Brady Chapter 10: Assessment Of The Trauma Patient

Front 1

Core Concept One: The difference between a significant and non-significant mechanism of injury.

Back 1

Discuss what changes in assessment and response between the two.

Front 2

Core Concept Two: The difference between patients who need a rapid trauma assessment and patients who need a focused physical exam.

Back 2

Discuss what info influences the decision between each.

Front 3

Core Concept Three: How to perform a focused physical exam for a trauma patient.

Back 3

Discuss when this is called for, what is looked for at each step, and what interventions must be taken based on findings.

Front 4

Core Concept Four: How to perform a rapid trauma assessment.

Back 4

Discuss when this is called for, what is looked for at each step, and what interventions must be taken based on findings.

Front 5

Core Concept Five: How to perform a detailed physical examination for a trauma patient.

Back 5

Discuss when this is called for, what is looked for at each step, and what interventions must be taken based on findings.

Front 6

Vocab: Colostomy, Crepitation, DCAP-BTLS, Detailed Physical Exam, Distention, Focused History and Physical Exam, Ileostomy, Jugular Vein Distention (JVD), Paradoxical Motion, Priapism, Rapid Trauma Assessment, Stoma, Tracheostomy.

Back 6

In glossary.

Front 7

Skills One: Demonstrate the rapid trauma assessment that should be used to treat a patient based on mechanism of injury.

Back 7

Show and tell.

Front 8

Skills Two: Demonstrate the skills involved in performing the detailed physical exam.

Back 8

Show and tell.

Front 9

Knowledge and Attitude One: Discuss the reasons for reconsideration concerning the mechanism of injury.

Back 9

Discuss.

Front 10

Knowledge and Attitude Two: State the reasons for performing a rapid trauma assessment.

Back 10

Discuss.

Front 11

Knowledge and Attitude Three: Recite examples and explain why patients should receive a rapid trauma assessment.

Back 11

Discuss.

Front 12

Knowledge and Attitude Four: Describe the areas included in the rapid trauma assessment and discuss what should be evaluated.

Back 12

Discuss.

Front 13

Knowledge and Attitude Five: Differentiate when the rapid assessment may be altered in order to provide patient care.

Back 13

Discuss.

Front 14

Knowledge and Attitude Six: Discuss the reason for performing a focused history and physical exam.

Back 14

Discuss.

Front 15

Knowledge and Attitude Seven: Recognize and respect the feelings that patients might experience during assessment.

Back 15

Discuss.

Front 16

Knowledge and Attitude Eight: Discuss the components of the detailed physical exam.

Back 16

Discuss.

Front 17

Knowledge and Attitude Nine: State the areas of the body that are evaluated during the detailed physical exam.

Back 17

Discuss.

Front 18

Knowledge and Attitude Ten: Explain what additional care should be provided while performing the detailed physical exam.

Back 18

Discuss.

Front 19

Knowledge and Attitude Eleven: Distinguish between the detailed physical exam that is performed on a trauma patient and that of the medical patient.

Back 19

Discuss.

Front 20

Knowledge and Attitude Twelve: Explain the rationale for the feelings that these patients might be experiencing.

Back 20

Discuss.

Front 21

Focused History and Physical Exam -- Trauma Patient (No Significant MOI)

Back 21

After scene size-up and initial assessment: 1. Reconsider the MOI; 2. Perform Focused Physical Exam based on chief complaint and MOI; 3. Assess baseline vital signs; 4. Obtain a SAMPLE history.

Front 22

Focused History and Physical Exam -- Trauma Patient (Significant MOI)

Back 22

After scene size-up and initial assessment: 1. Reconsider the MOI; 2. Continue manual stabilization of the head and neck; 3. Consider requesting ALS; 4. Reconsider your transport decision; 5. Reassess mental status; 6. Perform Rapid Trauma Assessment; 7. Assess baseline vital signs; 8. Obtain a SAMPLE history.

Front 23

Significant MOIs (adult or child)

Back 23

1. Ejection from Vehicle
2. Death in same passenger compartment
3. Falls of more than 15 feet or 3x patient's height
4. Rollover of vehicle
5. High-speed vehicle collision
6. Vehicle-pedestrian collision
7. Motorcycle crash
8. Unresponsive or altered mental status
9. Penetrations of the head, chest, or abdomen, e.g., stab and gunshot wounds

Front 24

Additional Significant MOIs for a Child

Back 24

10. Falls from more than 10 feet
11. Bicycle collision
12. Vehicle in medium speed collision.

Front 25

Why Reconsider the MOI?

