focused history and physical examination for trauma patients chapter 10
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Focused History Focused History
and Physical and Physical
Examination for Examination for
Trauma PatientsTrauma Patients
CH
AP
TER
10
CH
AP
TER
10
Do a rapid assessment for multisystem injuries.
Mechanism of InjuryMechanism of InjuryMechanism of InjuryMechanism of Injury
High-risk Mechanisms High-risk Mechanisms
Ejection from a vehicleEjection from a vehicle
Same passenger compartment where another diedSame passenger compartment where another died
Fall of more than 20 feetFall of more than 20 feet Greater than 10 feet Greater than 10 feet (or twice patient’s height)(or twice patient’s height)
for infants & childrenfor infants & children
Vehicle roll-overVehicle roll-over
High-risk Mechanisms continued High-risk Mechanisms continued
High-speed collisionHigh-speed collision
Vehicle-pedestrian collisionVehicle-pedestrian collision
Motorcycle crashMotorcycle crash
Unresponsive or altered mental statusUnresponsive or altered mental status
Penetrating trauma to head, chest Penetrating trauma to head, chest or abdomenor abdomen
Kinematics Kinematics of Traumaof Trauma
Kinematics Kinematics of Traumaof Trauma
Kinematics:Kinematics:
In trauma, the process of In trauma, the process of surveying an accident scene to surveying an accident scene to determine injuries that may have determine injuries that may have resulted from forces involving resulted from forces involving motion.motion.
It is based on the fundamental laws of physics.
Motor vehicle collisions can Motor vehicle collisions can produce tremendous produce tremendous forces.forces.
Motor Vehicle Collisions Motor Vehicle Collisions
Head-on or frontal impactHead-on or frontal impact Down and underDown and under Up and overUp and over
Rear impactRear impact Lateral or side impactLateral or side impact RolloverRollover Rotational impactRotational impact
Down-and-Under InjuryDown-and-Under Injury
Up-and-Over InjuryUp-and-Over Injury
Lateral impacts can affect Lateral impacts can affect the chest, pelvis and the chest, pelvis and cervical spine.cervical spine.
Other Collisions Other Collisions MotorcycleMotorcycle
Head-on collisionHead-on collision Angular-impact collisionAngular-impact collision Ejection-impact collisionEjection-impact collision
Vehicle-pedestrianVehicle-pedestrian AdultAdult PediatricPediatric
FallsFalls
Adults struck by vehicles Adults struck by vehicles tend to sustain lower tend to sustain lower extremity injuries.extremity injuries.
Children struck by vehicles Children struck by vehicles tend to sustain chest and tend to sustain chest and abdominal trauma.abdominal trauma.
Organ Organ InjuriesInjuriesOrgan Organ InjuriesInjuries
Shear injury:Shear injury:
Damage to body organs that Damage to body organs that occurs as a result of a sudden occurs as a result of a sudden change of speed change of speed (during (during acceleration or deceleration).acceleration or deceleration).
Can result from any type of impact.
The aorta is
subject to shear injuries.
Compression injury:Compression injury:
Damage to body organs that Damage to body organs that occurs as a result of a occurs as a result of a compression-type force. compression-type force.
Restraints such as
seat belts and airbags
are associated with
injuries when not
used properly.
An improperly positioned An improperly positioned lap belt can result in lap belt can result in abdominal injuries.abdominal injuries.
Penetrating Penetrating InjuriesInjuries
Penetrating Penetrating InjuriesInjuries
Categories of Energy Capacity Categories of Energy Capacity
Low-energy weaponsLow-energy weapons Knife, ice pickKnife, ice pick
Medium-energy weaponsMedium-energy weapons Handgun, bow and arrowHandgun, bow and arrow
High-energy weaponsHigh-energy weapons Assault weapons, hunting riflesAssault weapons, hunting rifles
With a GSW, look for an With a GSW, look for an exit exit woundwound also. also.
Patients involved in an
incident with significant
mechanism, may
initially APPEAR TO BE
STABLE.
