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81 Cards in this Set

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Focused history and physical examination of the trauma patient could also be called...
..."secondary assessment" or "secondary survey" since it comes AFTER the initial assessment
How do you decide whether you make a RAPID assessment or a FOCUSED assessment on the scene?
This is based on the presence of a "significant mechanism of injury." If none is present, do a focused assessment. If one is present, perform a rapid assessment.
What nine elements allow you to determine that there's a "significant mechanism of injury?"
1) Ejection from vehicle

2) Rollover of vehicle

3) Vehicle/pedestrian collision

4) High speed collision

5) Death in the same passenger compartment

6) Motorcycle crash

7) Fall greater than 15 ft or 3 times the patient's height

8) Penetrating injury of head, chest, or abdomen

9) Altered mental status.
What items on the interior of a car can you examine to determine mechanism of injury?
1) Windshield
2) Steering wheel
3) Pedals
4) Mirror
5) Dashboard
6) Deployed airbags (could have cracked windshield)
What eight steps do you take when you determine a significant mechanism of injury?
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.
When determining whether or not a significant mechanism of injury is present and a child is involved, what additional situations must you consider as "significant?"
1) Falls greater than 10 ft

2) bike collision

3) vehicle in med. speed collision
What mnemonic device helps you remember what to look for when inspecting patients for injuries?
DCAPBTLS:

Deformities
Contusions
Abrasions
Punctures/Penetrations
Burns
Tenderness
Lacerations
Swelling
When assessing pain reported in abdominal quadrants, which is the last quadrant to palpate?
The part that allegedly hurts! You don't want to start by hurting your patient right off the bat... check the other quadrants then circle back to the "injured" one.
If no significant mechanism of injury is determined, how do you proceed?
1) Reconsider mechanism of injury

2) Determine chief complaint

3) Perform focused physical exam based on:
Chief complaint
Mechanism of injury

4) Get baseline vital signs

5) Obtain SAMPLE history
What are the components of the SAMPLE history?
Signs/Symptoms
Allergies
Medications
Past pertinent medical history
Last oral intake
Events leading up to the illness
What are the three cardinal rules of assessment?
1) Explain to the patient what you're doing

2) Expose areas before assessing

3) Assume spinal injury
What two types of cervical collars may you see?
1) STIFNECK rigid extrication collar (very common)

2) Philadelphia cervical collar (outdated)
When might you not have time to do a detailed exam?
If the patient has critical injuries.
When is the detailed physical exam done?
During transport, after the rapid trauma assessment.
When moving on to the focused history and physical exam, you must first place the patient into one of what two categories?
Trauma or Medical
What's MOI?
Mechanism of injury
When you've determined that you're about to do a focused history and physical exam on a trauma patient, what must you determine next?
Whether or not there was a significant mechanism of injury.
After scene size-up and initial assessment, If you determine that the mechanism of injury in the case of a trauma patient is significant, what do you do next?
1) Reconsider the mechanism of injury

2) Continue manual stabilization of head and neck

3) Consider requesting ALS personnel

4) Reconsider your transport decision

5) Reassess mental status

6) Perform rapid trauma assessment

7) Assess baseline vital signs

8) Obtain a sample history
After scene size-up and initial assessment, If you determine that the mechanism of injury in the case of a trauma patient is NOT significant, what do you do next?
1) Reconsider the mechanism of injury

2) Determine the chief complaint

3) Perform focused physical exam based on chief complaint and mechanism of injury

4) Assess baseline vitals

5) Obtain a sample history
What's the first step of the focused history and physical exam for ANY trauma patient?
Reconsider the mechanism of injury
What's the first difference between the assessment of a patient with a significant MOI and one without a significant MOI?
When there's no significant MOI, you skip the head-to-toe examination and focus on the areas that the patient tells you are painful, or that you suspect may be injured because of the MOI.
Define "crepitation"
The grating or crackling sound or feeling of broken bones moving against one another.
In the case of a trauma patient with no significant MOI, what comes after you reconsider the MOI?
You determine the chief complaint.
In the case of a trauma patient with no significant MOI, what comes after you determine the chief complaint?
You perform a focused physical exam, focusing on what the patient tells you is injured AND what else you suspect may be injured.
Define "deformities"
Parts of the body that no longer have their normal shape
Define "contusions."
Bruises
Define "abrasions."
Scrapes
Define "lacerations."
Cuts
Before conducting your physical exam of a trauma patient, what must you do?
Remove their clothes as necessary.
In the case of a trauma patient with no significant MOI, what comes after you perform a focused physical exam?
Obtain baseline vital signs and a SAMPLE history, then take any interventions necessary
When do you immobilize the cervical spine with a collar?
Anytime you suspect spine injury due to signs, symptoms, history, or mechanism of injury, you apply the cervical collar after you examine the neck.

