Principles of Patient Assessment in ems focused History & Physical Exam Trauma Patient

Principles of Patient Assessment in EMS

Focused History & Physical Exam Trauma Patient

Introduction

• In U.S. trauma is the leading cause of death (ages 1 to 44)

• Many MOI have predictable patterns

• Evaluation of MOI is essential. Top MOIs:

• Motor vehicle crashes
• Falls
• Poisoning
• Burns
• Drownings

Reconsider MOI

• Early evaluation of the MOI should guide the EMS provider to suspect certain injury patterns

• “Index of suspicion” – injury patterns help the EMS provider anticipate the potential for shock or other problems

Reconsider MOI (continued)

• 2 major factors for injuries are:

• The amount of energy exchanged with the body
• The anatomical structures involved

• Inappropriate identification of MOI may result in incorrect treatment and high mortality rates

Reconsider MOI (continued)

• “Index of suspicion” for a spinal injury:

• Cracked windshield
• Bent steering wheel
• Dented dashboard
• Side door intrusion into motor vehicle

Evaluating the MOI

• The presence of a significant MOI is a key decision point in the assessment algorithm

• This key decision point can make a significant impact on the life or death of a critical trauma patient

Evaluating the MOI (continued)

• Key decisions regarding the MOI should help the EMS provider:

• Minimize scene time
• Quickly perform a rapid trauma assessment
• Perform life-saving procedures
• Transport to the appropriate facility

Evaluating the MOI (continued)

• Consider the following questions:

• How long ago did this happen?
• How fast or what velocity was involved?
• How hard was the impact or surface impacted upon?
• How high did the patient fall from?
• How far did the patient travel before stopping?

Evaluating the MOI (continued)

• Distracting injuries can keep more serious injuries from being discovered quickly

• Scene management can also cause delays:

• Multiple patients
• Relatives
• Bystanders
• Other rescuers

• Minor trauma can appear serious at first

Significant Trauma

• Detailed observation is key to managing the patient with significant trauma

• Don’t be distracted by less serious injuries

Golden Hour

• Time is a critical factor for the patient with a significant MOI

• Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply

Platinum Ten Minutes

• The maximum time EMS providers stay on the scene for a critical trauma patient

Rapid Trauma Assessment (RTA)

• Quick and systematic exam of these body sections:

• Head
• Chest
• Abdomen
• Pelvis
• Extremities
• Back/buttocks

Rapid Trauma Assessment (RTA)

• After the RTA obtain baseline VS and a SAMPLE history

• When the patient is unresponsive obtain the information from bystanders, relatives, or other first responders

• Do not extend the scene time to obtain info

Rapid Trauma Assessment (RTA)

• Perform a detailed physical exam enroute

• Transportation destination depends on the needs of the patient and capabilities of a trauma center as well as your local protocols

Rapid Trauma Assessment (RTA)

• All your efforts on the scene and enroute may be for naught when a critical trauma patient is transported to an inappropriate facility

Ongoing Assessment (OA)

• Repeat IA, reassess VS, and interventions

• Repeat OA every 5 minutes on critical trauma patients

• In cases of short manpower or short transport time – performing the OA takes priority over the DPE

Minor Trauma

• Examples:

• Isolated extremity injury
• Minor burns
• Small lacerations or abrasions

• An exception would be a minor injury with an altered mental status or intoxication

Focused Physical Exam: Assess

• D – deformity

• C – contusions

• A – abrasions

• P – punctures/penetrations

• B – burns

• T – tenderness

• L – lacerations

• S – swelling

Focused Physical Exam: Assess

• Range of motion (ROM)

• Pulse, motor, and sensation (PMS)

• Skin color, temp. and condition (CTC)

Additional Steps in Minor Trauma Patient Assessment

• Develop a treatment plan

• Perform interventions(s)

• Obtain baseline VS

• Obtain SAMPLE history

• Perform OA every 15 minutes

Conclusion

• EMS providers can make a significant impact on the life or death of a critical trauma patient by:

• Minimizing scene time
• Performing a RTA
• Performing life-saving interventions
• Transporting to an appropriate facility

Conclusion

• The decision point as to the presence of a significant MOI will predicate the extent of exam, speed, priority of transport, and destination