BASIC TRAUMA

EMERGENCIES

Alexander James M. Gabrino RN, AEMT

Community Affairs Assistant II
FLIGHT NURSE EMT INEAC Aviation Corp
MMDA – Public Safety Division
 TOPICS:

I. Body Substance Isolation

II. Mechanism of Injury VS Nature of Illness
III. Soft Tissues Injuries
❑ Wounds
❑ Dressing/Bandages
IV. Musculo-Skeletal Injuries
❑ Splinting
V. Bleeding and Shock
VI. Patient Assessment
LESSON OBJECTIVES

Upon completion of this lesson, the

participant will be able to:

1. Know what is Body Substance

Isolation.
2. Identify the Mechanism of Injury (MOI)
Vs Nature of Illness (NOI)
3. Identify soft tissue injuries.
4. Classify the types of open wounds
 LESSON OBJECTIVES

4. Demonstrate the proper application of

dressing and triangular bandage.
5. List down the types of musculo-skeletal
injuries.
6. Demonstrate patient assessment
7. Apply splints
I. BODY SUBSTANCE
ISOLATION
 Body Substance Isolation (BSI)

Is a practice of isolating all body substances (E.g Blood,

Urine, Feces, Tears, and Etc.) of an individual, of those
who might be infected with illness , to reduce possibility
of transmitting disease.
 Personal Protective
Equipment (PPE)
Personal Protective Equipment (PPE) means any device or appliance
designed to be worn or held by an individual for protection against one
or more health and safety hazards.
 TYPES OF PERSONAL
PROTECTIVE EQUIPMENT /
GARMENT

▪ Respirators
▪ Skin Protection
• Hearing Protection
▪ Eye Protection • Protective ensembles
 SCENE SAFETY

◾Starts prior to arrival

◾Ensure the scene is
safe before entering
◾Implement BSI
(Body Substance
Isolation)
• Ensuring the scene is safe
is rooted in situational
awareness – being able to
capture the clues and cues
that helps a responder
comprehend what is
happening
II. MECHANISM OF INJURY
VS
NATURE OF ILLNESS
 MECHANISM OF INJURY

◾The method by which damage

(trauma) to skin, muscles, organs,
and bones occur. (external force)

Evaluate:
–Amount of force applied to body
–Length of time force was applied
–Area of the body involved
 SIGNIFICANT MECHANISM
OF INJURY

◾Ejection from vehicle ▪ Vehicle-pedestrian

◾Death in passenger collision
compartment ▪ Motorcycle crash
◾Fall greater than 15'- ▪ Unresponsiveness or
20ft' altered mental status
◾Vehicle rollover ▪ Penetrating trauma to
the head, chest, or
◾High-speed collision abdomen
 NATURE OF ILLNESS

◾Condition is caused by an illness.

◾Determine the nature and extent of the patient’s
illness
◾Not caused by outside force
 THE IMPORTANCE OF
MOI/NOI

◾Guides
preparation for
care to patient
◾Suggests
equipment that will
be needed
◾Prepares for
further re-
assessment
 C-SPINE STABILIZATION

◾Consider early
during assessment.
◾To prevent movement
of the cervical spine.
◾Do not move
without
immobilization.
◾Achieve normal
alignment of the cervical
spine.
III. SOFT TISSUE INJURIES
SOFT TISSUE INJURIES

◾Is the damage of muscle, ligaments

and tendons of various parts of the
body.
◾can result in pain, swelling, bruising
` and loss of function.
 SOFT TISSUE INJURIES
MANAGEMENT

◾RICE-R
▪ is an effective procedure used in the initial treatment of a soft
tissue injury for the first 48-72 hours .
▪R - est
▪I - ce, I-mmobilize
▪C - ompression
▪E – levation
▪R – eferral/reassessment
SOFT TISSUE INJURIES
MANAGEMENT

◾No HARM Protocol

▪This method should not be used within
the first 48–72 hours after the injury in
order to speed up the recovery process.
▪H - eat
▪A - lcohol
▪R – unning/ re-Injury
▪M - assage
SOFT TISSUE INJURIES
MANAGEMENT

