14)detailed assessment
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Detailed Assessment
Detailed Assessment
• What:• Deliberate head-to-toe assessment• Encompasses ALL aspects of physical exam • Seeks information not previously obtained
• Why:• Assess secondary injuries
• When:• After critical decisions and treatment have been made
• Who:• Medical pt based on NOI• Unresponsive pt (med/trauma)
• Rule in/out trauma• Trauma pt –Injury specific
• i.e. baseball player struck in eye- exam eyes, ears, nose, mouth, etc.
Detailed AssessmentHead
• Inspect/Palpate• DCAP-BTLS • Crepitation
Detailed AssessmentFace
• Inspect/Palpate• DCAP-BTLS • Crepitation
• Battle’s Signs• Bruising immediately
behind the ears• Suggestive of basal skull
fracture • Raccoon eyes
• Bilateral black eyes• Suggestive of a basal skull
fracture
Detailed AssessmentEars
• Inspect/Palpate• DCAP-BTLS
• Drainage• Apply loose dressing
• Halo test• If fluid is present draining out of nose/ears• Collect small sample with gauze pad• If CSF is present in the blood it will separate out• A halo is created
• Blood in the center• CSF in the periphery
• Battle’s Signs• Bruising immediately behind the ears• Suggestive of basal skull fracture
Detailed AssessmentEyes
• Inspect• DCAP-BTLS
• Discoloration• Unequal pupils• Foreign material • Blood in anterior
chamber
Blood in anterior chamber
Foreign Body
Jaundice Constricted
Unequal
Dilated
Detailed AssessmentNose
• Inspect/Palpate• DCAP-BTLS
• Drainage• Bleeding
Detailed AssessmentMouth
• DCAP-BTLS • Drainage• Bleeding • Teeth• Obstructions• Swollen/lacerated tongue
• Seizure?• Odors
• DKA?• Discoloration
Detailed AssessmentNeck
• Inspect/Palpate• DCAP-BTLS • Crepitation• C-Spine “Step Off”
• Jugular Vein Distention • Indicates increased venous
pressure • Assessed at 45O
• Trachea• Midline • Deviation…
• Subcutaneous Emphysema • APPLY C-COLLAR!!!!!!!!!!!!!!!
JVD
Detailed AssessmentChest
• Inspect/Palpate• DCAP-BTLS • Crepitation
• Paradoxical Motion• Movement of part of the chest
wall that is opposite that of the rest of the chest
• Flail Segment • Breath sounds
• Mid clavicular lines bilaterally• Mid axillary lines bilaterally • Present or Absent• Equal or diminished
Detailed AssessmentAbdomen
• Inspect/Palpate• DCAP-BTLS • Crepitation
• Rebound Tenderness• Distention • Resistance
• Firm• Tender• Soft
Rapid Trauma AssessmentPelvis
• Inspect/Palpate• DCAP-BTLS • Crepitation
• Stability • If no pain • Gently compress pelvis
posteriorly and medially
• Priapism • Painful erection of the penis indicative of spinal injury • Loss of sympathetic tone
Rapid Trauma Assessment Extremities
• Inspect/Palpate• DCAP-BTLS • Crepitation
• Work bilaterally at the same time• Makes comparison easy• 1 L of blood from femur Fx
• ONLY 1-2 Cm swelling• Start at top and work your way down• Palpate entirely around the part• Assess for PMS!!!!!!!!
• Pulse• Motor• Sensation
Rapid Trauma AssessmentPosterior
• Use C-Spine Control!!!!• Log-roll pt to lateral position
and inspect for• DCAP-BTLS • Crepitation• Vertebral “step offs”
• !!!DON’T FORGET THE PT HAS A BACK!!!!
Detailed Assessment
• Treat minor injuries found. • Reassess vitals!!!!!!!!