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Chapter 10 Focused History and Physical Examination of the Trauma Patient Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 1 Case History You respond to a 35-year-old male who has been in a front-end, high-speed collision. He was the driver of the car and there is a deformed steering wheel. You take the appropriate BSI precautions and ensure that the scene is safe, perform your initial assessment, and begin your physical examination and history. Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2 Reconsider Mechanism of Injury Ejection from vehicle Death in same passenger compartment Falls > 20 feet Rollover of vehicle High-speed vehicle collision Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 3 Reconsider Mechanism of Injury Vehicle-pedestrian collision Motorcycle crash Unresponsive or altered mental status Penetrations of the head, chest, or abdomen Type of instrument in blunt trauma Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 4 Hidden Injuries Seat belts and airbags can prevent death/injury. Patients who use safety devices may still have serious injuries. Shearing forces Shoulder belt Lap belt Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 5 Hidden Injuries Airbags may not be effective without use of a seat belt. Lift airbag and look at the steering wheel for deformity Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 6 Infant and Child Considerations Falls >10 feet Bicycle collision Vehicle in medium-speed collision Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 7 Elderly Subject to injury with a lesser mechanism May have a different response to an injury than younger adults Carefully evaluate for bone injury, even with minor mechanisms. Do not compensate as well for serious injury Tend to decompensate (become worse) more quickly May be taking medications that affect vital signs Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 8 Rapid Trauma Assessment Performed on patients with significant mechanism of injury to determine life-threatening injuries In the responsive patient, symptoms should be sought before and during the trauma assessment. Maintain spinal stabilization. Consider ALS request. Reconsider transport decision. Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 9 Assess Mental Status AVPU Alert Verbal stimuli Painful stimuli Unresponsive Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10 Inspect and Palpate DCAP/BTLS Deformities Contusions Abrasions Punctures/penetrations Burns Tenderness Lacerations Swelling Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11 Rapid Trauma Assessment Head DCAP/BTLS Crepitation Careful palpation to avoid injury to brain Assume cervical spine injury with blunt head trauma Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12 Rapid Trauma Assessment Neck DCAP/BTLS Crepitation Subcutaneous emphysema Jugular venous distention Tracheal shift Apply CSID Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13 Rapid Trauma Assessment Chest DCAP/BTLS Breath sounds Paradoxical breathing Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14 Rapid Trauma Assessment Abdomen DCAP/BTLS Firm vs. soft Distended Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15 Rapid Trauma Assessment Pelvis DCAP/BTLS Crepitation Tenderness Motion Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16 Rapid Trauma Assessment Lower Extremities DCAP/BTLS Distal pulse Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17 Rapid Trauma Assessment Lower Extremities Sensation Motor function Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18 Rapid Trauma Assessment Upper Extremities DCAP/BTLS Distal pulse Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19 Rapid Trauma Assessment Upper Extremities Sensation Motor function Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20 Rapid Trauma Assessment Back DCAP/BTLS Look for exit wounds with penetrating trauma Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21 Assess Baseline Vital Signs Pulse Respirations Blood pressure Temperature Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22 Assess SAMPLE History Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to the incident Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23 Patients with No Significant Mechanism of Injury Perform focused history. Perform focused assessment on the specific injury site. Assess baseline vital signs. Assess SAMPLE history. Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24 Summary Reconsider the mechanism of injury. Perform rapid trauma assessment. Check for signs of injury (DCAP/BTLS) in all body regions. Maintain spinal stabilization. After assessing the head and neck, apply a cervical collar. Log roll the patient to assess the posterior body. Assess baseline vital signs. Collect a SAMPLE history. For patients with no significant mechanism of injury, physical examination should be focused on the injured body part. Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
