Patient Assessment/Management – Trauma A) Scene Size Up 1) BSI 2) Scene Safety 3) MOI # of patients additional resources? ALS? 4) Cspine
B) Initial Assessment
1) General impression – Age, Sex, Position 2) AVPU – A+O x 4 (person, place, time, event) 3) Chief complaint / life threats 4) Airway: assess and maintain jaw thrust; suction; OPA/NPA 5) Oxygen 6) Ventilation – adequate? 7) Manage life threats Inspect Palpate Auscultate Seal Stabilize “Gas” (O2) 8) Bleeding – assess and control 9) Pulse: conscious→ radial; unconscious→ carotid Strong or thready Regular or irregular 10) Skin – CTC: Color, Temperature, Condition (dry or moist) Treat for shock if indicated! 11) Transport Decision – priority?
C) Focused History and Physical Exam
1) Reconsider Mechanism of Injury If significant→ rapid trauma assessment If not significant→ focused trauma assessment based on chief complaint 2) Vital signs Pulse: rate & quality Respirations: rate & quality Blood pressure 3) SAMPLE History Signs and symptoms Allergies
Medications Past Pertinent History Last Oral Intake Events leading up to incident
D) Physical Exam 1) Assess the head: I & P scalp and ears. Check for Battle's sign behind ears, fluid from ears. I & P face, including oral and nasal areas. Inspect around eyes and eyelids. Check for redness and contact lenses. Check pupils for equality and reactivity. 2) Assess the neck: I & P neck. Assess for JVD. Assess for tracheal deviation. Apply cervical collar. 3) Assess the chest (paradoxical motion): I & P Auscultate midclavicular and midaxillary. 4) Assess the abdomen and pelvis (distension, rigidity). I & gently palpate abdomen; gently compress pelvis and iliac crests. Verbalize assessment of genitalia/perineum as needed (priapism, incontinence). 5) Assess the extremities: I & P all 4 extremities, checking PMS (pulse, motor, sensory). 6) Assess the posterior (thorax and lumbar) while logrolling onto backboard. Secure to board. Manage secondary injuries and wounds appropriately!
E) Ongoing Assessment (verbalize) 1) Repeat initial assessment. 2) Repeat vital signs, including eyes and skin. 3) Repeat focused assessment. Reassess any interventions.
NY EMT-B Practical Skills Station 1