▶Monitor for the rapid change of vital

signs that might indicate internal
bleeding.
▶Treat for Shock
▶Immediately transport to nearest capable
hospital as soon as possible
SOFT TISSUE WOUNDS

WOUND – is a type of injury which

happens relatively quickly in which skin is
torn, cut, or punctured or where blunt
force trauma causes a contusion.
2 Classification of Wound
1. Open Wound
2. Closed Wound
CLASSIFICATION OF
WOUND

◾OPEN WOUNDS
-is an injury involving an external
or internal break in body tissue,
usually involving the skin
-Skin breaks on which the
patient is at risk for
contamination, which may
lead to infection.
OPEN WOUNDS

◾Occurs when
your skin rubs
or scrapes
against a
rough or hard
surface
ABRASION
MANAGEMENT FOR
ABRASION

▶clean the
surface of the
wound
▶if with
bleeding, apply
dressing &
bandage
OPEN WOUNDS

◾Occurs
when your
skin rubs or
scrapes
against a
rough or
LACERATION hard surface
MANAGEMENT FOR
LACERATION

▶clean the
surface of
the wound
▶apply
dressing &
bandage
▶if possible,
close the
open wound
OPEN WOUND

◾A flap of skin
although torn or
cut, is not torn
completely loose
from the body
◾Degloving injury
▪ Ring injury
AVULSION
MANAGEMENT FOR
AVULSION

▶-clean the surface

of the wound
▶return skin flap to
original position
▶control bleeding
(direct pressure,
apply dressing)
OPEN WOUNDS

◾Loss of Body
part, usually a
finger, toe, arm,
or leg, that occurs
as the result of an
accident or injury.

AMPUTATION
MANAGEMENT FOR
AMPUTATION

▶use universal precautions &

secure the scene
▶ clean the wound
▶immobilize partial amputation
with bulky dressing and splint.
▶Wrap complete amputation in
dry sterile dressing and place in
bag.
MANAGEMENT FOR
AMPUTATION

▶Put bag in cool container filled

with ice. Do not let the object
freeze!
▶Transport severed part with
patient.
OPEN WOUNDS

◾Caused by
explosion
causing
multisystem
trauma.

Blast Injuries
MANAGEMENT FOR
BLAST INJURY

▶use universal precautions & secure the scene

▶ clean the wound
▶Control bleeding (DT)
▶Cover with sterile dressing
▶Transport to the nearest capable hospital
OPEN WOUNDS

◾Caused by an object
such as a knife
entering the body.
◾Caused by an
object puncturing
the skin, such as a
nail or
needle.

PENETRATION / PUNCTURE
 MANAGEMENT FOR
PENETRATING INJURIES OF THE
NECK

◾Secure the
dressing in place
with roller gauze,
adding more
dressing if needed.
◾Wrap gauze
around and under
patient’s shoulder.
FOR INJURIES TO NECK
◾use universal precautions and secure
the scene
◾apply slight to moderate pressure on
the bleeding with an occlusive dressing
◾tape down the edges of the dressing to
form an airtight seal
◾never apply pressure to both sides of
the neck at the same time
FOR INJURIES TO NECK
◾place the patient on the left side
◾if without spinal injury, place the patient
on 15 degree head elevation, if possible
◾if an object is impaled in the neck,
stabilize it in place with bulky dressing. Do
not remove it.
◾Manage for shock.
OPEN WOUNDS

◾A direct
injury
resulting from
the crush
◾Occurs when
force or
CRUSH INJURY pressure is put
on a body part
OPEN WOUNDS

◾Physical
trauma due
to a bullet
from a
firearm.
GUNSHOT WOUND
OPEN WOUNDS

◾Caused by either
penetrating or blunt
injury to the abdomen
and abdominal cavity
can also be
laceration or breaking
of the skin or mucous
membrane

ABDOMINAL WOUND
MANAGEMENT FOR ABDOMINAL
INJURIES

➢ use universal precautions

and secure the scene
➢ do not touch the abdominal
organs or try to re-place the
exposed organs.
➢ If penetrating injury do not
remove the stabbed object
MANAGEMENT FOR ABDOMINAL
INJURIES