Use a collar in case to traumatic damage to the upper body, falls from a height, or altered mental status.
What's the most important factor in selecting a cervical collar?
Size. Too small and you could impede breathing or circulation. Too large and you may not sufficiently immobilize the spine.
If you don't have access to a suitably-sized cervical collar and you suspect cervical spine injury, how do you proceed?
Place a rolled towel around the patient's neck and tape the patient's head to the backboard.
What 8 considerations must you remember when putting on a collar?
1) Finish initial assessment and necessary interventions first.

2) Assess and examine patient's neck before applying collar

3) Reassure the patient

4) Make sure collar is the right size

5) Remove necklaces and large earrings

6) Keep patient's hair out of the way

7) Keep neck in neutral position when applying collar.

8) Continue to provide manual stabilization as well until patient is on a backboard
When assessing the head during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus crepitation
When assessing the neck during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus crepitation and jugular vein distension
When assessing the chest during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus crepitation, breath sounds (present? absent? equal?), and paradoxical motion
When assessing the abdomen during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus unusual firmness, softness, or distention.
When assessing the pelvis during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus tenderness, crepitation, motion
When assessing the extremities during a physical examination, what should you be on the lookout for?
DCAP-BTLS plus distal pulse, motor function, and sensation
When assessing the back during a physical examination, what should you be on the lookout for?
DCAP-BTLS
Once you determine that you're dealing with a trauma patient and a significant mechanism of injury, what eight steps do you take?
1) Reconsider mechanism of injury

2) Continue spinal stabilization

3) Consider request for ALS (advanced life support personnel)

4) Reconsider transport decision

5) Reassess mental status

6) Perform rapid trauma assessment

7) Obtain baseline vitals

8) Obtain a SAMPLE history
When applying a rigid cervical collar to a seated patient, what six steps must you take?
1) Stabilize head and neck from the rear

2) Properly angle the collar for placement

3) Position the collar bottom

4) Set the collar in place around the neck

5) Secure the collar

6) Maintain manual stabilization of the head and neck
When applying an adjustable collar to a supine patient, what four steps must you take?
1) Kneel at the patient's head and stabilize the head and neck

2) Set the collar in place

3) Secure the collar

4) Continue to manually stabilize the head and neck
What do you with a trauma patient immediately after examining the neck?
Apply a cervical collar.
Define "paradoxical motion."
A type of breathing in which all or part of a lung inflates during inspiration and balloons out during expiration; the opposite of normal chest motion. This can be caused by "flail chest," which happens when multiple ribs are completely snapped.
Define "flail chest."
A condition resulting from a crushing chest injury. When multiple consecutive ribs are completely broken, that portion of the chest will move OPPOSITE to normal -- i.e. moving inward during inspiration and outward during expiration
If you're too busy to determine the mechanism of injury because you're performing life-saving interventions, what should you do?
Ask another member of emergency personnel -- police, EMT, fire, anybody present that's free -- to help you get that information.
If you're examining a vehicle in order to determine MOI, what do you do when you see deployed airbags?
"Lift and look." See if the deflated airbags are concealing any important information pertaining to the MOI such as a bent or broken steering wheel, dashboard deformities, etc.
What do you do with EVERY trauma patient until you have them on a long backboard?
Provide manual stabilization of the head and neck.
When transporting a trauma patient with a significant MOI, where should you take them if it's close enough?
To a trauma center.
When you're performing a rapid trauma assessment on a trauma patient with a significant MOI, where do you perform the assessment?
On the scene, before loading the patient onto the ambulance.
What should you be doing with a responsive patient before and during the rapid trauma assessment?
Asking about symptoms.
What's an effective way of examining the back of the head during a rapid trauma assessment?
Starting at the top of the neck, run your fingers up the back of the head. If there's blood on your gloves, there's a wound. If there's no blood on the ground, however, it doesn't need to be dressed immediately.
What do you assume when you see flat neck veins in a patient that's lying down?
Assume substantial blood loss.
When assessing the neck during a physical examination, what object should you look out for?
A medical ID necklace.
Define "Jugular Vein Distension" or "JVD."
Bulging of the neck veins
Define "stoma."
A permanent surgical opening in the neck through which the patient breathes.
Define "tracheostomy."
A surgical incision held open by a plastic or metal tube.
Where do you listen for breath sounds?
Just under the clavicles in the mid clavicular line and at the bases of the lungs in the mid-axillary line.
When examining the chest, what do you do?
1) Palpate the clavicles

2) Palpate the sternum gently

3) Position hands on both sides of the chest and feel for equal expansion of both sides of the chest.

