But all obstructed breathing is NOT noisy –Assume airway problems with: »Decreased LOC »Head, face, neck, thorax trauma OPEN - CLEAR - MAINTAIN

8. 8 Initial Assessment l Breathing –Is patient breathing –Is patient moving air adequately? –Is O 2 getting to blood LOOK - LISTEN - FEEL

9. 9 Initial Assessment l Breathing –Give O 2 immediately if : »Change in LOC »Possible shock »Possible severe hemorrhage »Chest pain »Chest Trauma »Dyspnea »Respiratory Distress If you think about giving O 2, GIVE IT!

10. 10 Initial Assessment l Breathing –Assist ventilations if: »Rate is <12 »Rate is >24 »Decreased tidal volume »Increased respiratory effort If you can’t tell if ventilations are adequate, THEY AREN’T!

11. 11 Initial Assessment l Breathing –If breathing is compromised: »Expose »Palpate »Auscultate Try to find, correct cause

12. 12 Initial Assessment l Circulation –Is heart beating? –Is patient perfusing? –Serious external hemorrhage ?

13. 13 Initial Assessment l Circulation –Pulses present? »Radial => BP > 80 systolic »Femoral => BP > 70 systolic »Carotid => BP > 60 systolic –Skin color, temperature »Cool »Pale »Moist

14. 14 Initial Assessment l Circulation –If circulation is compromised: »Expose »Palpate »Auscultate Try to find, correct cause

15. 15 Initial Assessment l Circulation –If carotid pulse absent: »Extricate »CPR »MAST »Transport Fewer than 1% of blunt trauma victims in cardiac arrest survive

16. 16 Initial Assessment l Disability –Level of consciousness = Best indicator of brain perfusion –Pupils--Eyes are windows of CNS –Decreased LOC »Head injury »Hypoxia »Hypoglycemia »Shock

17. 17 Initial Assessment l Level of Consciousness (LOC) –A - Alert –V - Verbal –P - Painful –U - Unresponsive

18. 18 Initial Assessment l Decreased LOC + Unequal Pupils = Epidural or Subdural Hematoma Until Proven Otherwise

19. 19 Initial Assessment l Expose, Examine –You can’t treat what you don’t find –Remove clothing from critical patients ASAP –But do NOT delay resuscitation to remove clothing –Cover patient with blanket after exam is complete

20. 20 Initial Assessment l Vitals signs are not necessary to determine whether patient is critical l Regardless of your findings If the patient looks sick, he is sick

21. 21 Initial Resuscitation l Treat as you go! l Aggressively correct hypoxia, hypovolemia

22. 22 Initial Resuscitation l Immobilize C-spine l Maintain airway l Oxygenate l Rapid extrication to long board l Assist ventilations l Expose l MAST (PASG) l Transport l Reassess - Report

23. 23 Initial Resuscitation l Minimum Time On Scene l Maximum Treatment in Route Critical Trauma Goals

24. 24 History, Physical Exam l You will get to this with MOST trauma patients l Perform only after: –Initial assessment is completed, and –All life-threats are corrected l Do NOT hold critical trauma in field for secondary history, physical exam

25. 25 History, Physical Exam l Significant mechanism of injury, multiple injuries, possible unknown injuries? –Rapid head-to-toe assessment –Baseline vital signs –SAMPLE history

26. 26 History, Physical Exam l NO significant mechanism of injury, isolated trauma only –Focused assessment of injury site –Baseline vital signs –SAMPLE History

27. 27 Head to Toe Exam l Organized, systematic l Superior to Inferior l Proximal to Distal l Look - Listen - Feel - Smell

28. 28 Head to Toe Exam l Extremity assessment must include: –Pulse –Skin color, temperature –Capillary refill –Motor, sensory function

29. 29 Focused Exam l Isolated Injury l No significant mechanism of Injury l Head-to-toe not necessary since other injuries unlikely

30. 30 Focused Exam l Assess isolated injury only l Be prepared to perform head-to-toe exam if other injuries identified l Be prepared to manage as critical trauma patient if condition deteriorates

31. 31 Baseline Vital Signs l Pulse –Rate »Rapid »Slow –Rhythm »Regular »Irregular –Quality »Weak (Thready) »Full »Bounding

32. 32 Baseline Vital Signs l Respirations –Rate »Inadequate » 24 –Rhythm »Regular »Irregular –Quality »Shallow »Full »Deep »Labored

33. 33 Baseline Vital Signs l Blood Pressure –Hypotensive? –Hypertensive? –Narrow pulse pressure? –Wide pulse pressure?

34. 34 Baseline Vital Signs l Pupils –Dilated? –Unequal? –Reaction to light »Normal? »Sluggish? »Unequal? »Unresponsive?

35. 35 Baseline Vital Signs l Skin –Color –Temperature –Moisture –Turgor –Capillary refill

36. 36 SAMPLE History l Signs, Symptoms –Signs »Objective findings »What you perceive –Symptoms »Subjective »What patient experiences

37. 37 SAMPLE History l Allergies –ANY Allergies? »Don’t focus only on allergies to medication »All allergies could be significant –What are they? –Are you being treated for this condition?

38. 38 SAMPLE History l Medications –Do you take any medications? –What are they? –Are you taking them as prescribed? –Are you taking any over-the-counter meds? –May we see the medications?

39. 39 SAMPLE History l Past, Pertinent Medical History –Have you had any recent illnesses? –Have you been receiving medical care for any conditions?

40. 40 SAMPLE History l Last oral intake –Last food or drink l Events leading up to incident