Patient Assessment/Management - Trauma

Takes or verbalizes appropriate PPE precautions

“My PPE is on”

Scene Size up

• Determines the scene/situation is safe

• Determines the mechanism of injury/nature of illness

• Determines the number of patients

• Requests additional EMS assistance if necessary

• Considers stabilization of the spine

• "I have determined that the scene is safe."

• "I see [number] patient(s), [approximate age], [brief details]."

• "I will request ALS (Advanced Life Support) if needed."

• "I will consider C-spine stabilization."

Primary Survey

• Verbalizes the general impression of the patient

• Determines responsiveness/level of consciousness (AVPU)

• Determines apparent life-threats

• "This is a [age]yo [gender] who appears [stable/unstable/distressed] due to [obvious signs]."

Level of Consciousness (AVPU)

• A (Alert): "Patient is awake and oriented to name, place, and time."

• V (Voice): "Patient responds only to loud verbal stimuli."

• P (Pain): "Patient moans when trapezius pinch is applied."

• U (Unresponsive): "No response to sternal rub or other stimuli."

Apparent Life-Threats (ABCs with Critical Actions)

Airway

• Opens and assesses airway

• Inserts adjunct as indicated

Verbalize:

• Patent Airway: "Airway is open—patient speaking clearly."

• Obstructed Airway: "Snoring respirations noted—performing head-tilt chin-lift."

Actions:

• Medical Patient: Head-tilt chin-lift (if no trauma).

• Trauma Patient: Jaw-thrust without head extension.

• Assessment:

  • Look for chest rise.

  • Listen for stridor/gurgling.

  • Feel for air movement.

Verbalize:

• OPA (Oropharyngeal Airway): "Unresponsive patient—inserting OPA."

• NPA (Nasopharyngeal Airway): "Semi-responsive patient—inserting NPA."

Key Points:

• OPA: Only if unresponsive (no gag reflex).

• NPA: Use with altered LOC (e.g., seizures).

• Contraindications:

  • OPA: Avoid with oral trauma.

  • NPA: Avoid with facial fractures.

Breathing

• Assess breathing

• Assures adequate ventilation

• Initiates appropriate oxygen therapy

• Manages any injury which may compromise breathing/ventilation

Assess Breathing

• Look: Chest rise symmetry

• Listen: Lung sounds (all fields)

• Feel: Air movement, chest wall integrity

Ventilation Status

• Adequate: Normal rate/depth, SpO₂ ≥94%

• Inadequate: Labored/absent, SpO₂ <90%

Oxygen Therapy

• Mild distress: Nasal cannula 2-6L

• Severe hypoxia: Non-rebreather 15L

Life-Threat Interventions

• Obstruction: Clear/suction airway

• Pneumothorax: Seal wound, monitor for tension

• Respiratory arrest: BVM/advanced airway
  

Circulation

• Checks pulse

• Assess skin (either skin color, temperature or condition)

• Assesses for and controls major bleeding if present

• Initiates shock management (positions patient properly, conserves body heat)

Pulse Check

• Verbalize: "Radial pulse present, regular/irregular"

• Locations:

  • Stable: Radial

  • Unstable: Carotid/Femoral

Skin Assessment

• Color: Pink/Pale/Cyanotic

• Temp: Warm/Cool/Clammy

• Condition: Dry/Diaphoretic

• Verbalize: "Skin pale, cool, diaphoretic"

Major Bleeding

• Action Steps:

  1. Direct pressure

  2. Tourniquet if uncontrolled

  3. Hemostatic gauze if available

• Verbalize: "Applying tourniquet proximal to wound"

Shock Management

• Positioning:

  • Hypotensive: Supine, legs elevated

  • Trauma/Spinal: Flat, spine immobilized

• Thermoregulation: Blanket to conserve heat

• Verbalize: "Positioning supine, covering with blanket"

Identifies patient priority and makes treatment/transport decision

Priority Identification

• Priority 1 (Critical): "Unstable ABCs, major trauma, AMS—emergency transport."

• Priority 2 (Urgent): "Stable but potential for deterioration (e.g., abdominal pain)."

• Priority 3 (Non-urgent): "Minor illness/injury (e.g., sprain)."

Transport Decision

• Trauma Center: "Multi-system trauma—going to Level 1 trauma center."

• Stroke/Cardiac Center: "FAST-positive—transport to stroke center."

• Closest Facility: "Stable patient—transport to nearest ED."

Obtains baseline vital signs (must include BP, P and R)

Blood Pressure (BP)

• Method: Auscultatory (manual) or automated

• Normal Range: 120/80 mmHg

• Critical Findings:

  • Hypertensive Crisis: >180/120

  • Hypotension: <90 systolic (shock concern)

Pulse (P)

• Locations: Radial (stable), Carotid (unstable)

• Assessment:

  • Rate: 60-100 bpm (adult)

  • Rhythm: Regular/Irregular

  • Strength: Bounding/Weak/Thready

Respirations (R)

• Technique: Count for 30 sec × 2 (discreetly)

• Normal Range: 12-20/min (adult)

• Abnormalities:

  • Tachypnea: >20 (shock, distress)

  • Bradypnea: <12 (overdose, head injury)

  • Quality: Labored/Shallow/Agonal

Attempts to obtain SAMPLE history

Symptoms: "What hurts?"
Allergies: "Any allergies?"
Meds: "What meds do you take?"
PMHx: "Any medical conditions?"
Last intake: "When did you last eat/drink?"
Events: "What were you doing when it started?"

Secondary Assessment

Head

• Inspects and palpates scalp and ears

• Assesses eyes

• Inspects mouth, nose and assesses facial area