EMT

Trauma Assessment Procedures

Use of DCAP-BTLS for Focused Area of Assessment

  • Utilize DCAP-BTLS to conduct a focused assessment on the injury area.

    • DCAP-BTLS stands for:

      • Deformities

      • Contusions

      • Abrasions

      • Punctures/penetrations

      • Burns

      • Tenderness

      • Lacerations

      • Swelling

Assess Baseline Vital Signs

  • Vital signs are crucial indicators of a patient's physiological state.

  • Components include:

    • Pulse rate

    • Respiratory rate

    • Blood pressure

    • Skin color, temperature, and condition

    • Pupils

    • Oxygen saturation

Obtain SAMPLE History

  • Gathering medical history using the SAMPLE acronym:

    • S: Signs & Symptoms

    • A: Allergies

    • M: Medications (both prescribed and over-the-counter)

    • P: Pertinent past medical history

    • L: Last oral intake

    • E: Events leading to the injury or illness

Cervical Collar Application

How to Apply a Cervical Collar

  • Determine indications based on the patient's symptoms and physical findings.

Detailed Physical Exam

Who Needs a Detailed Physical Exam?

  • A detailed physical exam is warranted based on the patient's condition:

    • After critical interventions for a patient with significant Mechanism of Injury (MOI)

    • Occasionally for a patient with no significant MOI

    • Rarely for a medical patient

  • Detailed exams may not be possible for patients with critical injuries due to time constraints.

Steps in a Detailed Physical Exam

  • Assess the areas examined in rapid trauma assessment plus:

    • Face:

      • Examine eyes, nose, mouth, and ears thoroughly. Look for:

      • Symmetry of features

      • Discoloration

      • Unequal pupils

      • Foreign bodies

      • Blood in the anterior chamber

    • Neck:

      • Limited assessment due to cervical collar application.

    • Chest:

      • Assess breath sounds and presence of any abnormalities.

    • Extremities:

      • Reassess distal pulse, sensation, and motor function.

    • Conduct this assessment slowly, possibly during transport.

    • Reassess vital signs throughout the process.

Assessing Trauma Patients

Performance Objective

  • Students must learn to complete a trauma assessment through step-by-step procedure.

Determining Patient Type

  1. How do you determine if a patient is a medical patient or a trauma patient?

    • If there is a significant MOI, classify as trauma patient; otherwise, classify as medical patient.

Significant Mechanisms of Injury (MOI):

  • Examples:

    • Ejection from a vehicle

    • Death in the same passenger compartment

    • Falls greater than 15 feet or three times the patient's height

    • Rollover incidents

    • High-speed collisions

    • Vehicle-pedestrian collisions

    • Infants and children:

      • Falls from greater heights, bicycle collisions, and medium-speed vehicle collisions.

    • Motor vehicle crashes exhibit signs of MOI:

      • Bent steering wheel

      • Broken mirror

      • Distorted pedals

      • Spider-webbed windshield

      • Deformed dashboard

Assessment of the Medical Patient

Purpose and Methods

  • Performance Objective: Understand how to perform a medical patient assessment step by step.

Exploring Patient Condition

  • Responsive vs. Nonresponsive:

    • Responsive Medical Patient:

      • Start assessment with ABC (Airway, Breathing, Circulation).

      • Collect secondary history focused on the history of present illness (HPI):

      • O: Onset

      • P: Provocation

      • Q: Quality

      • R: Radiation

      • S: Severity

      • T: Time

    • Special Note for Pediatric Patients:

      • Adjust communication: Get on their level and use simple terms.

SAMPLE and OPQRST

Important Findings

  • In medical assessments:

    • Important findings vary by body area:

      • Neck: Significant vascular findings or medical identifications.

      • Abdomen: Signs of distention, firmness, or rigidity.

      • Chest: Assess for breath sounds.

      • Pelvis: Check for incontinence of urine/feces.

      • Extremities: Assess pulse, motor function, and sensation.

Focused History and Physical Exam

For Unresponsive Medical Patients

Steps to Conduct Exam

  1. Conduct a rapid physical exam.

  2. Record baseline vital signs.

  3. Consider requesting Advanced Life Support (ALS) if necessary.

  4. Collect SAMPLE history:

    • Signs and Symptoms

    • Allergies

    • Medications

    • Pertinent past history

    • Last oral intake

    • Events leading to the illness/injury

History of Present Illness (HPI)

  • Utilize OPQRST as previously detailed.

Vital Signs and Their Importance

Vital Signs Overview

How Vital Signs Are Assessed

  • Baseline Vital Signs Include:

    • Pulse rate (Adults: 60-100 beats per minute)

    • Respiratory rate (assess quality: normal, shallow, labored, noisy)

    • Skin color, temperature, and condition

    • Pupils (assess size and reactivity)

    • Blood Pressure measurement:

      • Systolic and Diastolic readings measured in mmHg using a sphygmomanometer

      • Normal systolic: ≤120 mmHg; Hypertension: >140 mmHg

      • Diastolic: Normal is 60-90 mmHg; Hypertension: >90 mmHg

      • For children (1-10 years) use: ext(Child′sageimes2)+80extmmHgext{(Child's age} imes 2) + 80 ext{ mmHg}

      • For adolescents >10 years, minimum systolic of 90 mmHg.

    • Pulse Oximetry:

      • Oxygen saturation levels:

      • 96-100% = normal

      • 91-95% = hypoxia

      • 86-90% = significant hypoxia

      • <85% = severe hypoxia

Reassessment of Vital Signs

  • Stable patients: every 15 minutes.

  • Unstable patients: every 5 minutes.

Interview Strategies for Unresponsive Patients

Conducting Effective Gatherings of Information

  • Position yourself appropriately next to the patient.

  • Identify yourself and what you do.

  • Speak in a normal, calm voice.

  • Use the patient's name to enhance connection.