Evaluating Patients with Evaluating Patients with Serious Injuries or Serious Injuries or Mechanisms of InjuryMechanisms of Injury
Evaluating Patients with Evaluating Patients with Serious Injuries or Serious Injuries or Mechanisms of InjuryMechanisms of Injury
Perform rapid trauma assessment of: Perform rapid trauma assessment of:
Unresponsive patientsUnresponsive patients
Trauma with significant mechanismTrauma with significant mechanism
Multisystem traumaMultisystem trauma
EMTs who work in a
multi-tiered response
system should request
ALS immediately, or
rendezvous with
responding ALS.
If ALS is not available If ALS is not available immediately, immediately, consider a helicopter.consider a helicopter.
Assume that unresponsive & head-Assume that unresponsive & head-
injured patients have spinal injured patients have spinal
injuries.injuries.
Performing the Performing the Rapid Trauma Rapid Trauma AssessmentAssessment
Performing the Performing the Rapid Trauma Rapid Trauma AssessmentAssessment
DCAP - BTLS Acronym DCAP - BTLS Acronym D D -- DeformitiesDeformities
C C -- ContusionsContusions
A A -- AbrasionsAbrasions
P P -- Penetrations or puncturesPenetrations or punctures
BB -- BurnsBurns
TT -- TendernessTenderness
LL -- LacerationsLacerations
SS -- SwellingSwelling
Assess the Assess the skullskull for for deformities.deformities.
Assess the Assess the neck.neck.
Jugular vein distention:Jugular vein distention:
An abnormal enlargement of An abnormal enlargement of the veins on the side of the the veins on the side of the neck in the sitting patient.neck in the sitting patient.
May signify increased pressure in the circulatory system from a crush injury to the chest or abdomen.
Jugular Vein Distention (JVD)Jugular Vein Distention (JVD)
Apply a cervical spine Apply a cervical spine immobilization device after immobilization device after assessing the neck.assessing the neck.
Inspect the Inspect the chest chest for DCAP - for DCAP - BTLSBTLS
Paradoxical motion:Paradoxical motion:
Movement of part of the chest Movement of part of the chest wall in the opposite direction wall in the opposite direction from the rest of the chest wall from the rest of the chest wall during respiratory efforts.during respiratory efforts.
Indicates a section of the chest wall has broken loose.
Crepitus:Crepitus:
A crackling sound or sensation A crackling sound or sensation that indicates air under the that indicates air under the skin; more easily palpated than skin; more easily palpated than seen. seen.
Crepitus also refers to the grating sound and sensation produced by broken bone ends.
2345
Listen forListen for breath soundsbreath sounds at four at four points.points.
MidaxillaryMidaxillaryLineLine
MidclavicularMidclavicularLineLine
Determine if the abdomen isDetermine if the abdomen is
FIRM, SOFT, FIRM, SOFT, oror
DISTENDEDDISTENDED
Gently press on the abdomen.
Assess each of the four abdominalabdominal quadrants.quadrants.
RightRightLowerLower
LeftLeftLowerLower
LeftLeftUpperUpper
RightRightUpperUpper
Swelling, bruising,
distention or a firm
abdomen may
indicate a serious
abdominal injury!
Assess pelvic stability - Assess pelvic stability - flexion.flexion.
Assess pelvic stability - Assess pelvic stability - compression.compression.
Palpate the Palpate the lower lower extremities.extremities.
Note the presence or Note the presence or absence of absence of pedal pulses.pedal pulses.
To determine To determine motor function,motor function, ask the patient to wiggle ask the patient to wiggle their toes.their toes.
Determine Determine sensation.sensation.
Palpate the Palpate the upper upper extremities.extremities.
Inspect and palpate the Inspect and palpate the back.back.
While one EMT completes
the focused physical
exam, another can
obtain baseline vital
signs.
Evaluating Patients with No Evaluating Patients with No Significant Mechanism of Significant Mechanism of InjuryInjury
Evaluating Patients with No Evaluating Patients with No Significant Mechanism of Significant Mechanism of InjuryInjury
A patient with a A patient with a
minor isolated minor isolated
injuryinjury may not may not
need a complete need a complete
trauma trauma
assessment.assessment.
SU
MM
AR
YS
UM
MA
RY Mechanism of InjuryMechanism of Injury
Evaluating Patients with Evaluating Patients with Serious Injuries or Serious Injuries or Mechanisms of InjuryMechanisms of Injury
Evaluating Patients with No Evaluating Patients with No Significant Mechanism of Significant Mechanism of InjuryInjury
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