Assessment of the Trauma Patient

CORE CONCEPTS

• Distinguishing between patients who have and don’t have significant

MOI

• Performing a focused history andphysical exam for a trauma patient

• Sizing and applying a cervical collar

• Ongoing assessment

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OVERALL ASSESSMENT SCHEME

Scene Size-Up

Initial Assessment

Trauma Medical

Physical Exam SAMPLE History

Vital Signs & Physical Exam

SAMPLE History & Vital Signs

HOSP
Detailed Ongoing
Physical Exam Assessment

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SIGNIFICANT MECHANISM OF INJURY

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Significant Mechanism of Injury

• Ejection from vehicle

• Death in same passenger compartment
• Fall of greater than 20 feet

(Continued)
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Significant Mechanism of Injury

 Rollover of vehicle
 High-speed vehicle collision
 Vehicle-pedestrian collision

(Continued)
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Significant Mechanism of Injury

 Motorcycle crash
 Unresponsive, or altered mental status
 Penetrating injury of head, chest, or abdomen

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Hidden Injuries

• Seat belts
• Airbags
• Lift and look

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Significant Mechanism of Injury

• Falls greater than 10 feet

Differences for Infants • Bicycle collision

and Children • Vehicle in medium-speed

collision

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If Significant Mechanism of Injury:

 Reconsider mechanism of injury.

 Continue spine stabilization.
 Consider requesting ALS.
 Reconsider transport decision.

(Continued)
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If Significant Mechanism of Injury:

 Assess mental status.

 Do rapid physical exam.
 Assess baseline vital signs.
 Obtain SAMPLE history.

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Mechanism of Injury Interior of Vehicle

Deformities to a vehicle’s interior may show where person

struck the surface and reveal a mechanism of injury.

(Continued)
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Bent Steering Wheel

Broken Mirror

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Distorted Pedals

Spiderwebbed
Windshield

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Deformed Dashboard

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 PRECEPTOR PEARL
The assessment and management of a trauma
patient need to focus on time and patient
priority. In some cases, the patient does not
have the time available in his/her life for the
EMT-B to take a lengthy approach. On patients
with significant MOI, try to limit the scene
time to a “platinum ten minutes!”

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Rapid Trauma Assessment

 Head
 Neck
 Chest
 Abdomen
 Pelvis
 Extremities
 Posterior

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Inspect and Palpate for DCAP-BTLS

D = Deformities B = Burns
C = Contusions T = Tenderness
A = Abrasions L = Lacerations
P = Punctures/ S = Swelling
penetrations

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Deformities

Contusions

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Abrasions

Punctures/penetrations

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Burns

Tenderness

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Lacerations

Swelling

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Mechanism of Injury

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Head: DCAP-BTLS + Crepitation

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Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation

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Chest: DCAP-BTLS + Crepitation and Breath Sounds (Presence
and Equality)

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Listen to both sides of the chest. Is air entry present? Absent?
Equal on both sides? Compare left side to right side.

Mid-clavicular Mid-axillary

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Abdomen: DCAP-BTLS + Firmness and Distention

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Pelvis: DCAP-BTLS (Compress Gently)

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Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor
Function

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Posterior: DCAP-BTLS

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Vital Signs

 Respirations
 Pulse
 Skin color, temperature, condition
 Pupils
 Blood pressure

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SAMPLE History

S = Signs and symptoms

A = Allergies
M = Medications
P = Pertinent past history
L = Last oral intake
E = Events leading to problem

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Interventions and Transport

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Cervical Collar Sizing and Application

STIFNECK TM Rigid Philadelphia Cervical

Extrication Collar Collar TM

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Sizing a Cervical Collar

Measure patient’s
1 neck. 2 Measure collar.

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STIFNECK TM Collar — Seated Patient

Slide collar up
toward patient’s chin.

Stabilize head and

neck manually.

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STIFNECK TM Collar — Seated Patient

Wrap collar around

back of neck.

Position front of
collar under chin.

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STIFNECK TM Collar — Seated Patient

Rearrange fingers to
maintain support.

Secure collar.

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STIFNECK TM Collar — Supine Patient

Stabilize head
and neck.

Kneel at patient’s head.

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STIFNECK TM Collar — Supine Patient

Slide back of collar under

patient’s neck.

Maintain stabilization.

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STIFNECK TM Collar — Supine Patient

Maintain manual
stabilization.

Secure collar.

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NO SIGNIFICANT MECHANISM OF INJURY

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No Significant Mechanism of Injury

 Reconsider mechanism of injury.

 Perform focused physical exam based on:
• Chief complaint
• Mechanism of injury

(Continued)
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No Significant Mechanism of Injury

 Assess baseline vital signs.

 Obtain SAMPLE history.

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Who Needs a Detailed Physical Exam?

• Patient’s condition determines whether a detailed physical exam

is needed.

(Continued)
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Who Needs a Detailed Physical Exam?

• A patient with minor injury and no significant mechanism of injury

probably does not.

(Continued)
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Who Needs a Detailed Physical Exam?

• A patient who has a significant mechanism of injury.

• If unsure, do a detailed physical exam.

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STEPS IN THE DETAILED PHYSICAL EXAM

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Detailed Physical Exam

• Assess areas examined in rapid trauma assessment plus:

• Face
• Ears
• Eyes
• Nose
• Mouth

(Continued)
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Detailed Physical Exam

 Examine more slowly than trauma assessment.

 Reassess vital signs.

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D = Deformities B = Burns
C = Contusions T = Tenderness
A = Abrasions L = Lacerations
P = Punctures/ penetrations S = Swelling

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Head DCAP-BTLS

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Ears DCAP-BTLS + Drainage

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Eyes

DCAP-BTLS plus  Discoloration

 Unequal pupils
 Foreign bodies
 Blood in anterior chamber

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Nose and Mouth

DCAP-BTLS plus
 Teeth
 Obstructions
 Swollen or lacerated tongue

(Continued)
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Nose and Mouth

DCAP-BTLS plus  Odors

 Discoloration
 Drainage
 Bleeding

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Neck: DCAP-BTLS + Jugular Vein Distention and Crepitation

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Chest: DCAP-BTLS + Crepitation and Breath Sounds
(Presence and Equality)

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Listen to both sides of the chest. Is air entry present? Absent?
Equal on both sides? Compare left side to right side.

Mid-clavicular Mid-axillary

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Abdomen: DCAP-BTLS + Firmness and Distention
Pelvis: DCAP-BTLS (Compress Gently)

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Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor
Function

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Posterior: DCAP-BTLS

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Perform the steps of the rapid trauma assessment —
BUT MORE SLOWLY.

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Reassess Vital Signs

• Respirations
• Pulse
• Skin color, temperature, condition

• Pupils

• Blood pressure

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REVIEW QUESTIONS

1. Give examples of patients with and without significant mechanism

of injury.
2. What do the letters DCAP-BTLS stand for?
3. Which trauma patients should have a detailed physical examination?

Assessment of the Trauma Patient Rev. 00