Emt: Brady Emergency Care 12Th Edition - Chapter 13 - Trauma Assessment

Front 1

Focused history and physical examination of the trauma patient could also be called...

Back 1

..."secondary assessment" or "secondary survey" since it comes AFTER the initial assessment

Front 2

How do you decide whether you make a RAPID assessment or a FOCUSED assessment on the scene?

Back 2

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.

Front 3

What nine elements allow you to determine that there's a "significant mechanism of injury?"

Back 3

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.

Front 4

What items on the interior of a car can you examine to determine mechanism of injury?

Back 4

1) Windshield
2) Steering wheel
3) Pedals
4) Mirror
5) Dashboard
6) Deployed airbags (could have cracked windshield)

Front 5

What eight steps do you take when you determine a significant mechanism of injury?

Back 5

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 6

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?"

Back 6

1) Falls greater than 10 ft

2) bike collision

3) vehicle in med. speed collision

Front 7

What mnemonic device helps you remember what to look for when inspecting patients for injuries?

Back 7

DCAPBTLS:

Deformities
Contusions
Abrasions
Punctures/Penetrations
Burns
Tenderness
Lacerations
Swelling

Front 8

When assessing pain reported in abdominal quadrants, which is the last quadrant to palpate?

Back 8

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.

Front 9

If no significant mechanism of injury is determined, how do you proceed?

Back 9

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

Front 10

What are the components of the SAMPLE history?

Back 10

Signs/Symptoms
Allergies
Medications
Past pertinent medical history
Last oral intake
Events leading up to the illness

Front 11

What are the three cardinal rules of assessment?

Back 11

1) Explain to the patient what you're doing

2) Expose areas before assessing

3) Assume spinal injury

Front 12

What two types of cervical collars may you see?

Back 12

1) STIFNECK rigid extrication collar (very common)

2) Philadelphia cervical collar (outdated)

Front 13

When might you not have time to do a detailed exam?

Back 13

If the patient has critical injuries.

Front 14

When is the detailed physical exam done?

Back 14

During transport, after the rapid trauma assessment.

Front 15

When moving on to the focused history and physical exam, you must first place the patient into one of what two categories?

Back 15

Trauma or Medical

Front 16

What's MOI?

Back 16

Mechanism of injury

Front 17

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?

Back 17

Whether or not there was a significant mechanism of injury.

Front 18

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?

Back 18

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

Front 19

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?

Back 19

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

Front 20

What's the first step of the focused history and physical exam for ANY trauma patient?

Back 20

Reconsider the mechanism of injury

Front 21

What's the first difference between the assessment of a patient with a significant MOI and one without a significant MOI?

Back 21

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.

Front 22

Define "crepitation"

Back 22

The grating or crackling sound or feeling of broken bones moving against one another.

Front 23

In the case of a trauma patient with no significant MOI, what comes after you reconsider the MOI?

Back 23

You determine the chief complaint.

Front 24

In the case of a trauma patient with no significant MOI, what comes after you determine the chief complaint?

Back 24

You perform a focused physical exam, focusing on what the patient tells you is injured AND what else you suspect may be injured.

Front 25

Define "deformities"

Back 25

Parts of the body that no longer have their normal shape

Front 26

Define "contusions."

Back 26

Bruises

Front 27

Define "abrasions."

Back 27

Scrapes

Front 28

Define "lacerations."

Back 28

Cuts

Front 29

Before conducting your physical exam of a trauma patient, what must you do?

Back 29

Remove their clothes as necessary.

Front 30

In the case of a trauma patient with no significant MOI, what comes after you perform a focused physical exam?

Back 30

Obtain baseline vital signs and a SAMPLE history, then take any interventions necessary

Front 31

When do you immobilize the cervical spine with a collar?

Back 31

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.

Front 32

What's the most important factor in selecting a cervical collar?

Back 32

Size. Too small and you could impede breathing or circulation. Too large and you may not sufficiently immobilize the spine.

Front 33

If you don't have access to a suitably-sized cervical collar and you suspect cervical spine injury, how do you proceed?

Back 33

Place a rolled towel around the patient's neck and tape the patient's head to the backboard.

Front 34

What 8 considerations must you remember when putting on a collar?

Back 34

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

Front 35

When assessing the head during a physical examination, what should you be on the lookout for?

Back 35

DCAP-BTLS plus crepitation

Front 36

When assessing the neck during a physical examination, what should you be on the lookout for?

Back 36

DCAP-BTLS plus crepitation and jugular vein distension

Front 37

When assessing the chest during a physical examination, what should you be on the lookout for?

Back 37

DCAP-BTLS plus crepitation, breath sounds (present? absent? equal?), and paradoxical motion

Front 38

When assessing the abdomen during a physical examination, what should you be on the lookout for?

Back 38

DCAP-BTLS plus unusual firmness, softness, or distention.

Front 39

When assessing the pelvis during a physical examination, what should you be on the lookout for?

Back 39

DCAP-BTLS plus tenderness, crepitation, motion

Front 40

When assessing the extremities during a physical examination, what should you be on the lookout for?

Back 40

DCAP-BTLS plus distal pulse, motor function, and sensation

Front 41

When assessing the back during a physical examination, what should you be on the lookout for?

