Chapter 13- Assessment of the Trauma Patient

What are Symptoms—subjective?

- Patient feels and tells you about - Chest pain, dizziness, nausea

What does Past Medical History- SAMPLE mean?

- Signs and symptoms - Allergies - Medications - Pertinent past history - Last oral intake - Events leading to injury or illness

What are Signs—objective?

- Things you see, hear, feel, smell during exam - Vital signs - Sweaty skin, staggering, vomiting

When considering the mechanism of injury (MOI), what is not considered a significant MOI in an adult?

A 10-foot fall

What is the letter "A" in the Physical Examination: DCAP-BTLS?

Abrasions

What is the "A" in the Past Medical History- SAMPLE?

Allergies

An easy way to remember what you are trying to find when you assess a suspected injured area of the patient's body is by the memory aid:

An easy way to remember what you are trying to find is the memory aid DCAP-BTLS.

When assessing and interviewing a patient, we ask about and look for signs and symptoms. What is a sign?

An objective finding you can see, hear or feel when examining the patient

You are examining a patient is mental status is altered, and he has a bruise behind the ear. This is referred to as what?

Battle's sign

What is the letter "B" in the Physical Examination: DCAP-BTLS?

Burns

You are treating a pitcher who was hit in the face with a ball that was hit by the batter. You remember from your EMT training that a blow above the what may damage the cervical spine?

Clavicles

A surgical opening in the wall of the abdomen with a bag in place to collect excretions from the digestive system

Colostomy

What is the letter "C" in the Physical Examination: DCAP-BTLS?

Contusions

The grating sensation or sound or feeling of broken bones rubbing together

Crepitation

A memory aid to remember deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling- symptoms of injury found by inspection or palpation during patient assessment

DCAP-BLTS

What is the letter "D" in the Physical Examination: DCAP-BTLS?

Deformities

An assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury

Detailed Physical Exam

A condition of being stretched, inflated or larger than normal

Distention

What is the "E" in the Past Medical History- SAMPLE?

Events leading to injury or illness

Physical Examination: Palpation

Feel for - Abnormalities in shape - Temperature - Texture - Sensation

The step of patient assessment that follows the primary assessment

Focused history and physical exam

When is it appropriate to apply a cervical collar?

If the mechanism of injury exerts great force on the upper body

You will obviously not be able to obtain a SAMPLE history from the patient if he is unresponsive. However, you may obtain one from:

If there is a friend, family member, or coworker nearby, that person may be able to give you information about the patient's medical history.

See Colostomy

Ileostomy

When evaluating a patient during the focused physical exam, the EMT needs to do what to each body part?

Inspect and palpate

Bulging of the neck veins

Jugular Vein Distention

What is the letter "L" in the Physical Examination: DCAP-BTLS?

Lacerations

What is the "L" in the Past Medical History- SAMPLE?

Last oral intake

Physical Examination: Auscultation

Listen for - Decreased or absent breath sounds

Physical Examination: Inspection

Look for - Abnormalities in symmetry - Color - Shape - Movement

What is the "M" in the Past Medical History- SAMPLE?

Medications

What is the difference between OPQRST and SAMPLE?

OPQRST is used for the present history and SAMPLE is used for the past history

What does "O" stand for in OPQRST?

Onset

Movement of part of the chest in the opposite direction to the rest of the chest during respiration

Paradoxical Motion

"Flail chest" is a common term for what type of trauma?

Paradoxical motion, or movement of part of the chest in the opposite direction from the rest of the chest, is a sign of a serious injury.

What is the "P" in the Past Medical History- SAMPLE?

Pertinent past history

Persistent erecting of the penis that can result from spinal cord injury and some medical problems

Priapism

What does "P" stand for in OPQRST?

Provokes

What is the letter "P" in the Physical Examination: DCAP-BTLS?

Punctures and penetrations

What does "Q" stand for in OPQRST?

Quality

What does "R" stand for in OPQRST?

Radiation of pain

Quick assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior body to detect signs and symptoms of injury

Rapid Trauma Assessment

What does "S" stand for in OPQRST?

Severity

What is the "S" in the Past Medical History- SAMPLE?

Signs and symptoms

A permanent surgical opening in the neck through which the patient breaths

Stoma

What is the letter "S" in the Physical Examination: DCAP-BTLS?

Swelling

What is the letter "T" in the Physical Examination: DCAP-BTLS?

Tenderness

In the secondary assessment, you will be checking the patient from head to foot for pain and tenderness. The difference between pain and tenderness is what?

Tenderness may not hurt unless the area is palpated, whereas pain is evident without palpation

What does "T" stand for in OPQRST?

Time

A surgical incision in the neck held open by a metal or plastic tube

Tracheostomy

A patient suffering from one or more physical injuries

Trauma Patient

Experienced EMTs often refer to a soft cervical collar as:

a "neck warmer"

If the mechanism of injury exerts great force on the upper body, or if there is any soft tissue damage to the head, face, or neck, you should:

apply full spinal immobilization.