Back 25

1. To pick up things you might have missed during rapid scene size up/initial impression;
2. To re-evaluate patient's priority for transport;
3. To appropriately tailor further assessment and care.

Front 26

Why Determine the Chief Complaint?

Back 26

1. So you know why you're there.
2. So you know what you're looking for.

Front 27

Why Perform a Focused Physical Exam?

Back 27

1. To follow up on what you can see;
2. To investigate what patient says is wrong (chief complaint);
3. To investigate suspicions aroused by MOI, both by feel and by touch;
4. To use a standardized exam ritual to find problems otherwise possibly overlooked.

Front 28

DCAP-BTLS (Acronym)

Back 28

Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling

Front 29

DCAP-BTLS (Visualize vs. Palpate)

Back 29

First, Look for: Contusions, abrasions, punctures, penetrations, burns, or lacerations. Then: Palpate for: Deformities, tenderness, and swelling.

Front 30

Deformities

Back 30

Parts of the body that no longer have the normal shape.

Front 31

Focused History and Physical Exam -- Trauma Patient (No Significant MOI)

Back 31

After scene size-up and initial assessment: 1. Reconsider the MOI; 2. Perform Focused Physical Exam based on chief complaint and MOI; 3. Assess baseline vital signs; 4. Obtain a SAMPLE history.

Front 32

Focused History and Physical Exam -- Trauma Patient (Significant MOI)

Back 32

After scene size-up and initial assessment: 1. Reconsider the MOI; 2. Continue manual stabilization of the head and neck; 3. Consider requesting ALS; 4. Reconsider your transport decision; 5. Reassess mental status; 6. Perform Rapid Trauma Assessment; 7. Assess baseline vital signs; 8. Obtain a SAMPLE history.

Front 33

Significant MOIs (adult or child)

Back 33

1. Ejection from Vehicle
2. Death in same passenger compartment
3. Falls of more than 15 feet or 3x patient's height
4. Rollover of vehicle
5. High-speed vehicle collision
6. Vehicle-pedestrian collision
7. Motorcycle crash
8. Unresponsive or altered mental status
9. Penetrations of the head, chest, or abdomen, e.g., stab and gunshot wounds

Front 34

Additional Significant MOIs for a Child

Back 34

10. Falls from more than 10 feet
11. Bicycle collision
12. Vehicle in medium speed collision.

Front 35

Why Reconsider the MOI?

Back 35

1. To pick up things you might have missed during rapid scene size up/initial impression;
2. To re-evaluate patient's priority for transport;
3. To appropriately tailor further assessment and care.

Front 36

Why Determine the Chief Complaint?

Back 36

1. So you know why you're there.
2. So you know what you're looking for.

Front 37

Why Perform a Focused Physical Exam?

Back 37

1. To follow up on what you can see;
2. To investigate what patient says is wrong (chief complaint);
3. To investigate suspicions aroused by MOI, both by feel and by touch;
4. To use a standardized exam ritual to find problems otherwise possibly overlooked.

Front 38

DCAP-BTLS (Acronym)

Back 38

Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling

Front 39

DCAP-BTLS (Visualize vs. Palpate)

Back 39

First, Look for: Contusions, abrasions, punctures, penetrations, burns, or lacerations. Then: Palpate for: Deformities, tenderness, and swelling.

Front 40

Deformities

Back 40

Parts of the body that no longer have the normal shape. (e.g., broken or fractured bones pushing up the skin over the bone ends).

Front 41

Contusions

Back 41

The medical term for bruises.

Front 42

Abrasions

Back 42

Scrapes; some of the most common injuries you will see.

Front 43

Punctures and Penetrations

Back 43

Holes in the body, frequently the result of gunshot wounds and stab wounds. WHEN they are small, they are easy to overlook!

Front 44

Burns

Back 44

Reddened, blistered, or charred-looking areas.

Front 45

Tenderness

Back 45

An area hurts when pressure is applied to it.

Front 46

Lacerations

Back 46

Cuts, open wounds that sometimes cause significant blood loss.

Front 47

Swelling

Back 47

Common result of injured capillaries bleeding under the skin.

