INITIAL & RAPID TRAUMA ADULT PHYS.

ASSESS & Other Summaries

INITIAL:
1) BSI (PPE) 2) SCENE SAFETY) 3) MOI/NOI (Mechanism of Injury / Nature of Illness) 4) NO. (#) of PATIENTS 5) ADDITIONAL RESOURCES (Fire, Utilities, Additional Units, HAZMAT) 6) GENERAL IMPRESSION

Rev. 07/23/2011

DECIDE LOAD & GO @ ANY POINT (SHOCK, TRAUMA, HIGH FALL)

7) C-SPINE (Immobilize before assessing to prevent patient movement)

8) LOC A.V.P.U. 9) AIRWAY O & C << EXPOSE CHEST IF NEC. >> LOOK for MED ALERTS (necklace, bracelet) Pacemakers/Patches/Scars With C-Spine

10) BREATHING R/R/Q LISTEN, LOOK & FEEL IF NO Breathing = Begin Assess for Resuscitation/CPR - JAW THRUST (Modified - if needed) - O2 IF NEEDED 11) CIRCULATION R/R/Q Radial / Carotid simultaneous. Presence and RRQ only IF NO = CPR (someone continues assessment) - SKIN COND C.M.T. Color/Moisture/Temp (P/W/D or Pale / Cool /Diaphoretic) - CRT (Perfusion) NO RADIAL PULSE = SYSTOLIC < 80mmHg

** - BLEEDING (profuse) SCAN for (LOOK UNDER CLOTHING AS NEEDED)

(- O2 IF NEEDED) 12) MAJOR ISSUES: BLEEDING (Hemorrhage) / STROKE / RESPIRATORY or CARDIAC 13) TRANSPORT DECISION: IF NOT ALREADY MADE Load and Go OR Stay and Play HALF-TIME (1) RE-State TRANS. Decision, (2) Obtain BASE LINE VITALS AND (3) S.A.M.P.L.E. 14) BASELINE VITALS (BP/PULSE/RESP/SPO2/D-STICK) - ASSIGN PARTNER TO TAKE & RECORD With C-Spine

S.A.M.P.L.E. <DELEGATE> (Gather info from relatives, witnesses, passengers, etc.)

<DELEGATE> (Re-Look for ID, Med Alerts, Wallet/Purse, Pockets for Meds. & Info.)

RAPID TRAUMA (FULL BODY) ASSESSMENT Only with C-Spine in place start
DCAP-BTLS TIC / TRD for Assessment Deformities /Contusions /Abrasions /Punctures (Penetrations)/ Burns /Tenderness /Lacerations /Swelling TIC Tenderness /Instability /Crepitus TRD (Abdominal) Tenderness (rebound) /Rigidity / Distention 1) SKULL & FACE E (PERRL & whites)/ E/N/M (clear & open) check for CSF and BLOOD 2) NECK- STEP OFF Jugular (distention) and Tracheal shift (TS is a LATE SIGN of pneumo-/hemothorax) With 3) C-COLLAR ON before ANY MORE ASSESSMENT OR 4) CLAVICLE PALPATE then C-COLLAR! C-Spine

5) CHEST (Palpate) and PARADOXICAL MOTION, CREPITUS, (A-)SYMETRY (EXPOSE! If patient altered LOC) - STERNUM STABILITY / RIBS - 5 POINT ASCULTATE (Mid-clavicle b/w 3rd-5th ribs and Mid-Axilary both sides) Re-LOOK for P.P.S. Also Listen to (#5) or rhythm and quality 6) ABDOMINAL T.R.D Tenderness(Rebound)/Rigidity/Distention >>>>>>> 4 QUADRANT PALPATE 7) PELVIC STABILITY down from top in from sides 8) GENITAL AREA sweep (VISUAL) incontinence/bleeding/priapism 9 AREA L.HYPO / EPIG. / R.HYPO

9) LOWER EXTRMITIES- Femur/Patella/lower legs PEDAL PULSE (PMS-Pulse R.LUM / UMBIL / L.LUM Motor Sensory) (Wiggle/Push?) R.ILLIAC/HYPOG/L.ILLAC

10) UPPER EXTREMITIES Palpate / RADIAL PULSE / re-check CRT / PMS Feel? Wiggle? Squeeze? 11) LOG ROLL On head mans count HAND ALWAYS ON P. SHOULDER (Remove = fail!) - If help available roll AWAY from injury / If along roll TOWARD injury (to stabilize) 12) UPPER BACK/SPINE/LOWER BACK/BUTTOCKS/EXTRIMITIES (ROLL BACK onto BACKBOARD) !!! C-SPINE UNTIL SECURE ON BACK BOARD! !!!

