Focused History and Physical Examination of the

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1 Henry: EMT Prehospital Care, Revised 3 rd Edition Lecture Notes Chapter 10: Focused History and Physical Examination of Trauma Patients Chapter 10 Focused History and Physical Examination of the Trauma Patient Slide 1 Case History You respond to a 35-year 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. Slide 2 Reconsider Mechanism of Injury Ejection from vehicle Death in same passenger compartment Falls > 20 feet Rollover of vehicle High-speed vehicle collision Slide 3 1

death/injury. Patients who use safety devices may still have serious injuries.

2 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 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 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 Slide 6 2

3 Falls >10 feet Infant and Child Considerations Bicycle collision Vehicle in medium-speed collision Slide 7 Elderly Subject to injury with a lesser mechanism Carefully evaluate for bone injury, even with minor mechanisms. May have a different response to an injury than younger adults Do not compensate as well for serious injury Tend to decompensate (become worse) more quickly May be taking medications that affect vital signs Slide 8 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. Slide 9 3

unctures/penetrationsenetrations Burns Tenderness Lacerations Swelling Slide 11 Head

4 Alert Assess Mental Status AVPU Verbal stimuli Painful stimuli Unresponsive Slide 10 Inspect and Palpate DCAP/BTLS Deformities Contusions Abrasions Punctures/ unctures/penetrationsenetrations Burns Tenderness Lacerations Swelling Slide 11 Head Crepitation Careful palpation to avoid injury to brain Assume cervical spine injury with blunt head trauma Slide 12 4

5 Neck Crepitation Subcutaneous emphysema Jugular venous distention Tracheal shift Apply CSID Slide 13 Chest Breath sounds Paradoxical breathing Slide 14 Abdomen Firm vs. soft Distended Slide 15 5

6 Pelvis Crepitation Tenderness Motion Slide 16 Lower Extremities Distal pulse Slide 17 Lower Extremities Sensation Motor function Slide 18 6

7 Upper Extremities Distal pulse Slide 19 Upper Extremities Sensation Motor function Slide 20 Back Look for exit wounds with penetrating trauma Slide 21 7

Assess Baseline Vital Signs Pulse Respirations Blood pressure Temperature Slide 22 Assess SAMPLE History Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading

8 Assess Baseline Vital Signs Pulse Respirations Blood pressure Temperature Slide 22 Assess SAMPLE History Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to the incident 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. Slide 24 8

9 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. Slide 25 9

Assessment of the Trauma Patient

CHAPTER 10 Assessment of the Trauma Patient Overall Assessment Scheme Scene Size-Up Initial Assessment Trauma Physical Exam Vital Signs & SAMPLE History Medical SAMPLE History Physical Exam & Vital Signs