Front 48

Physical Exam/Trauma Assessment -- What to Search for in each area (in addition to DCAP-BTLS)

Back 48

Head - Crepitation
Neck - Jugular Vein Distention, Crepitation
Chest - Paradoxical motion, crepitation, breath sounds (present, absent, equal)
Abdomen - Firmness, softness, distension
Pelvis - Pain, tenderness, motion
Extremities - (PMS) Distal Pulse, Motor function, sensation

Front 49

DCAP-BTLS Plus for: Head

Back 49

1. Crepitation

Front 50

DCAP-BTLS Plus for: Neck

Back 50

1. Jugular Vein Distention (JVD)
2. Flat Jugular Veins in Pt Lying Down
3. Crepitation in Cervical Vertebrae

Front 51

DCAP- BTLS Plus for: Chest

Back 51

1. Paradoxical Motion (Flail Segment)
2. Crepitation
3. Breath Sounds (present, absent, un/equal, ab/normal)

Front 52

DCAP-BTLS Plus for: Abdomen

Back 52

1. Firmness
2. Softness
3. Distention

Front 53

DCAP-BTLS Plus for: Pelvis

Back 53

1. Pain
2. Tenderness
3. Motion
4. Priapism

Front 54

DCAP-BTLS Plus for: Extremities

Back 54

1. PMS:
distal Pulse,
Motor function,
Sensation

Front 55

DCAP-BTLS Plus for: Posterior

Back 55

1. Remember to DO IT, while logrolling patient over for packaging!

Front 56

When is it appropriate to apply a cervical collar?

Back 56

When the MOI exerts significant force on the upper body or if there is any soft-tissue damage to the head, face, or neck from trauma (such as a cut or bruise from dashboard); any blow above clavicles, fall from a height, poor responsiveness, unknown MOI, or if cervical/spinal injury can't be ruled out.

Front 57

What if you don't have a cervical collar that fits?

Back 57

Better to place a rolled towel around the neck, remind the pt not to move his head, then tape the pt's head to the backboard, than not use anything.

Front 58

Before applying cervical collar: have you...?

Back 58

1. Intervened against all life-threatening problems?
2. Assessed the Pt's neck?
3. Reassured the Pt?
4. Sized the collar?
5. Moved Pt's hair, necklaces, and earrings?
6. Kept Pt's head in neutral anatomical position?

Front 59

Additions for Focused History & Physical Exam for Significant MOI

Back 59

1. Manual stabilization;
2. ALS request consideration;
3. Reconsideration of transport decision;
4. Reassessment of mental status.
5. Complete, head-to-toe rapid trauma assessment (instead of focused physical exam)

Front 60

FHPE - Trauma w/ Significant MOI

Back 60

1. Reconsider the MOI;
2. Continue manual stabilization of the head and neck;
3. Consider requesting Advanced Life Support;
4. Reconsider transport decision;
5. Reassess mental status;
6. Perform a rapid trauma assessment;
7. Obtain baseline vital signs;
8. Take a SAMPLE history.

Front 61

Airbag Rule (re: significant MOI)

Back 61

When you see a deployed airbag, remember to "Lift and Look." Once deployed, an airbag can conceal important information about the patient's mechanism of injury. When you see bent/broken steering wheel/dashboard, suspect significant MOI.

Front 62

Pediatric Note (re: significant MOI)

Back 62

A child may sustain the same injury as an adult from less force. For this reason, there are additional MOI's to consider significant when children and infants are concerned.

Front 63

What is a significant Mechanism of Injury?

Back 63

A way of getting hurt that carries a high risk of serious injury; high-risk situations.

Front 64

Why continue spinal stabilization?

Back 64

To prevent any cervical-spine injury from becoming a paralyzing one. Ensure that someone is manually stabilizing the Pt's head and neck all the way through the assessment, until C-collar is applied and Pt is fully immobilized on a backboard.

Front 65

Why consider requesting ALS/Medevac?

Back 65

To increase Pt's chances of survival by providing highest specialized level of care at earliest possible time. Familiarize yourself with local specialized centers (i.e., stroke center, burn center, trauma center) and local arrangements, and make sure these latter are in writing for efficiency and anti-confusion.

Front 66

Why reconsider your transport decision?

