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 Se o b u u e a wf n r n r n c eo t a c n d e lm u s t s e r li s I u r a it I o r n t ni o n e e I ge n s s s os 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 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

Examples:

Head-on collision:

Up and over injury

up and over the steering wheel

Down and under injurydown and under the steering wheel

Rear-end collisionHead and neck injury

Side impact collisionSkeletal and internal injuries

RolloverPossibility of ejection

Rotational ImpactObserve 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 TraumaShooting; stabbing

Velocity: Speed of the objectLow velocity

StabbingInjury usually isolated to area penetrated

multiple woundsdamage 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

ResponsiveFour parts

History of present illnessFocused physical exam

OPQRSTSAMPLE

Baseline VSPrior historyDCAPBTLS

UnresponsivePatient history from family, bystanders etc.Rapid assessment

Abd: distension, firmness, rigidityPelvis: Incontinence of urine, feces

ID braceletsBaseline VSConsider need for ALSHistory 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