chapter 15 - secondary assessment (trauma)

physical exam steps to master

• observation

• palpation

• auscultation

DCAP-BTLS

D- deformaties

C-contusions

A- abrasions

P- punctures/ penetrations

B- burns

T- tenderness

L- lacerations

S- sweling

suprasternal notch

u- shaped dip where the clavicle and sternum meet

• where collar should stop

rapid trauma assessment

for when the MOI is significant or a high priority patient

• ie: falls, crashes

• or unresponsiveness, penetrating wound above the torso, not patent airway, respiratory compromise, signs of shock

head to toe assessment unlike just looking at major complaint

battle’s sign

bruise behind the ear (may develop later) important sign of skull injury

CSF

cerebrospinal fluid

surrounds the brain and spinal cord

• if found leaking out of a patient make sure to keep patient clean and try to prevent bacteria from entering cause it can get to the brain

rapid head assessment

if you feel blood during palpation but there is no blood dripping on the ground you do not need to bandage it right away

rapid neck assessment

• look for JVD when patient is sitting up

  • if so it means blood is backing up in the veins because the heart isn’t pumping effectively

• or look for flat neck veins when patient is laying down

stoma

permanent surgical opening in neck

tracheostomy

sergical incision held open by a metal or plastic tube

when to apply a c collar?

after primary/ life threats delt with and after rapid assesment of head and neck

paradoxical motion

movement of part of the chest in the opposite direction from the rest of the chest

• serious injury

• can happen with flail chest or when some ribs are broken and “floating”

rapid chest assessment

look for presence and equality and paradoxical motion

rapid abdomen assessment

check for firmness, softness and distention

• firmness- sign of internal bleeding or injury to organs

• pulsating mass (could be an enlarged aorta)- if felt stop pressing abdomen

colostomy or ilestomy

backs on abdomen for excretions

rapid assessment of pelvis

look for broken bones, tenderness or if patient tells you an area hurts

priapism

persistent erection that is a result of a spinal cord injury or medical problems

rapid assessment of extremities

• look for CMS

  • pulse, motor skills and sensation

• if they are a high priority patient and you find broken extremities don’t splint until on route to hospital

pediatric rapid assessment

• don’t press too hard on head (frontanelles)

• if see any blood or clear fluids coming from nose or ears - suspect skull fracture

• neck: might not have broken spinal

• check: ribs could not break but could still be injuries to organs within

• abdomen: this area more susceptible to trauma than adults abdomen’s

  • **** children are abdominal breathers so any threat to abdomen is a threat to their breathing

detailed physical exam

• for en route to the hospital of a trauma patient with high priority or in a bad MOI and after rapid trauma assessment

• similar to rapid assessment