Back 66

Because the rapid-trauma assessment gives you the chance to see the MOI more closely, and determine whether your level of care is sufficient, or if additional resources/a higher priority transport is required.

Front 67

AVPU LOC

Back 67

Alert, Verbal response, Painful response, Unresponsive Levels of Consciousness.

Front 68

Why reassess mental status?

Back 68

A patient who is less than fully alert or whose mental status is deteriorating is a high priority for transport. Repeat AVPU assessment to note whether your Pt's mental status is unchanged, improved, or deteriorated.

Front 69

Why perform a rapid trauma assessment (especially on a high-priority patient)?

Back 69

The care you provide enroute will be based on the results of the rapid assessment, as will the hospital's preparations. A rapid trauma assessment costs only a few moments and should be performed at the scene before loading the Pt into the ambulance. Last chance to detect and intervene on life-threatening injuries possibly overlooked. RTA emphasizes evaluation of the areas of the body where the greatest threats to the Pt may be.

Front 70

Rapid Trauma Assessment - Parts checked (quickly)

Back 70

Head
Neck (apply cervical collar)
Chest
Abdomen
Pelvis
Extremities
Posterior body (immobilize to a backboard)

Front 71

Rapid Assessment of the Head

Back 71

Assess for DCAP-BTLS and crepitation. Run gloved fingers through the Pt's hair and palpate gently. Starting with fingers at top of neck and slide upward carefully toward top of Pt's head. Blood on gloves = open wound; but no blood on floor or ground means no immediate dressing required.

Front 72

Rapid Assessment of the Neck

Back 72

DCAP-BTLS and Jugular Vein Distention. Bulging JV's w/ Pt sitting means blood is backing up in veins b/c heart not pumping effectively. Could be cardiac tamponade or tension pneumothorax. Whereas flat JV's in a flat (lying down) Pt means "Blood Loss," since JV's SHOULD be bulging then: problem if flat.

Also: Stomas in anterior neck might be found: suction/ventilation will be provided through these if necessary.

Also: medical necklaces.

Front 73

Application of a Cervical Collar

Back 73

Happens directly after Rapid Assessment of the Neck.

Front 74

Rapid Assessment of the Chest

Back 74

1. Expose Pt's Chest (w/ eye towards weather and privacy).
2. DCAP-BTLS, Crepitation, BREATH SOUNDS (present and equal), and Paradoxical Motion (flail chest - also requires/reveals significant MOI).
3. Check for Paradox motion/crepitation at same time: start by palpating clavicles, then gently feel sternum. Position hands on sides of chest and feel for both sides expanding equally. May feel broken bones or floating paradoxical segments now.
4. Palpate entire rib cage for deformities. Gently pressure sides of ribcage: Pt. will say if it hurts. May feel crackle/crunch under skin from escaped air.
5. Listen for breath sounds just under the clavicles in the mid-clavicular line, and at the bases of the lungs in the mid-axillary (armpit, side of body) line. Absent or unequal breath sounds may mean collapsed/punctured lung.

Front 75

Rapid Assessment of the Abdomen

Back 75

1. DCAP-BTLS, firmness, softness, distention (appears larger than normal: sign of internal bleeding; hard to tell).
2. May see colostomy or ileostomy bags: take care not to disturb/cut.
3. Warm hands. Palpate abdomen in quadrants, saving complaint of pain quad for last.
4. Press with palm-side fingers, about 1", perhaps w/ fingers laced.
5. PULSATING MASS. RUPTURED AORTA. TICKING TIME BOMB. LOAD AND F'ING GO.

Front 76

Rapid Assessment of the Pelvis

Back 76

1. DCAP-BTLS, bleeding, priapism (from spinal cord injury/certain medical problems).
2. So rich w/ blood vessels/delicate: stop palpation at first indication of pain from Pt: consider this reason enough to treat Pt. for injured pelvis.
3. If Pt. unconsc., palpate 'til flinch or groan, or motion of the bones. If either present, treat for injury.

Front 77

Rapid Assessment of the Extremities.

Back 77

1. All four for PMS plus DCAP-BTLS:
Pulse (present, distally?)
Motor function 1: (Pt. move hands/feet?)
Motor function 2: (How strongly?)
Sensation (Pt. have feeling in hands/feet?)
2. Check BEFORE AND AFTER ANY INTERVENTIONS (splinting, bandaging, immobilization) and ongoing during transport; adjust interventions as necessary.
3. Diminished pulse/function may be a sign of injury that has compromised circulation, motor or nerve function.
4. If Pt. fails any extremity test, load & go. Any deformity, diminished function, or other indication of injury to an extremity, do not splint at scene: rather, treat enroute.

