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ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT

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Title: ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT


1
ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT
  • Instructor Name
  • Title
  • Unit

2
OVERVIEW
  • SCENE SIZE-UP
  • TRANSPORT DECISION AND CRITICAL INTERVENTIONS
  • DETAILED EXAM
  • ONGOING EXAM

3
SCENE SIZE-UP
  • BSI DECISION
  • SCENE SAFETY
  • TOTAL NUMBER OF PATIENTS
  • ESSENTIAL EQUIPMENT
  • ARE ADDITIONAL RESOURCES NEEDED
  • MECHANISM OF INJURY

4
(No Transcript)
5
Trauma Assessment A hands on approach
6
What is Trauma?
  • A serious injury or shock to the body by violence
    or accident!

7
Trauma Assessment is a Basic life support skill!
8
Touching the patient is a must to find possible
injuries!
9
What are we looking for?
  • Life threats that are going to kill the patient
    right now!
  • Any obvious injuries that the patient has
  • Any underlying injuries the patient may have we
    cant see
  • Changes that may occur during transport

10
How fast do patients die?
11
Now lets take a look at how the assessment
should go!
12
Scene size-up
  • This is the overall picture of the scene to
    ensure the safest environment for yourself, your
    crew, other responding personnel, patient, and
    bystanders in that order.

13
Scene size-up
  • BSI (body substance isolation)
  • Scene safety
  • Number of victims
  • Other help or equipment needed
  • Mechanism of injury

14
Mechanism of Injury
  • Predictable pattern of injuries caused by forces
    applied to the body
  • Helps you key in on possible injuries

15
Initial assessment
  • General impression- your gut feeling on patient
    status and priority of transport
  • LOC- AVPU on patient with simultaneous initiation
    of c-spine immobilization
  • Airway- open/clear if not fix it
  • Breathing- rate/quality
  • interventions to airway- oxygen by NRB or BVM
  • Circulation- compare radial vs. carotid pulses,
    skin color/temp/condition
  • Control any major bleeding!

16
Decisions, decisions, decisions
  • Load and Go or Stay and play
  • Rapid trauma survey
  • Focused trauma survey

17
Rapid Trauma assessment
  • Should take less than two minutes to perform
  • A quick scan of whole body
  • Identifies any life threats
  • Used to mentally note injuries to fix later

18
DCAP-BLS-TIC
  • Deformities
  • Contusions
  • Abrasions
  • Punctures/penetrations
  • Burns
  • Lacerations
  • Swelling
  • Tenderness
  • Instability
  • crepitation

19
HEAD
  • Palpate the head looking for DCAP-BLS-TIC
  • Examine the facial bones
  • Look at ears , nose, and mouth for any fluids
    coming from them
  • Check for Battle signs or raccoon eyes

20
Neck
  • Visualize neck for DCAp-bls-tic
  • Check neck for tracheal deviation
  • Check neck for Jugular vein distention
  • Palpate the back of the neck
  • Consider applying the c-collar

21
Chest
  • Visualize chest for DCAP-bls-tic
  • Listen to breath sounds(this is a bls skill)
  • Palpate the chest
  • IF a open wound or flail chest is found have a
    partner place a gloved hand over area till you
    finish rapid trauma survey

22
Abdomen
  • Visualize the abdomen for dcap-bls-tic
  • Palpate abdomen for rigidity, guarding, or
    tenderness
  • If patient alert and tells you where pain is feel
    that area last

23
Pelvis
  • Palpate the pelvis for dcap-bls-tic
  • It is a in and down motion
  • Do not rock the pelvis
  • If you find a unstable pelvis do not mess with it
    again

24
Lower extremities
  • Visualize lower extremities for dcap-bls-tic
  • Palpate down one leg at a time
  • Check for pulse, motor, sensory function to both
    feet
  • Check for capillary refill

25
Upper extremities
  • Visualize upper extremities for dcap-bls-tic
  • Palpate both arms
  • Feel for pulse, motor, and sensory
  • Check capillary refill

26
Back
  • Log roll the patient with c-spine stabilization
  • Visualize back for dcap-bls-tic
  • Palpate back from neck to legs

27
Secure patient to board
  • Secure body first
  • Then secure head
  • Reassess PMS after moving patient
  • Securing head first or not securing body could be
    a major problem if patient becomes sick and you
    have to roll patient to maintain airway!

28
Attempt to obtain sample history
  • Signs/symptoms
  • Allergies
  • Medicines including OTC and herbal
  • Pertinent past medical history
  • Last oral intake not just eating
  • Events leading to trauma

29
Now the patient is in the ambulance enroute to
the hospital!
30
Baseline Vitals
  • Pulse
  • Respirations
  • Blood pressure
  • O2 sat
  • Skin color/condition

31
Neurological exam
  • LOC
  • Pupils
  • Motor
  • sensory

32
Detailed exam
  • Do a slower exam of body
  • Touch the whole body looking for injuries
  • Fix problems as you find them
  • Fix problems that you noted in rapid trauma
    assessment
  • Looking for dcap-bls-tic again

33
Maintain body temperature during exam and
transport
34
PERFORM ONGOING ASSESSMENT
  • PERFORM REASSESSMENT OF ABCS
  • REASSESS VITALS EVERY THREE TO FIVE MINUTES
  • REASSESS INTERVENTIONS AND EFFECTIVENESS

35
Give oral report
  • Give short concise report
  • Use the mint pneumonic
  • Mechanism of injury
  • Injuries from head to toe
  • Neurological exam including gcs score
  • Treatments performed and vital signs

36
Transfer patient out of your care!
37
PITFALLS
  • Approaching the patient before performing a Scene
    Size-Up
  • Trying to do too much on-scene
  • Attempting to stabilize the patient in the field

38
SUMMARY
  • Scene Size-Up
  • BTLS Primary Survey
  • Initial Assessment
  • Rapid Trauma Survey or Focused Exam
  • Critical interventions and transport decision
  • Detailed Exam
  • Ongoing Exam

39
We are finished now
  • Question?
  • Comments
  • Snide remarks
  • If not thank you

40
QUESTIONS?
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