Trauma Assessment And Management Flashcards
General impression:
Age Sex Weight General appearance Position Purposeful movement Obvious injuries Skin colour LIFE THREATENING BLEEDING
LOC
AVPU
Chief complaint / sx
ITLS Primary Survey:
Scene size-up
Initial Assessment
MOI: A.) Generalized / Unknown - Rapid Trauma Survey
B.) Localized MOI
Load-and-go situation?
ITLS secondary survey / ITLS ongoing exam
AVPU
Alert (alert, orientated, obey commands)
V - Respond to Verbal stimuli (awake but confused, or unconscious but responds in some way to verbal stimuli)
P - Responds to Pain (unconscious but responds in some way to touch or painful stimuli)
Unresponsive (no gag or cough reflex)
Airway (with c-spine control)
Snoring
Gurgling
Stridor
Silence
Breathing
Present?
Rate
Depth
Effort
Abnormal respiratory rates
Adult 24
Small child 35
Infant 60
Circulation
Radial / carotid present? Rate Rhythm Quality Skin colour Temperature Moisture Cap refill Has bleeding been controlled?
Rapid Trauma System
Head and neck Chest Abdomen Pelvis Lower / upper extremities Posterior Vital signs Pupils GCS
Head and neck
Wounds
Neck vein distention (tension pneumothorax / cardiac tamponade)
Tracheal deviation
Chest
Asymmetry (paradoxical motion) Contusions Penetrations Tenderness Instability Crepitation Breath sounds? Present? Equal? If unequal: percussion) Heart tones
Decompress tension pneumothorax if
+ altered mental status
+ cyanotic
+ absent radial pulses
Abdomen
Contusions Penetrations / evisceration Tenderness Rigidity Distention
Pelvis
Tenderness
Instability
Crepitation
Lower / upper extremities
Obvious swelling
Deformity
Motor and sensory
Posterior
Obvious wounds
Tenderness
Deformity
Vital signs (if radial pulse present)
Measured pulse
Breathing
BP
HGT (if altered mental status)
SAMPLE hx
Symptoms Allergies Medications Past med hx Last oral intake Events preceding the incident
If altered mental status: Brief neurological exam
Pupils: Size? Reactive? Equal?
GCS: Eyes, voice, motor
Focused exam
Focused exam of identified injury. Also evaluate the spine if distracting injury and any possibility of spinal injury.
If radial pulse present: Vital signs
If altered mental status: Brief neurological exam
Transport immediately:
Initial assessment: altered mental status / abnormal breathing / abnormal circulation
Signs during rapid trauma survey: penetrating wounds to torso / abnormal chest exam / tender, distended abd / pelvic instability / bilat femur #
Significant MOI and/or poor gen health
Priority patient
Dangerous MOI
High-risk group
Hx revealing: LOC / Difficulty breathing / severe pain of head, neck or torso
Initial assessment reveals: Altered mental status / abnormal breathing / abnormal circulation
ITLS Ongoing Exam done?
Every 5 min for critical patients Every 15min for stable pt Each time pt is moved Each time an intervention is performed Any time the pt's condition worsens
Procedure of ITLS Ongoing Exam
- Complete SAMPLE hx.
- Reassess mental status.
- Vital signs (pulse, RR, BP, Pulse Oximeter, cardiac monitor, CO2 monitor, T)
- Reassess ABCs:
- Airway (recheck patency / inhalation injury in burn victim)
- Breathing
- Circulation (skin colour, condition, temperature, cap refill) - BLEEDING STILL CONTROLLED?
- Neck (obvious wounds, tenderness, swelling / JVD, tracheal deviation)
- Chest (Asymmetry, contusions, penetrations, tenderness, instability, creps)
- Breath sounds (present, equal, heart sounds)
- Reassess abdomen (contusions, penetrations or evisceration, tenderness, rigidity, distention)
- Check each injury.
- Check interventions.
- Recheck monitors.
ITLS Secondary Survey Procedure:
- Repeat initial assessment.
- Consider monitors.
- Record vital signs again.
- Brief neurological exam.
- Detailed head-to-toe exam.
ITLS Secondary Survey Procedure:
Initial assessment:
General impression ( better, worse, unchanged) LOC Airway Breathing Radial pulse - carotid if no radial BLEEDING STILL CONTROLLED
ITLS Secondary Survey Procedure:
Detailed Exam:
- Pt hx (SAMPLE)
- Vital signs
- GCS
- Head (DCAP-BLS, TIC) - pupils, Battles sign, Raccoon eyes, drainage from nose/ear
- Neck (DCAP-BLS, TIC) - JVD, tracheal deviation
- Chest (DCAP-BLS, TIC) - asymmetry
- Breath sounds
- Abdomen
- Pelvis (DCAP-BLS, TIC)
- Lower / upper extremities (DCAP-BLS, TIC) distal PMS
- Posterior (DCAP-BLS, TIC)
Glascow Coma Scale:
Eye opening - 4: spontaneous - 3: to voice - 2: to pain - 1: none Verbal: 5 - oriented 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - silent Motor: 6 - obeys commands 5 - localizes pain 4 - withdraws 3 - abnormal flexion 2 - abnormal extension 1 - no movement
DCAP-BLS
Deformity Contusions Abrasions Penetrations Burns Lacerations Swelling
TIC
Tenderness
Instability
Crepitus