Front 78

Rapid Assessment of the Upper Extremities

Back 78

1. Assess distal circulation in the upper extremities by feeling for radial pulses.
2. Assess distal motor function by checking the Pt's ability to move both hands through entire range of motion.
3. Assess strength in hands by asking Pt to squeeze your fingers, both hands at once.
4. Assess distal sensation by asking Pt. "which finger am I touching?"
4u. If Pt. unresponsive, assess distal sensation by pinching the back of hand, watching and listening for a response.

Front 79

Rapid Assessment of the Lower Extremities

Back 79

1. Check distal circulation in the lower extremities by feeling the posterior tibial pulse just behind the medial malleolus in the ankle (the vein heelside of the inside ankle bone) OR the dorsalis pedalis pulse (big vein) on the top of the foot.
2. Assess distal motor function by checking the Pt's ability to move his feet through whole range of motion.
3. Assess strength in the feet and legs by asking the patient to push her feet against your hands, both at once.
4. Assess distal sensation in the feet by asking Pt. "Which toe am I touching?"
4u. If Pt. unresponsive, assess distal sensation in the lower foot by pinching the top of the foot, watching and listening for response.

Front 80

Rapid Assessment of the Posterior Body and Immobilization on a Backboard

Back 80

1. With a partner, log roll Pt. onto side, protecting C-spine.
2. While someone gets backboard, Inspect and palpate spine, to the sides of the spine, buttocks, and posterior extremities.
3. If pelvic injury: local direction may direct MAST/PASG anti-shock pants onto the backboard before rolling Pt down onto it. Alternately, know how to form a pelvic wrap from a folded sheet.

Front 81

Pelvic Wrap

Back 81

1. Prepare a backboard with a sheet, folded flat, approx. 10" wide and lying across the backboard perpendicularly.
2. Carefully roll the Pt. to the backboard. Center teh sheet at the Pt's greater trochanter (bony prominences at the promixal ends of the femurs). The sheet will be below the iliac "wings" of the pelvis. This is the correct position.
3. Bring the sides of the sheet around to the front of the Pt. Bringing the sheet sides together and tying them will compress and stabilize the pelvis. Sheet should feel firm enough on the pelvis to keep it in normal position without over-compression.
4. Secure the sheet using ties or clamps so the compression is maintained.
- More pelvic-injury care listed on p. 654.

Front 82

Obtain Baseline Vital Signs and SAMPLE History

Back 82

In trauma situations, it is good to think of the "S" in SAMPLE also for Story of the Injury (history). Info: such as speed of the vehicle, whether seat belts were used, whether the patient lost consciousness. If shot: try to obtain caliber of the gun, type of ammunition, distance from Pt. when discharged. When stabbed, size and type of the knife.

Front 83

General Principles with the Focused Physical Exam/Rapid Trauma Assessment

Back 83

1. Tell the Pt. what you are going to do.
2. Expose any injured area to examine.
3. Try to maintain eye contact.
4. Assume spinal injury.
5. FOCUSED PHYSICAL EXAM (no significant MOI), you may stop/alter assessment to provide priority-appropriate care. Incl.'s controlling minor bleeding, and splinting.
6. RAPID TRAUMA ASSESSMENT: apply a C-collar if spine injury is suspected.

Front 84

Pediatric Note for Focused Physical Exam/Rapid Trauma Assessment

Back 84

1. May need to spend more time reassuring and explaining procedures to children.
2. Kneel or otherwise get on same level with the child.
3. Young children may be less frightened if you begin assessment at the toes and work towards the head, vs. regular head-down approach.
4. A child's airway is narrower, softer, and more susceptible to being closed. A C-collar that is too tight can easily constrict a child's airway. A collar that is too high can close the airway by stretching the neck. Take especial care when choosing C-collar for a child.