Once you complete the focused physical exam to assess injuries, you will:

assess baseline vitals.

Your patient has been outdoors in the sun most of the day. He has a reddened and blistered areas on his shoulders and neck called what?

burns

Clear fluid that is draining from the ears and nose is called what fluid?

cerebrospinal

When a patient tells you that he called because he cut his wrist with a razor, this is called the what?

chief complaint

When assessing the abdomen of an adult male critical trauma patient, the EMT should inspect/palpate for what in addition to wounds and deformities?

colostomy and/or ileostomy

When assessing the head of an adult male critical trauma patient, the EMT should inspect/palpate for what in addition to wounds and deformities?

crepitation

Swelling in trauma-related injuries is caused by:

damaged capillaries- Swelling is a very common result of injured capillaries bleeding under the skin.

Your patient was thrown from his motorcycle when he stopped suddenly. His thighs are very painful and a strange shape. When a body part is injured and it no longer has its normal shape, this is referred to as what?

deformity

If you are treating a severely injured trauma patient, it may be appropriate to skip the what?

detailed exam

You are treating a patient who was in the front seat of an automobile involved in a collision. You observe a spider-web crack in the windshield and the facial lacerations on the patient. Most likely the patient what?

did not wear a seat belt or three-point harness

Always assume that the unconscious trauma patient:

has a spine injury.

A focused physical exam differs from a rapid trauma assessment in that the rapid trauma assessment:

is a complete, head-to-toe rapid exam.

When assessing the neck for an adult female critical trauma patient, the EMT should inspect/palpate for what in addition to wounds and deformities?

jugular vein distention

A patient with diminished breath sounds on one side of the chest may have:

lung collapse.

If a cervical collar is the wrong size, it may do what?

make breathing more difficult or obstruct the airway

The final step of the detailed physical exam is to what?

make sure you have notified the ED

The detailed physical exam is not designed for what?

medical patient with very few signs and symptoms

Bulging neck veins while the patient is supine indicate:

normal circulation.

The EMT should lift and look under the airbag after the patient has been removed from the vehicle in order to:

note any visible damage to the steering wheel

The physical exam incudes the basics of inspection, auscultation and what?

palpation

When assessing the chest for an adult female critical trauma patient, the EMT should inspect/palpate for what in addition to crepitation and deformities.

paradoxical motion

When performing the detailed physical exam, you note blood in the anterior chamber of the eye. This tells you that the what?

patient's eye is bleeding inside

In addition to looking for deformities, you should look for what when examining the mouth?

possible airway obstruction, loose or broken teeth, tongue lacerations or swelling

When assessing the pelvis of an adult male critical trauma patient, the EMT should inspect palpate for what in addition to wounds, deformities, and tenderness?

priapism

If you are treating a patient who could be either medical or trauma, it is always best to assess for what?

primary survey problems first

When assessing a patient with a significant mechanism of injury, instead of a focused physical exam, you perform a(n):

rapid trauma assessment.

The neck veins are usually not visible when the patient is what?

sitting up

"Battle sign" is an indication of a:

skull injury- A bruise behind the ear of a trauma patient is called Battle sign, and is an important sign of a skull injury.

A common result of injured capillaries bleeding under the skin is called what?

swelling

An important principle to remember when examining a patient is to what?

tell the patient what you are going to do, assume spinal injury, and try to maintain eye contact

A difference between the detailed physical exam and the rapid trauma exam includes what?

the detailed exam is usually done en route to the ED

The history of the present illness or injury for a trauma patient includes what?

the direction & strength of the force, actions taken to prevent or minimize the injury, equipment used to protect the patient

You should obtain a trauma patient's baseline vitals after:

the physical exam.

The need for cervical immobilization should be based on what?

the trauma patient's level of responsiveness, the location of injuries to the patient & the mechanism of injury

A good time to assess the posterior of the patient is:

when rolling the patient on his side to apply a backboard.

A focused history and physical exam for a patient with a significant mechanism of injury differs from that of the patient with no significant mechanism of injury in that:

with a significant mechanism of injury, spinal stabilization procedures are always performed.

No Significant Mechanism of Injury (MOI)?

• Chief Complaint • Focused History & Found History • Vitals • History • Detailed Exam

What does Physical Examination: DCAP-BTLS mean?

• Deformities • Contusions • Abrasions • Punctures and penetrations • Burns • Tenderness • Lacerations • Swelling

What are the Components of the Rapid Trauma Assessment?

• Head • Neck • Chest • Abdomen • Pelvis • Back • Extremities • Baseline vital signs

Significant Mechanism of Injury (MOI)?

• History of Present Illness/Injury • C-Spine • ALS- helicopter • Rapid Trauma Assessment • Vitals • Medial History • Detailed Exam- if there is time

What are the Elements of History of Present Illness?

• Nature of force involved • Direction and strength of force • Protective equipment used by patient • Actions taken to prevent or minimize injury • Areas of pain and injuries resulting from incident