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PATIENT ASSESSMENT

TRAUMA

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BODY SUBSTANCE

ISOLATION

Personal protective equipment (PPE) must be

applied prior to contact with any body

substance, common PPE available to the medicshould include the following:

Gloves.

Eye protection.

Respiratory protection (Surgical Mask) Impervious clothing.

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INITIAL SCENE

ASSESSMENT/SAFETYAsk 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 appropriateactions to secure the scene prior to movingforward to the incident site.

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INITIAL SCENE

ASSESSMENTThese 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.

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DETERMINE THE

MECHANISM OF INJURYLook 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).

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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 triagecategory.

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DETERMINE THE NUMBER

OF PATIENTSMILITARY TRIAGE

ImmediateDelayed

Minimal

Expectant

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DIRECTS C-SPINE

STABILIZATIONSpinal 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 lifescenarios will be dictated by MOI, localprotocols, and environment.

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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 traumaassessment.

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GENERAL IMPRESSION

The general impression is your immediate

assessment formed in the first few seconds of

exposure to the patients environment combinedwith the chief complaint. What is the MOI and

does the patient have any life threatening injuries?

(This is not verbalized to the patientbut will beverbalized for classroom scenarios).

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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.

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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.

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POSITION THE PATIENT

If the patient is found in any other position

other than supine, you may have to

reposition to provide appropriate care. Ifrequired 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.

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LOG ROLL

NOTE: THE C-COLLAR MUST BEAPPLIED PRIOR TO ROLLING OR

MOVING A PATIENT WITH ASUSPECTED C-SPINE INJURY.

Maintain C-Spine and L-Spine control andin line.

Consider MAST.

Assess the posterior from head to foot.

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ASSESS AIRWAY AND

BREATHING If the patient is alert and oriented - move to

assess the patients breathing.

If the patient has an altered LOC considerthe following:

NOTE: THIS MUST BE ACCOMPLISHED

WITHIN 5 MINUTES OF STARTINGTHE ASSESSMENT

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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)

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ASSESS AIRWAY

LOOK - I see bilateral rise and fall of thechest.

LISTEN - I hear deep and normalrespiratory effort.

FEEL - I feel exhalation on my ear.

NOTE: The rate is not counted, butcontinuous practice and experience allowsyou to guestimate the rate.

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ASSESS BREATHING

APPROXIMATE RATE: Use the method

of abnormal vs. normal rate.

(28). Slow or Rapid. RHYTHM: Regular vs. Irregular.

DEPTH: Shallow vs. Deep.

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ASSESS CIRCULATION

CAROTID PULSE: BP is > 60.

FEMORAL PULSE: BP is > 70.

RADIAL PULSE: BP is > 80.

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ASSESS PULSE

If the patient is alert - assess the radial pulse.

If the patient has a decreased LOC - assess

both the carotid and radial pulsessimultaneously.

If no pulse - begin CPR.

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ASSESS PERFUSION

Assessment of perfusion can be easilyaccomplished in three ways:

Capillary refill - < 2 seconds Skin color - In light skinned patients color

will be obvious, in dark skinned patients itis easiest to assess the mucous membranesof mouth or fingernail beds.

Skin temperature - Warm.

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EXPOSE THE BODY

Proper assessment of airway interventions

and inspection for life threatening injuries

requires exposure of the thorax

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DOC, IT HURTS,

RIGHT BY MY...

EXPOSE, EXPOSE!

YOU CANT TREAT

WHAT YOU CANT SEE!

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TREATMENTS

TREAT ALL INJURIES THAT CAN OR

WILL CREATE COMPLICATIONS

WITH AIRWAY OR BREATHING. PATIENTS THAT ARE NOT

BREATHING OR BREATHING

INADEQUATELY DETERIORATERAPIDLY.

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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 thepatient, do so to manage life-threatening

bleeding.

NOTE: If life-threatening bleeding isdetected it will be managed immediately.

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ACCESS THE BODY

PREVIOUS TREATMENTS/INTERVENTIONS

CHECK FOR BURNS, FRACTURES, ANDSIGNS OF SHOCK

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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 informationfrom bystanders at the scene or family members in

better condition.

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INITIATE

TRANSPORTATION The golden hour begins with injury to the

patient not with the arrival of EMS.

Trauma patients are not resuscitated in thefield only in the E.D. or O.R.

NOTE: TRANSPORTATION OF THEPATIENT MUST BE INITIATEDWITHIN 10 MINUTES OF STARTINGTHE ASSESSMENT.

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THE END

The detailed physical exam, to

include IVs will be completed in 12

minutes. The time for the IV itselfwill be 6 minutes.

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