13) EN ROUTE more detailed exam + PULSE-OX and D-STICK (BLOOD SUGAR - Glucometer) (S.A.M.P.L.E. AGAIN and Radio Report Sequence on Back) (ADDITIONAL VITALS SET stable every 10, unstable every 5)

S.A.M.P.L.E.
S - Signs & Symptoms A- Allergies (look for Med. Alerts) M- Medications (on person, in purse, in house) P- Pertinent Past History L- Last Oral Intake E- Events leading to Illness or Injury (MOI/NOI)

O.P.Q.R.S.T
O - Onset P Provocative / Palliative Q - Quality R - region, radiation, recurrence S Severity (1-10, or worst imaginable scale) T Time (since onset)
AS - Assoc. symptoms PN Pertinent negatives

RADIO REPORTING SEQUENCE Identify Unit: This is Med (#). We are en route to your facility with a
____ AGE ____ SEX M Mechanism of Injury (Nature of Illness) MVC Motor Vehicle Crash (and details i.e. roll ) C Chief Complaint (describe primary injury or illness) V- Vital Signs A/B/C, Pulse Ox, BP, D-Stick (Glucose) I Injuries (list and/or describe) T- Treatment/Interventions (what has been (is being) done and results: stable, improving, declining ETA Estimated Time of Arrival and Needs When we arrive I need

SUMMARY of NORMALS and RESPONSES VITALS: ADULT Blood Pressure 90-140/60-90 (sys./dia.)

Pulse: Respiration:

CHILD 80-100/ 2/3 sys 0r 90+(2Xage)upper lim. 70+(2xage) lower lim. M: 100+Age to 40/ 60-90 F: 90+Age to 40/ 60-90 60-100 bpm 80-100 bpm 12-20 breaths/min 15-30 breaths/min.

INFANT 100-120/ 2/3 sys

NEO-Nat.

100-120 bpm 25-30 breaths/min.

120-160 bpm

O2 NORMS, ADMINISTRATION & INTUBATION (diffusion = movement of gases from area of higher to area of lower concentration across a membrane) Lungs > blood > tissues > cells NORMS: Tidal Volume (VT = 500 ml in one inhale or exhale (1 cycle) (From PPT Thoracic Trauma 5-7 ml/kg) Total Lung Capacity (TLC) = 6 l. in average adult male Dead volume (air not exchanged in normal respiration) = 150 ml (adult male) or 2ml/kg body wt. NORMAL (AMBIENT) AIR = 21% 02 Exhaled air: 17% O2 ADMINISTRATION(& INTUBATION) Simple face Mask: 40-60% O2 (8-12 lpm no less than 8 lpm) Nasal Canula: @ 1 l/m = 24% O2 @ 4 l/m = 36% Never admin. above 6 lpm. @ 2 l/m = 28% @ 5 l/m = 40% (ineffective and causes mucus @ 3 l/m = 32% @ 6 l/m = 44% membrane drying) (WHEN ADMINISTERING BREATHS MANUALLY RATE is BREATH every 6-8 SEC. (8-10 Breaths/min.) Venturi: precise control 24%, 28%, 35%, 40% FROPVD (Flow Restricted O2 Powered Ventilation Device) Non-Rebreather OR BVM (Bag Valve Mask): 80-95% @ 12-15 l/m (shock or trauma = 15 lpm!) Airway adjuncts: Nasopharyngeal Oropharyngeal Combi-tube / King Airway: 100% O2 (on BVM) CPR and RESCUE BREATHING Breathing: 2 Rescue breaths (watch for chest rise) then every 6-8 seconds (8-10 breaths/min) CPR: ADULT CHILD INFANT 1 Rescuer 30:2 (1 -2) 30:2 1/3-1/2 30:2 1/3-1/2 2 Rescuer 30:2 15:2 chest depth 15:2 chest depths NORMAL RANGES pH. 7.35-7.45 Deviation +/- .4 fatal Base to Acid Ratio: 20 (HCO3-) : 1 (H2CO3) PO2 : 80-100 PCO2 : 34-45 (usu. 40)

HCO3 (bicarbonate) : 18-31 (usu. 22-26) SpO2: Norm. 95-99% Mild Hypoxia 91-94% Moderate Hypoxia 86-91% Severe Hypoxia > 85% BP Adult Male S: 90-140 (100+age to 140)/ D: 60-90 Female S: / D: Female (pregnancy) (usually blood vol. is higher / BP lower / Pulse more rapid) Child S: 80-110 / D: 2/3 systolic Infant S: 70-95 / D: 2/3 systolic Pulse Adult (M/F) 60-100 bpm Child 80-100 Infant 100-120 Neonate 120-160 Respiration. A. 12-20 bpm C 15-30 I. 25-50 Neo 40-60 Vt - Vd = Va. (tidal /dead space /alveolar) - Adult male: t=500-800mL d=150mL a=350mL Minute vol. = amount of exchange/min. Vmin = Vt - Vd x respiratory rate Functional Reserve capacity = from full inhale to forcible exhale apx. 4,500 mL D-Stick. BGL 80-120 mg/dL Temp 98.6 varies. (range EKG - 4 lead hookup: Salt (WHITE) R shoulder Pepper (BLACK) L shoulder Relish (GREEN) L leg inner below knee OR L lower abdomen at pelvis (anterior) Ketchup (RED) R leg inner below knee OR R lower abdomen at pelvis (anterior)

