chapter 14 focused history and physical examination of the trauma patient

Chapter 14Focused History and Physical Examination of the Trauma Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

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Overview

Determination of Trauma The Rapid Trauma Assessment The Focused Trauma Assessment


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Determination of Trauma

The objective of the initial assessment is to discover and treat life threatening injuries

Immediate transportation quickly follows when the patient is seriously ill or injured

The EMT should continue the assessment, giving special attention to injuries


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Complete head-to-toe rapid trauma assessment for major mechanism of injury

Focused trauma assessment for minor isolated trauma


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General principles of physical examination– Touching a patient is considered performing a

medical examination– The relationship between the EMT and the patient

is based on trust and respect


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General principles of physical examination– Be polite– Maintain the patient’s privacy– Be honest– Focus the patient’s attention


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Reconsider the mechanism of injury– What cannot be seen can kill a patient– Consider the worst case scenario– Have a high index of suspicion


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Reconsider the mechanism of injury– A serious mechanism calls for a rapid trauma

assessment– A minor mechanism can have a major impact– Consider ALS backup


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The Rapid Trauma Assessment

Initial assessment and rapid trauma assessment

Should take about one or two minutes to complete

Continually reassess ABCs


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Physical signs of injury– DCAP-BTLS



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Physical signs of injury– D: Deformity


Courtesy of Dr. Deborah Funk, Albany Medical Center, Albany, NY


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Physical signs of injury– C: Contusion

• Another word for bruise• Result from blood pooling

under the skin• Potentially serious



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Physical signs of injury– A: Abrasion

• Skin is scraped and underlying tissue is exposed

• Shows where force was applied to the body




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Physical signs of injury– P: Puncture

• Caused by an object penetrating the skin and underlying tissue

• May be very deep • Should be considered

serious




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Physical signs of injury– B: Burn

• Should be considered serious• Can result in infection

or hypovolemia




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Physical signs of injury– T: Tenderness

• Gently assess the skin for underlying pain

• The patient will usually show some sign of pain



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Physical signs of injury– L: Laceration

• A deep cut in the skin• Need to be sutured




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Physical signs of injury– S: Swelling

• Can be difficult to assess• Compare both sides of

the body



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Steps of the rapid trauma assessment– Head and neck

• Check the head thoroughly• Assess the neck and trachea



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Steps of the rapid trauma assessment– Chest

• Look• Listen• Feel



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Steps of the rapid trauma assessment– Extremities

• Significant bleeding can accompany a broken bone

• Assess using DCAP-BTLS



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Steps of the rapid trauma assessment– Back and buttocks

• Check using DCAP-BTLS• Carefully control the spine



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Steps of the rapid trauma assessment– Baseline vital signs and SAMPLE history

• A baseline set of vital signs is a part of every physical assessment

• A SAMPLE history is then performed



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With isolated injury, rapid trauma assessment may not be necessary

Focus on the injured part



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An assessment limited to the area of injury Performed in the same manner as the rapid

trauma assessment



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The Focused Trauma Assessment

Watch this video clip that demonstrates a focused assessment


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Stop and Review

Describe each component of DCAP-BTLS. Describe the rapid trauma assessment by

body regions.

chapter 14 focused history and physical examination of the trauma patient

Documents

thomson corporation

thomson delmar learning

trauma patient

rapid trauma assessmentshould

minor isolated trauma

physical signs of injurya

physical signs of injurydcap

physical signs of injuryc