➢ cover the exposed

organs with clean cloth
or sterile dressing
➢ cover the dressing with
occlusive dressing and
with more bulky dressing
OPEN WOUNDS

➢Soft-tissue
injuries to the
face and scalp
are common.
➢Wounds to the
face and scalp
bleed profusely.
FACE and SCALP INJURIES
MANAGEMENT FOR EPISTAXIS
OR NOSE BLEED

1.Place the patient in a sitting

position
2.Have him or her lean forward
3.Keep the patient calm and still
as possible (rest)
4.Ensure ventilation to the patient
 MANAGEMENT FOR
EPISTAXIS OR NOSE BLEED

5. Do not remove object inside

the nose if there is.
6. Do not pack the nose
 MANAGEMENT FOR SKULL
INJURY

1. Do not attempt to stop the

flow of blood which could
increase the pressure
inside the skull causing
even more damage
 MANAGEMENT FOR SKULL
INJURY

2. Place a loose dressing

around the area to collect
the drainage
3. Cover the wound to
prevent infection
4. Immediately transport to
hospital
OPEN WOUNDS

◾Physical injury
to the body’s
abdominal cavity
consisting of a
laceration or
breaking of the
skin or mucous
IMPALED OBJECT
membrane
CLASSIFICATION OF
WOUND

CLOSED WOUNDS – Injury

beneath the unbroken skin
- Can be severe with damage to
internal organs
- Caused by impact with a
blunt/hard object.
- If Skin breaks, the patient is
at risk for contamination,
which may lead to infection.
CLOSED WOUNDS

◾Blunt, non
penetrating
injuries that crush
and damage small
blood vessels
◾Characterized
by erythema
CONTUSION (Bruise) and ecchymosis
CLOSED WOUNDS

◾Caused by
damage to a
blood vessel
that in turn
causes blood
to collect
HEMATOMA
under the skin
CLOSED WOUNDS

◾Caused by a
great or
extreme
amount of force
applied over a
long period of
CRUSHING INJURIES time
❑ DRESSING AND
BANDAGES
 DRESSING

- Is a sterile pad or compress applied to

wound to promote healing and protect
the wound from further harm.
PURPOSE
▶1) cover the wound
▶2) help control bleeding
▶3) prevent additional
contamination
 KINDS OF DRESSING

◾ OCCLUSIVE DRESSING
▪ wax or plastic material; creates an
airtight seal for an open abdominal, chest
and large neck injuries
KINDS OF DRESSING

◾ GAUZE PAD DRESSING

 KINDS OF DRESSING

◾ SELF ADHERING DRESSING

▪ Type of dressing, bandage or wrap that
coheres to itself, but does not adhere
well to other surface
 KINDS OF DRESSING

◾ MULTI-TRAUMA DRESSING
▪ IDEAL FOR STOPPING BLEEDING
AND IS HIGHLY ABSORBENT
 BANDAGES

- Used to hold a dressing in place

- Control Bleeding by direct pressure
when used as a broad or narrow
folded bandage
Kinds of Bandage:
▶1) Roller Bandage
▶2) Triangular Bandage
▶3) Tubular Bandage
 BANDAGING

Parts of Triangular Bandage:

 BANDAGING

Folding
OPEN PHASE

BROAD

SEMI - BROAD

NARROW
 BANDAGING

SQUARE KNOT
 BANDAGING

TRIANGLE OF FOREHEAD / SCALP

 BANDAGING

ARMSLING
 BANDAGING

TRIANGLE OF CHEST / BACK

 BANDAGING

TRIANGLE OF SHOULDER
 BANDAGING

TRIANGLE OF HIP
 Bandaging

TRIANGLE OF FOOT
 BANDAGING

TRIANGLE OF HAND
IV. MUSCULO – SKELETAL INJURIES
 MUSCULOSKELETAL
INJURIES
Closed Fracture – the
overlying skin is intact.
Proper splinting helps
prevent closed fracture from
becoming open fracture.
FRACTURE
 MUSCULOSKELETAL
INJURIES
Open fracture – skin has been
broken or torn either from the
inside by the injured bone or from
the outside by the object that
caused the penetrating wound
with the associated bone injury.
FRACTURE
 MUSCULOSKELETAL
INJURIES