4) Palpate the entire rib cage for deformities.

5) Listen to breath noises
What do you do when you're examining a patient and you find a colostomy or ileostomy
Leave the bag in place -- be careful not to cut it when removing clothes.
What steps do you take when examining the abdomen?
Palpate the four quadrants. If the patient complains of chest in a specific quadrant, palpate that site last.

Be on the lookout for unusual firmness, distension, or a pulsating mass (which could be an enlarged aorta -- in which case, stop palpating and get to the hospital).
Define "priapism."
Persistent erection of the penis that may result from spinal injury and some medical problems.
Define "pneumatic antishock garment (PASG)"
A PASG is a device used to stabilize an injured pelvis during transport
If a patient is unresponsive, how do you check his or her distal sensation in the extremities?
Pinch the skin on top of the foot and hand and watch for a reaction.
When assessing the extremities, what additional steps must you take?
1) Assess distal pulse

2) Assess motor function (in responsive patient) by asking them to move their hands

3) Assess strength in hands by asking patient to squeeze your fingers

4) Assess sensation by touching a finger and asking "which one am I touching?"

5) Check distal circulation in feet using posterior tibial pulse or dorsalis pedis pulse.

6) Assess distal motor function (in responsive patient) by asking patient to move feet

7) Assess strength in patient's feet by asking them to push against your hands

(in unresponsive patients, check sensation by pinching the skin on hand/foot and watching for reaction)
Define "detailed physical exam."
An examination performed en route to the hospital similar to the rapid exam, but also paying attention to:

1) Face
2) Ears
3) Eyes
4) Nose
5) Mouth
When do you perform a detailed physical exam on a trauma patient with a significant MOI?
Only after you've performed a rapid trauma examination, obtained baseline vitals, gotten as much of a SAMPLE history as you can, and performed all critical interventions. Usually during transport. It's good to repeat your initial assessment before performing the detailed exam, making note of:

1) General impression
2) Mental status
3) ABCs
What's a higher priority: addressing life-threatening problems or performing a detailed examination?
Addressing life-threatening problems.
From the beginning of the call up to the detailed physical examination, what should the series of events be?
1) Scene size-up

2) Initial assessment and critical interventions

3) Focused history and physical examination

4) Baseline vital signs

5) SAMPLE history

6) Repeat initial assessment

7) For trauma patients with significant MOI, or if you have doubts about the extent of injury, perform a detailed physical exam (if time permits)

8) Ongoing assessment for life-threatening problems, plus reassessment of vital signs. Provide critical intervention as needed.
When examining the scalp and cranium during a detailed physical exam, what should you be looking for?
DCAP-BTLS + Crepitation
When examining the face during a detailed physical exam, what should you be looking for?
DCAP-BTLS
When examining the ears during a detailed physical exam, what should you be looking for?
DCAP-BTLS plus drainage and bleeding (check behind ears for bruising, also called "Battle's Sign", which is an indicator of skull injury)
When examining the eyes during a detailed physical exam, what should you be looking for?
DCAP-BTLS plus:

1) discoloration

2) unequal pupils

3) foreign bodies

4) blood in anterior chamber
When examining the nose during a detailed physical exam, what should you be looking for?
DCAP-BTLS plus drainage and bleeding
When examining the mouth during a detailed physical exam, what should you be looking for?
DCAP-BTLS plus:

1) loose or broken teeth

2) objects that could cause obstruction, swelling or laceration of tongue

3) unusual breath odor

4) discoloration
What do you call clear or straw-colored fluid leaking from the ears (and possibly nose?)
Cerebrospinal fluid -- this is a BAD sign, this indicates skull fractures.
When you're dealing with a trauma patient with no significant MOI and your index of suspicion is giving you doubts, what should you do?
Perform a detailed physical exam. Keep in mind the fear that a responsive trauma patient feels, and their need for emotional support.
What do you do after performing a focused physical exam on a trauma patient with no significant MOI?
Take baseline vitals.
What's the difference between "visceral pain" and "somatic pain?"
Somatic pain is an easy-to-locate and easy-to-define pain located in the musculoskeletal or integumentary system -- or anywhere else on the outer part of the body.

Somatic pain is poorly localized, dull, worsening pain that indicates internal injury.