PATIENT ASSESSMENT

TRAUMA

BODY SUBSTANCE ISOLATION

Personal protective equipment (PPE) must be applied prior to contact with any body substance, common PPE available to the medic should include the following: Gloves. Eye protection. Respiratory protection (Surgical Mask) Impervious clothing.

INITIAL SCENE ASSESSMENT/SAFETY

Ask yourself if the scene is safe and adequate protection is provided to the following: Yourself(the rescuers). The Patient(s). The Bystanders. If the scene is not safe, take the appropriate actions to secure the scene prior to moving forward to the incident site.

INITIAL SCENE ASSESSMENT

These actions may include but are not limited to the following: Tactical situation - provide tactical security in the military environment and police security in the civil environment. Fire - allow fire personnel to suppress the fire. Electrical hazard - allow power company to cut power. Special Rescue, i.e.., hazmat, high angle, swift water.

DETERMINE THE MECHANISM OF INJURY

Look at the environment and ask yourself what caused the injury? Examples: Gun shot wound (GSW)/stab wound. Assault. Blast injury. Fall from heights. Motor vehicle accident (MVA)/Motorcycle accident (MCA).

DETERMINE THE NUMBER OF PATIENTS

How many patients: Consider triage if two or more. Triage is initiated by the senior medical provider at the scene. He rapidly surveys each casualty and places them in a triage category.

DETERMINE THE NUMBER OF PATIENTS

MILITARY TRIAGE Immediate Delayed Minimal Expectant

DIRECTS C-SPINE STABILIZATION

Spinal stabilization will be used on all trauma patients if the MOI indicates, i.e., Fall from heights, MVA/MCA, etc.
NOTE: Spinal stabilization will be used in almost all classroom scenarios. Real life scenarios will be dictated by MOI, local protocols, and environment.

Note:
Spinal stabilization can be directed by the primary care provider if there is more than one provider - USE YOUR ASSETS. The C-Collar is not placed on the patient at this time - it is placed on the patient after the neck is assessed in the rapid trauma assessment.

GENERAL IMPRESSION
The general impression is your immediate assessment formed in the first few seconds of exposure to the patients environment combined with the chief complaint. What is the MOI and does the patient have any life threatening injuries? (This is not verbalized to the patient but will be verbalized for classroom scenarios).

DETERMINE RESPONSIVENESS/LOC

A - Alert, responds without prompting. V - Verbal stimulus, responds to verbal commands (not necessarily appropriately) P - Painful stimulus, withdraws or groans when pain is elicited (sternal rub/nail bed). U - Unresponsive, does not respond to verbal or painful stimuli.

DETERMINE LIFE THREATS

Identify injuries that may compromise the airway/breathing (open chest wound) or produce profound irreversible shock (massive external hemorrhage). Manage rapidly and temporarily at this time.

POSITION THE PATIENT

If the patient is found in any other position other than supine, you may have to reposition to provide appropriate care. If required this must be done with spinal immobilization. If appropriate care can be given with the patient in the position found, defer movement until it interferes with treatment.

LOG ROLL
NOTE: THE C-COLLAR MUST BE APPLIED PRIOR TO ROLLING OR MOVING A PATIENT WITH A SUSPECTED C-SPINE INJURY. Maintain C-Spine and L-Spine control and in line. Consider MAST. Assess the posterior from head to foot.

ASSESS AIRWAY AND BREATHING

If the patient is alert and oriented - move to assess the patients breathing. If the patient has an altered LOC consider the following: NOTE: THIS MUST BE ACCOMPLISHED WITHIN 5 MINUTES OF STARTING THE ASSESSMENT

OPEN THE AIRWAY

MODIFIED JAW THRUST: For Trauma and suspected C-Spine injury. HEAD-TILT, CHIN-LIFT: For Medical.
Clear Airway as required: (suction/Heimlich/laryngoscopic)

ASSESS AIRWAY

LOOK - I see bilateral rise and fall of the chest. LISTEN - I hear deep and normal respiratory effort. FEEL - I feel exhalation on my ear. NOTE: The rate is not counted, but continuous practice and experience allows you to guestimate the rate.

ASSESS BREATHING

APPROXIMATE RATE: Use the method of abnormal vs. normal rate. (<10 or >28). Slow or Rapid. RHYTHM: Regular vs. Irregular. DEPTH: Shallow vs. Deep.

ASSESS CIRCULATION

CAROTID PULSE: BP is > 60. FEMORAL PULSE: BP is > 70. RADIAL PULSE: BP is > 80.

ASSESS PULSE

If the patient is alert - assess the radial pulse. If the patient has a decreased LOC - assess both the carotid and radial pulses simultaneously. If no pulse - begin CPR.

ASSESS PERFUSION
Assessment of perfusion can be easily accomplished in three ways: Capillary refill - < 2 seconds Skin color - In light skinned patients color will be obvious, in dark skinned patients it is easiest to assess the mucous membranes of mouth or fingernail beds. Skin temperature - Warm.

EXPOSE THE BODY

Proper assessment of airway interventions and inspection for life threatening injuries requires exposure of the thorax

DOC, IT HURTS, RIGHT BY MY...

EXPOSE, EXPOSE! YOU CANT TREAT WHAT YOU CANT SEE!

TREATMENTS

TREAT ALL INJURIES THAT CAN OR WILL CREATE COMPLICATIONS WITH AIRWAY OR BREATHING. PATIENTS THAT ARE NOT BREATHING OR BREATHING INADEQUATELY DETERIORATE RAPIDLY.

IDENTIFY AND CONTROL MAJOR BLEEDING

Assess the patient for major bleeding, perform a blood sweep from the patients head to their toes, if you need to expose the patient, do so to manage life-threatening bleeding. NOTE: If life-threatening bleeding is detected it will be managed immediately.

ACCESS THE BODY

PREVIOUS TREATMENTS/INTERVENTIONS CHECK FOR BURNS, FRACTURES, AND SIGNS OF SHOCK

OBTAIN A S.A.M.P.L.E. HISTORY

Signs and Symptoms. Allergies. Medications. Pertinent past medical history. Last oral intake(time or hours ago). Events leading up to the injury/illness. NOTE: It may be required to gain this information from bystanders at the scene or family members in better condition.

INITIATE TRANSPORTATION

The golden hour begins with injury to the patient not with the arrival of EMS. Trauma patients are not resuscitated in the field only in the E.D. or O.R. NOTE: TRANSPORTATION OF THE PATIENT MUST BE INITIATED WITHIN 10 MINUTES OF STARTING THE ASSESSMENT.

THE END

The detailed physical exam, to include IVs will be completed in 12 minutes. The time for the IV itself will be 6 minutes.

T I O S E NS U Q ? ?