▶ SIGNS AND SYMTOMS

1. Deformity or angulations
2. Pain & tenderness upon palpation or
movement
3. Crepitus (lumalangitngit) – sound or
feeling of broken bone ends rubbing
together
4. Swelling (pamamaga)
 MUSCULOSKELETAL
INJURIES

▶SIGNS AND SYMTOMS

5. Bruising or discoloration
6. Exposed bone ends
7. Joint locked in position – reduces motor
ability or reduced ability to articulate a joint
8.Numbness or paralysis – may occur distal
to site of injury caused by bone pressing on
a nerve
 MUSCULOSKELETAL INJURIES
MANAGEMENT

RICES-R
is an effective procedure used
in the initial treatment of a
soft tissue injury.
R - est
I - ce
C - ompression
E – levation
S - plinting
R - eferral
❑SPLINTING
 SPLINTING

- Used to stabilize a
broken bone while
the injured person
is taken to the
hospital for more
advanced treatment
BASIS FOR SPLINTING

Reasons:
1. Prevent movement of any fragments, bone
ends or dislocated joints (reduce farther
injury)
2. Reduce pain & minimize the following
common complications from bone to joint
injuries:
 BASIS FOR SPLINTING

Reasons:
3. To prevent closed fracture from becoming
an open fracture
4. To minimize blood loss or shock.
 SPLINTING EQUIPMENT

WOOD SPLINT

Rigid Splint -made of wood,

aluminum wire, plastic,
cardboard or
compressed wood fibers
ALUMINUM PADDED WIRE

CARDBOARD
PRESSURE SPLINT – is an
air splint. It is soft and
pliable before being
inflated but rigid once they
are applied and filled with
air.
◾IMPROVISED SPLINT -
made of cardboard box,
cane, ironing board,
rolled-up magazine,
umbrella, broom handle
and any other similar
object
◾CONFORMING/FORMABLE
SPLINT- can be molded to
different angles commonly
used for joint injuries(for
improvised - pillow, blanket)
◾SLING and SWATHE – two triangular bandages
used to hold an injured arm in place against the
body)

SLING AND SWATHE SPLINT

SLING SPLINT
 GENERAL RULE FOR
SPLINTING

▶Always communicate your plans with your patient if

possible.
▶Before immobilizing an injured extremity, expose and control
bleeding.
▶Always cut away clothing around the injury site before
immobilizing the joint. Remove all jewelry from the site and
below it.
 GENERAL RULE FOR
SPLINTING

▶Assess P.M.S. (Pulse, Motor Function And Sensation)

▶Do not attempt to push protruding bone ends back into
place.
▶Pad a splint before applying it.
▶If joint is injured, immobilize it and the bones above and
below.
 DISLOCATION OF THE
SHOULDER

• Most commonly dislocated large

joint
• Usually dislocates anteriorly
• Is difficult to immobilize
• Splint the joint with a pillow or
towel between the arm and the
chest wall.
• Apply a sling and a swathe.
CLAVICLE AND SCAPULAR
INJURIES

• Splint with a sling and swathe

 FRACTURES OF THE
HUMERUS

⚫ Occurs either proximally, in the

mid-shaft, or distally at the
elbow.
⚫ Splint with sling and swathe,
supplemented with a padded
board splint.
 ELBOW INJURIES

⚫ Fractures and dislocations often occur around the

elbow.
⚫ Injuries to nerves and blood vessels common.
⚫ Assess neurovascular function carefully
 FRACTURES OF THE
FOREARM

⚫ Usually involves both radius and ulna

⚫ Use a padded board, air, vacuum, or pillow splint.
INJURIES TO THE WRIST
AND HAND
 INJURIES OF KNEE
LIGAMENTS

⚫Splint in position found.

