Focused History and Physical Examination for Trauma Patients CHAPTER 10.

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.

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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