GLASGOW COMA SCALE EYES Opening: 4 SPONTANEOUS 3 to voice 2 to pain 1 NONE VERBAL Response: 5 ORIENTED 4 confused 3 inappropriate 2 incomprehensible 1 NONE Motor Response (PMS): 6 OBEYS COMMANDS 5 localizes pain 4 withdraws (from pain or painful stimuli) 3 flexion 2 posturing 1 NONE REVISED TRAUMA SCORE (Including finding from Glasgow Coma Scale) RESPIRATION rate: 4 10-29 rpm(respirations per minute) 3 GREATER THAN 29 rpm 2 6-9 rpm 1 1-5 rpm 0 NO RESPIRAIONS SYSTOLIC B/P: 4 GREATER THAN 89 mmHg 3 76-89 mmHg 2 50-75 mmHg 1 1-49 mmHg 0 NONE GLASCOW COMA SCALE: 4 GCS of 13-15 3 GCS of 9-12 2 GCS of 6-8 1 GCS of 4-5 0 GCS <4

BANDAGE TYPE AND APPLICATIONS: DRY BULKY lacerations, abrasions PRESSURE - bleeding control / stabilizing (i.e. FLAIL CHEST) OCCLUSIVE penetrations/punctures of the thoracic(chest), abdominal, neck (i.e. knife wounds, gun shot wounds, etc.) WET (Sterile H2O): Burns WET with OCCLUSIVE: eviscerations TRAUMA DRESSING: Large open wounds, flail chest (tape tightly to stabilize)

KENDRICK EXTRACTION DEVICE (KED) 1. BSI / PPE SCENE SAFE MOI/NOI - # PATIENTS ADD. RESOURCES? (If patient is alert and responsive stable, normal range vitals, normal LOC) 2. Approach vehicle (patient) from the front (SIR / MAAM) LOOK STRAIGHT AT ME. DO NOT MOVE YOUR HEAD. ANSWER WITH YES OR NO. DO YOU UNDERSTAND? 3. Partner to hold and maintain C-SPINE (Do not release until patient fully immobilized on back board!) MY PARTNER IS GOING TO HOLD YOUR HEAD STABLE. 4. CHECK PMS in all extremities 5. Apply C-COLLAR (Poss. reassess PMS) 6. Attach tails (LEG STRAPS) to back of KED to prevent tangles when installing it 7. Kneel next to patient 8. Support patient (hand at base of C-Collar and back ON MY PARTNERS COUNT OF THREE BEND FORWARD AT THE HIPS (WAIST). WE WILL STABILIZE YOU. 9. POSITION THE KED. So that it will Chicken wing the patient when strapped. 10. Return patient to neutral position resting against the KED ON PARTNERS COUNT LEAN BACK AND LOOK UP. DO NOT MOVE YOUR HEAD. 11. Come to the front and check its positioning 12. STRAPPING THE KED: a. MIDDLE Mnemonic: My Baby Looks Hot Tonight. b. BOTTOM c. LEGS d. HEAD e. TOP On securing and tightening TOP (last) have patient take a deep breath and hold it while strap is adjusted. DOES THIS IMPEDE (RESTRICT) YOUR BREATHING? 13. RE-CHECK PMS in all extremities 14. MOVE TO BACKBOARD a. PARTNER MAINTAINS C-SPINE b. ROTATE PATIENT 90 DEG. (back toward you) c. LOWER ONTO BACKBOARD i. RELEASE LEG STRAPS d. SPIDER STRAP TO LONG SPINE BOARD (shoulders, feet, middle, head) e. BLOCK AND SECURE HEAD f. RE-CHECK PMS BEFORE TRANSPORT

12 POINT * LEAD SET-UP Since this is not an invasive procedure it should be within our scope of practice to assist with connecting 12 point leads for monitoring. WHITE (upper right mid clav) BLACK (upper left mid clav) RED* (lower left abdomen @ pelvis) GREEN *(lower right abdomen @ pelvis) (* or on inside of right leg below knee) (*Or midline abdomen for 3-lead) (SALT / PEPPER / SALSA / RELISH) BROWN (V1) (4TH IC right of sternum) YELLOW (V2)(4th IC left of sternum) GREEN (V3) (down from V2 below pect./breast) BLUE (V4) (under pect./breast midclavicular) ORANGE (V5)(anterior side under pect./breast) PURPLE (V6) (right side midline, posterior to V5 and slightly up) *There are only 10 pads but they read between themselves to create the 12 line graph.