Back 41

DCAP-BTLS

Front 42

Once you determine that you're dealing with a trauma patient and a significant mechanism of injury, what eight steps do you take?

Back 42

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

Front 43

When applying a rigid cervical collar to a seated patient, what six steps must you take?

Back 43

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

Front 44

When applying an adjustable collar to a supine patient, what four steps must you take?

Back 44

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

Front 45

What do you with a trauma patient immediately after examining the neck?

Back 45

Apply a cervical collar.

Front 46

Define "paradoxical motion."

Back 46

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.

Front 47

Define "flail chest."

Back 47

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

Front 48

If you're too busy to determine the mechanism of injury because you're performing life-saving interventions, what should you do?

Back 48

Ask another member of emergency personnel -- police, EMT, fire, anybody present that's free -- to help you get that information.

Front 49

If you're examining a vehicle in order to determine MOI, what do you do when you see deployed airbags?

Back 49

"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.

Front 50

What do you do with EVERY trauma patient until you have them on a long backboard?

Back 50

Provide manual stabilization of the head and neck.

Front 51

When transporting a trauma patient with a significant MOI, where should you take them if it's close enough?

Back 51

To a trauma center.

Front 52

When you're performing a rapid trauma assessment on a trauma patient with a significant MOI, where do you perform the assessment?

Back 52

On the scene, before loading the patient onto the ambulance.

Front 53

What should you be doing with a responsive patient before and during the rapid trauma assessment?

Back 53

Asking about symptoms.

Front 54

What's an effective way of examining the back of the head during a rapid trauma assessment?

Back 54

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.

Front 55

What do you assume when you see flat neck veins in a patient that's lying down?

Back 55

Assume substantial blood loss.

Front 56

When assessing the neck during a physical examination, what object should you look out for?

Back 56

A medical ID necklace.

Front 57

Define "Jugular Vein Distension" or "JVD."

Back 57

Bulging of the neck veins

Front 58

Define "stoma."

Back 58

A permanent surgical opening in the neck through which the patient breathes.

Front 59

Define "tracheostomy."

Back 59

A surgical incision held open by a plastic or metal tube.

Front 60

Where do you listen for breath sounds?

Back 60

Just under the clavicles in the mid clavicular line and at the bases of the lungs in the mid-axillary line.

Front 61

When examining the chest, what do you do?

Back 61

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

Front 62

What do you do when you're examining a patient and you find a colostomy or ileostomy

Back 62

Leave the bag in place -- be careful not to cut it when removing clothes.

Front 63

What steps do you take when examining the abdomen?

Back 63

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).

Front 64

Define "priapism."

Back 64

Persistent erection of the penis that may result from spinal injury and some medical problems.

Front 65

Define "pneumatic antishock garment (PASG)"

Back 65

A PASG is a device used to stabilize an injured pelvis during transport

Front 66

If a patient is unresponsive, how do you check his or her distal sensation in the extremities?

Back 66

Pinch the skin on top of the foot and hand and watch for a reaction.

Front 67

When assessing the extremities, what additional steps must you take?

Back 67

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)

Front 68

Define "detailed physical exam."

Back 68

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

Front 69

When do you perform a detailed physical exam on a trauma patient with a significant MOI?

Back 69

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

Front 70

What's a higher priority: addressing life-threatening problems or performing a detailed examination?

Back 70

Addressing life-threatening problems.

Front 71

From the beginning of the call up to the detailed physical examination, what should the series of events be?

Back 71

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.

Front 72

When examining the scalp and cranium during a detailed physical exam, what should you be looking for?

Back 72

DCAP-BTLS + Crepitation

Front 73

When examining the face during a detailed physical exam, what should you be looking for?

Back 73

DCAP-BTLS

Front 74

When examining the ears during a detailed physical exam, what should you be looking for?

Back 74

DCAP-BTLS plus drainage and bleeding (check behind ears for bruising, also called "Battle's Sign", which is an indicator of skull injury)

Front 75

When examining the eyes during a detailed physical exam, what should you be looking for?

Back 75

DCAP-BTLS plus:

1) discoloration

2) unequal pupils

3) foreign bodies

4) blood in anterior chamber

Front 76

When examining the nose during a detailed physical exam, what should you be looking for?

Back 76

DCAP-BTLS plus drainage and bleeding

Front 77

When examining the mouth during a detailed physical exam, what should you be looking for?

Back 77

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

Front 78

What do you call clear or straw-colored fluid leaking from the ears (and possibly nose?)

Back 78

Cerebrospinal fluid -- this is a BAD sign, this indicates skull fractures.

Front 79

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?

Back 79

Perform a detailed physical exam. Keep in mind the fear that a responsive trauma patient feels, and their need for emotional support.

Front 80

What do you do after performing a focused physical exam on a trauma patient with no significant MOI?

Back 80

Take baseline vitals.

Front 81

What's the difference between "visceral pain" and "somatic pain?"

Back 81

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.

Front 82

How would abnormal neck veins look when sitting up? When laying down?

Back 82

Abnormal:

JVD, neck veins bulging when patient sitting up (blood backing up in veins, not able to reach head)
neck veins flat when patient lying down. (Flat veins in flat patient = blood loss, not enough blood to fill them)