Front 85

Study Guide for Detailed Physical Exam

Back 85

1. Repeat initial assessment.
2. Complete all critical interventions.
3. Head - WITH ORIFICES
4. Neck
5. Chest
6. Abdomen
7. Pelvis
8. Extremities
9. Posterior body
10. Reassess vital signs

Front 86

Important Differences: Detailed Physical Exam vs. Rapid Trauma Assessment

Back 86

1. The head is more thoroughly examined (i.e., orifices);
2. The exam usually takes place in the ambulance, enroute. Noise and motion may interfere with some procedures.
3. Immobilization devices have been applied and you must work around them: examining ears through holes in the head immobilizer/below head tape; examining the neck through openings in the C-collar; examining only as much of the posterior as you can reach.

Front 87

Sequence of Assessment Priorities (incl. Detailed Physical Exam)

Back 87

1. Scene size-up;
2. Initial assessment and critical interventions for immediately life-threatening problems;
3. Focused history and physical exam, vital signs, plus interventions as needed;
4. Repeat initial assessment for immediately life-threatening problems. Provide critical interventions as needed.
5. Detailed physical exam (time and critical-care needs permitting);
6. Ongoing assessment for life-threatening problems, plus reassessment of vital signs. Provide critical interventions as needed.

Front 88

Detailed Physical Exam: DCAP-BTLS Plus for Scalp and Cranium

Back 88

1. DCAP-BTLS
2. Crepitation

Front 89

Detailed Physical Exam: DCAP-BTLS Plus for Face

Back 89

1. DCAP-BTLS

Front 90

Detailed Physical Exam: DCAP-BTLS Plus for Ears

Back 90

1. DCAP-BTLS
2. Drainage (clear, cerebrospinal fluid)
3. Bleeding

Front 91

Detailed Physical Exam: DCAP-BTLS Plus for Eyes

Back 91

1. DCAP-BTLS
2. Discoloration
3. Unequal Pupils
4. Foreign Bodies
5. Blood in Anterior Chamber

Front 92

Detailed Physical Exam: DCAP-BTLS Plus for Nose

Back 92

1. DCAP-BTLS
2. Drainage (clear, cerebrospinal fluid)
3. Bleeding

Front 93

Detailed Physical Exam: DCAP-BTLS Plus for Mouth

Back 93

1. DCAP-BTLS
2. Loose or broken teeth
3. Objects that could cause obstruction
4. Swelling/laceration of tongue
5. Unusual breath odor
6. Discoloration

Front 94

Why do a Detailed Physical Exam?

Back 94

May reveal signs or symptoms of injury that you missed or that have changed since the rapid trauma assessment.
If you have not already exposed the Pt, you need to do so now. It is much easier to protect the Pt's privacy in the closed ambulance.

Front 95

Contraindications of a Detailed Physical Exam

Back 95

1. Only performed after critical interventions, if time and critical-care needs permit.
2. If you are treating a severely injured patient, you may be too busy to begin or complete the detailed physical exam at all. This is not a failure on your part.
3. Performing a detailed physical exam is always a lower priority than addressing life-threatening problems.

Front 96

Detailed Physical Exam: DCAP-BTLS Plus for Scalp and Cranium

Back 96

1. DCAP-BTLS
2. Crepitation

Front 97

Detailed Physical Exam: DCAP-BTLS Plus for Face

Back 97

1. DCAP-BTLS

Front 98

Detailed Physical Exam: DCAP-BTLS Plus for Ears

Back 98

1. DCAP-BTLS
2. Drainage (clear, cerebrospinal fluid)
3. Bleeding
4. Battle's Sign behind ears.

Front 99

Detailed Physical Exam: DCAP-BTLS Plus for Eyes

Back 99

1. DCAP-BTLS
2. Discoloration
3. Unequal Pupils
4. Foreign Bodies
5. Blood in Anterior Chamber

Front 100

Detailed Physical Exam: DCAP-BTLS Plus for Nose

Back 100

1. DCAP-BTLS
2. Drainage (clear, cerebrospinal fluid)
3. Bleeding

Front 101

Who is Detailed Physical Exam meant for?

Back 101

1. Not medical Pt's: harder to pick up outward signs of medical issues, and not much you can do in field about them if you did.
2. Not trauma Pt's without Significant MOI: focused assessment was all field treatment they needed.
3. You should perform a detailed physical exam on a trauma Pt who has a significant MOI and on any patient who has an unclear or unknown MOI (i.e., coming across a fallen unconscious Pt: did he pass out and fall, or fall and conk out?).
4. When in doubt, do a detailed physical exam.