TRAUMA ASSESSMENT
Emergency Medical Technician -
Basic
1
Scene Size-Up
Safety
– Yourself
– Your partner
– Other responders
– Bystanders
– Patient
2
Scene Size-Up
Scene
– Location?
– Appearance?
– Where is patient?
– What is condition of vehicle?
– Were seatbelts used?
– Mechanism of Injury? Amount of force?
3
Scene Size-Up
Situation
– Additional support?
– Critical vs. Non-critical patient?
4
Initial Assessment
Find life threats
If life-threat is present, CORRECT IT!
If you can’t correct it:
– Oxygenate
– Ventilate
– TRANSPORT
5
Initial Assessment
With critical trauma you may never get
past the initial assessment
Most obvious or dramatic injury usually
isn’t what’s killing the patient
Listen to patient’s chief complaint
6
Initial Assessment
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
7
Initial Assessment
Breathing
– Is patient breathing
– Is patient moving air adequately?
– Is O2 getting to blood
LOOK - LISTEN - FEEL
8
Initial Assessment
Breathing
– Give O2 immediately if:
» Change in LOC » Chest pain
» Possible shock » Chest Trauma
» Possible severe » Dyspnea
hemorrhage » Respiratory Distress
If you think about giving O2,
GIVE IT!
9
Initial Assessment
Breathing
– Assist ventilations if:
» Rate is 24
» Decreased tidal volume
» Increased respiratory effort
If you can’t tell if ventilations are adequate,
THEY AREN’T!
10
Initial Assessment
Breathing
– If breathing is compromised:
» Expose
» Palpate
» Auscultate
Try to find, correct cause
11
Initial Assessment
Circulation
– Is heart beating?
– Is patient perfusing?
– Serious external hemorrhage ?
12
Initial Assessment
Circulation
– Pulses present?
» Radial => BP > 80 systolic
» Femoral => BP > 70 systolic
» Carotid => BP > 60 systolic
– Skin color, temperature
» Cool
» Pale
» Moist
13
Initial Assessment
Circulation
– If circulation is compromised:
» Expose
» Palpate
» Auscultate
Try to find, correct cause
14
Initial Assessment
Circulation
– If carotid pulse absent:
» Extricate
» CPR
» MAST
» Transport
Fewer than 1% of blunt trauma
victims in cardiac arrest survive
15
Initial Assessment
Disability
– Level of consciousness = Best indicator of brain
perfusion
– Pupils--Eyes are windows of CNS
– Decreased LOC
» Head injury
» Hypoxia
» Hypoglycemia
» Shock
16
Initial Assessment
Level of Consciousness (LOC)
– A - Alert
– V - Verbal
– P - Painful
– U - Unresponsive
17
Initial Assessment
Decreased LOC + Unequal Pupils =
Epidural or Subdural Hematoma Until
Proven Otherwise
18
Initial Assessment
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
19
Initial Assessment
Vitals signs are not necessary to determine
whether patient is critical
Regardless of your findings
If the patient looks sick,
he is sick
20
Initial Resuscitation
Treat as you go!
Aggressively correct hypoxia, hypovolemia
21
Initial Resuscitation
Immobilize C-spine Expose
Maintain airway MAST (PASG)
Oxygenate Transport
Rapid extrication to Reassess - Report
long board
Assist ventilations
22
Initial Resuscitation
Critical Trauma Goals
Minimum Time On Scene
Maximum Treatment in Route
23
History, Physical Exam
You will get to this with MOST trauma
patients
Perform only after:
– Initial assessment is completed, and
– All life-threats are corrected
Do NOT hold critical trauma in field for
secondary history, physical exam
24
History, Physical Exam
Significant mechanism of injury, multiple
injuries, possible unknown injuries?
– Rapid head-to-toe assessment
– Baseline vital signs
– SAMPLE history
25
History, Physical Exam
NO significant mechanism of injury, isolated
trauma only
– Focused assessment of injury site
– Baseline vital signs
– SAMPLE History
26
Head to Toe Exam
Organized, systematic
Superior to Inferior
Proximal to Distal
Look - Listen - Feel - Smell
27
Head to Toe Exam
Extremity assessment must include:
– Pulse
– Skin color, temperature
– Capillary refill
– Motor, sensory function
28
Focused Exam
Isolated Injury
No significant mechanism of Injury
Head-to-toe not necessary since other
injuries unlikely
29
Focused Exam
Assess isolated injury only
Be prepared to perform head-to-toe
exam if other injuries identified
Be prepared to manage as critical
trauma patient if condition deteriorates
30
Baseline Vital Signs
Pulse
– Rate – Quality
» Rapid » Weak (Thready)
» Slow » Full
– Rhythm » Bounding
» Regular
» Irregular
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Baseline Vital Signs
Respirations
– Rate – Quality
» Inadequate » Shallow
» 24 » Full
» Deep
– Rhythm
» Labored
» Regular
» Irregular
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Baseline Vital Signs
Blood Pressure
– Hypotensive?
– Hypertensive?
– Narrow pulse pressure?
– Wide pulse pressure?
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Baseline Vital Signs
Pupils
– Dilated?
– Unequal?
– Reaction to light
» Normal?
» Sluggish?
» Unequal?
» Unresponsive?
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Baseline Vital Signs
Skin
– Color
– Temperature
– Moisture
– Turgor
– Capillary refill
35
SAMPLE History
Signs, Symptoms
– Signs
» Objective findings
» What you perceive
– Symptoms
» Subjective
» What patient experiences
36
SAMPLE History
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?
37
SAMPLE History
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?
38
SAMPLE History
Past, Pertinent Medical History
– Have you had any recent illnesses?
– Have you been receiving medical care for any
conditions?
39
SAMPLE History
Last oral intake
– Last food or drink
Events leading up to incident
40