⚫Support with pillows.
 INJURIES TO THE
TIBIA AND FIBULA

◾Stabilize with a
padded rigid long
leg splint or an air
splint that extends
from the foot to
upper thigh.
 FOOT STABILIZATION

◾A pillow splint can provide

excellent stabilization of the foot.
V. BLEEDING AND SHOCK
 BLEEDING

◾Blood escaping from the circulatory

system from damaged blood vessels.
◾ It can be external and internal.
 EXTERNAL BLEEDING
Blood is leaving the body through some type
of wound.

- severity of sudden loss of blood that are serious:

ADULT - more than 1000 cc
(1liter)
CHILDREN – 500 cc (1/2 liter)
INFANT – 100 TO 200 CC
 TYPES OF EXTERNAL
BLEEDING

High
Pressure

Med
Pressure

Low
Pressure
INTERNAL BLEEDING

▶It is not visible and seldom obvious and can

result to severe blood loss with rapid
progression of shock and even death.

▶SOURCES: injured or damaged internal

organs and fracture extremities especially
femur, hip and pelvis
INTERNAL BLEEDING

▶CAUSE: Blunt trauma, abnormal clotting within

the body, result of certain fractures especially
pelvic fracture.

▶SEVERITY: depends on the patient’s overall

condition, age, other medical condition and the
source of internal bleeding
 SIGN AND SYMPTOMS OF
INTERNAL BLEEDING

• Pain, tenderness, swelling or

discoloration of suspected site or
injury
• Bleeding from the mouth, rectum,
vagina other orifice
SIGN AND SYMPTOMS OF
INTERNAL BLEEDING

• Vomiting bright red blood or like

color of dark coffee grounds
• Dark, tarry stools or stools with
bright red blood (Melena)
• Tender, rigid and/or distended
abdomen
LATE SIGN AND SYMPTOMS
OF INTERNAL BLEEDING

• Anxiety, restlessness, combativeness or altered

mental status
• Weakness, faintness or dizziness
• Shallow, rapid breathing
• Rapid, weak pulse
LATE SIGN AND SYMPTOMS
OF INTERNAL BLEEDING

• Pale, cool, clammy skin

• Capillary refill greater that 2 seconds (in infants
and children under 6 only)
• Dropping blood pressure
• Dilated pupils that are sluggish in responding to
light
• Nausea and vomiting
 INTERNAL BLEEDING

▶CLOSED FRACTURE OF
FEMUR– can cause one (1)
liter blood loss
▶LACERATION TO THE
LIVER OR SPLEEN – can
cause severe loss of blood,
potentially fatal
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

◾Before offering any help. You must f i r s t ensure your own

safety!

◾Ensure that PPE is provided and worn

◾If at any time. Your safety is threatened remove yourself

and the victim if possible from danger and find a safe
location
 Alert/call 911

This will notify emergency medical responders and depending

on the situation. Police officers to respond on the scene
BLEEDING
Look and identify any Life
Threatening Bleeding and identify
and locate for the source of bleeding.

Expose and remove the covering

clothing over the wound so that you
can clearly assess it.

Pelvic Fracture: 1.5 L – 3.0 L of Blood Loss

Femur/Long bone/ Thigh Bone : 1.0 L – 1 .5 L of Blood Loss
COMPRESS
Take any clean cloth
and cover the wound

1. If large and deep pack the

wound with the clean cloth

3.Apply direct pressure with both

hands directly over the bleeding wound
4.Hold pressure to stop the bleeding, continue
pressure until managed by the medical responders
 Direct Pressure on a
Wound
- Take any clean cloth and cover
the wound
- If large and deep pack the wound
with the clean cloth
- Apply direct pressure with both
hands directly over the bleeding
wound
- Hold pressure to stop the
bleeding, continue pressure until
managed by the medical
responders
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE
 PRIMARY PRINCIPLE OF
TRAUMA CARE RESPONSE

Wound Packing and Direct Pressure

 SHOCK

◾failure of the circulatory system to

provide adequate blood supply
throughout the body (inadequate tissue
perfusion).
CAUSES OF SHOCK

-Inability of the heart to pump enough

blood through the organs
-Severe loss of blood; insufficient blood in
the system
-Excessive dilation of blood vessels.
Blood volume will be insufficient to fill
them and shock will develop
 SIGN OF SHOCK

◾Breathing Shallow and rapid

: Rapid and Weak
◾Pulse: Pale, cool and clammy
◾Skin: Pale, often with blue
◾Face: color(cyanosis) in the lips,
tongue,and ear lobes
◾Eyes Lacklustre, pupils dilated
:
 SYMPTOMS OF
SHOCK

◾Nausea and possible vomiting

◾Thirst
◾Weakness
◾Vertigo – a dizzy confused state of
mind
◾Uneasiness and fear – some patients
these symptoms can be the first sign of
shock.
 MANAGEMENT FOR
SHOCK

◾Maintain open airway

◾Prevent further loss of blood (by
using direct pressure, elevations and
pressure points)
◾Elevate the lower extremities 20-30
cm only if there are no suspected
spinal, neck, chest or abdominal
injuries.
 MANAGEMENT FOR
SHOCK

◾Keep the patient warm, but

not overheat.
◾Provide care for specific
injuries.
◾Transport immediately to
nearest capable hospital.
VI. PATIENT ASSESSMENT
PATIENT ASSESSMENT PROCESS
FOR
NATURE OF ILLNESS (NOI)
VS
MECHANISM OF INJURY (MOI)
NATURE OF ILLNESS

If Perform Scene size Up If

unsafe and Ensure Safety safe

Unsafe scene requires Perform Primary

control. Wait until the Assessment
hazzard is controlled (MOI/NOI)

Assess Mental Status

(Level Of
Consciousness)
 Assess ABC
(Airway, Breathing &
Circulation)

Unstable Patient Stable Patient

Perform Rapid Obtain Chief

Assessment 90sec Complaint and
(injury focused) SAMPLE

Vital Signs Perform Head to toe

(BP, RR, PR, O2) Physical Assessment

Obtain present illness

Vital Signs
and SAMPLE history
(BP, RR, PR, O2)
 Perform Reassessment

Hand off patient information,

and patient’s personal
property to responding EMS
unit and help ready for
transport
MODE OF INJURY
If Perform Scene size Up If
unsafe and Ensure Safety safe

Unsafe scene requires Perform Primary

control. Wait until the Assessment
hazzard is controlled (MOI/NOI)

Assess Mental Status

(Level Of
Consciousness)
 Assess ABC
(Airway, Breathing &
Circulation)

Significant MOI No Significant MOI

Perform Rapid
Perform Head to toe
Trauma Assessment
assessment
(90sec)

Vital Signs Vital Signs

(BP, RR, PR, O2) (BP, RR, PR, O2)

Obtain
Obtain SAMPLE
SAMPLE history
history
 Perform Complete
secondary Assessment

Hand off patient information,

and patient’s personal
property to responding EMS
unit and help ready for
transport
 Normal Values
Blood Pressure Pulse Rate Respiratory O2 Saturation
Rate

Adult Sys: 70-110 60-100bpm 12-20 cpm 95-100

(19 yrs >) Dias: 60-80

Adoloscent Sys: 70-110 60-100bpm 12-20 cpm 95-100

12-19 Dias: 60-80

Child Sys: 80-120 80-120bpm 20-30 cpm 98-100

(1 yr- 12 yrs) Dias: <70

Infant ( Sys: 20-30 120-160bpm 30-60 cpm 98-100

0-12 mos) Dias: <60
 PATIENT ASSESSMENT PLAN

SCENE SIZE UP INITIAL PHYSICAL EXAM. PATIENT ON GOING ASSESSMENT PATIENT’S HAND
ASSESSMENT HISTORY OFF

What is the current General DCAP-BTLS/ DOTS SAMPLE Repeat Initial Assessment Patient age and sex
situation? impression
• MOI/NOI
•Observe for
hazards

Where is it going? Responsiveness Head Signs & Repeat physical Chief complaint
• What are the Symptoms assessment
possibilities?

How do I control it? Airway Neck Allergies Reassess treatment and Level of
•What are the resources intervention responsiveness
needed?

Breathing Chest & Back Medications Calm and reassure the Airway status
patient

Circulation Abdomen Past History Breathing status

Patient Status Pelvis Last Oral Physical exam
Update Intake findings

Extremities SAMPLE History

Vital Signs Event Treatment

 PATIENT PHYSICAL ASSESSMENT
PROCESS
➢ Ensure Scene Safety

➢ Introduce your Self

➢ Consider early Spinal Cord Stabilization

 ASSESS LEVEL OF
CONSCIOUSNESS

Primary Asssessment

◾A lert - Spontaneous eye opening, oriented, Obeys

command
V erbal – Responsive to Verbal Stimuli
P ain - Responsive to Pain Stimuli
U nresponsive – No Response
PRIMARY ASSESSMENT

◾A irway – Clear/patent airway (open airway)

B reathing – Labored/not (Respiratory rate)
C irculation- Pulse, Capillary refill, (blood Pressure)
D isability – Level of Consciousness/GCS
E xposure – expose for thorough assessment
 HEAD TO TOE PHYSICAL
ASSESSMENT

➢ Head (skull)

assess skull inspect and palpate scalp and face to look for sign of
fracture

“CREPITUS”
presence of lumalangit- ngit sound when there is a fractured in the
skull. Bones rubs together.
 HEAD TO TOE PHYSICAL
ASSESSMENT

➢ Head (ears, nose, & mouth)

assess Face and all orifice look for sign of head injury
“HALO SIGN”
 HEAD TO TOE PHYSICAL
ASSESSMENT

➢ Head (eyes)
assess Eyes for presence of PEARRLA
“ P upil E qually R ound R eactive L ight
A ccommodation ”
 HEAD TO TOE PHYSICAL
ASSESSMENT

➢ Head (battle sign & Raccoons eye)

assess for Raccoons Eye & Battle Sign as a

sign of head injury
Head to Toe Physical Assessment
➢ Neck (General appearance)

• Assess neck’s general appearance

• Assess neck for presence of bleeding and

deformities
 HEAD TO TOE PHYSICAL
ASSESSMENT

➢ Neck (trachea Deviation)

Assess for tracheal deviation sign of respiratory

distress
“Deviated Trachea”
 HEAD TO TOE PHYSICAL
ASSESSMENT
➢ Neck (Jugular Vein Distention)

Assess for Jugular Vein Distention sign of

cardiovascular distress
“Jugular Vein Distention”
Head to Toe Physical Assessment
Shoulders and Clavicle
➢ Clavicle/Collar bone ➢ Shoulders

Assess for presence of

crepitus (sign of fracture)
Head to Toe Physical Assessment
➢ Chest (Sternum and ribcage)

assess sternum and ribcage for crepitus or

paradoxical breathing (flail chest) as a sign of possible
fracture.
Head to Toe Physical Assessment
➢ Abdomen (4 Quadarants)

assess and palpate abdomen for presence of

open wound and signs of possible internal bleeding.
Head to Toe Physical Assessment
➢ Pelvis (Hips)

assess pelvis for possible fracture with the open

close book technique ( push, pull and rock the pelvis)

Fracture
Head to Toe Physical Assessment
➢ Priapism (spinal cord
injury)

assess for priapism (Painful

erection of the male genitals)
as a sign of Spinal Cord
Injury
Head to Toe Physical Assessment
➢Lower Extremities
Femur

- longest bone in the body

-1 -1.5L average blood loss
(fractured)
Head to Toe Physical Assessment
➢ Lower Extremities ➢ Lower Extremities
Patella (Knee Caps) Tibia and Fibula

Knee
Caps
(Patella)
Head to Toe Physical Assessment
➢ Lower Extremities
Foot (PMS)

Pulse
Motor
Sensory
Head to Toe Physical Assessment
➢Upper Extremities
Head to Toe Physical Assessment
➢ Upper Extremities
Hands (PMS)

Pulse
Motor
Sensory
Head to Toe Physical Assessment
➢ Posterior Back

• General
Appearance
• Alignment of the
Spine
• Discharge
THANK YOU VERY MUCH…