Indiana Ems Commission Practical Exam Study - Patient Assessment/management -- Trauma

Front 1

Step 1)

Back 1

Take or verbalize body substance isolation precautions -- "BSI!"

(critical fail if missed)

Front 2

After BSI, what comes next?

Back 2

Scene size up

Front 3

What are the steps of scene size up?

Back 3

1) Scene safe? (critical fail if missed)
2) Mechanism of injury
3) Number of patients
4) Additional help? CALL FOR ALS!
5) Consider spinal stabilization (critical fail if missed)

Front 4

What comes after scene size up?

Back 4

Initial assessment

Front 5

What are the steps of initial assessment?

Back 5

1) Verbalize general impression of the patient

2) Determine level of consciousness (AVPU)

3) Determine chief complaint/apparent life threats

4) Assess airway and breathing
a) Assess
b) Initiate appropriate oxygen therapy (critical fail if missed)
c) Assure adequate ventilation
d) Injury management

5) Assess Circulation
a) Assess and controls major bleeding
b) Assesses pulse
c) Assesses skin color, temperature, condition

TREAT FOR SHOCK! Critical fail if missed. Critical fail if ANY ABC problems are missed.

6) Identify priority patients/make transport decision (will be a load and go probably every time. Critical fail if you don't assess proper transport priority. Better safe than sorry)

Front 6

What comes after initial assessment?

Back 6

Focused history and physical examination/rapid trauma assessment

Front 7

What are the steps of the focused history and physical examination/rapid trauma assessment?

Back 7

1) Select appropriate assessment (focused if no significant MOI, rapid trauma if significant MOI -- usually there will be a significant MOI)

a) head: Check for DCAPBTLS and crepitation
b) neck: Check for DCAPBTLS, JVD, and crepitation (then apply cervical collar)
c) chest: DCAPBTLS plus crepitation, paradoxical motion, and auscultate breath sounds (absent/present/equal/unequal)
d) abdomen: DCAPBTLS plus soft/firm/distended
e) pelvis: DCAPBTLS with gentle compression for tenderness or motion
f) extremities: DCAPBTLS plus motor function, sensation, pulse (MSP)
g) posterior: DCAPBTLS

2) Obtain (or direct assistance to obtain) baseline vital signs

3) Obtain SAMPLE history

Front 8

What is "MSP?"

Back 8

Motor, sensory, and pulse

Front 9

What comes after detailed physical exam?

Back 9

Manage secondary injuries and wounds appropriately

Front 10

What comes after management of secondary injuries?

Back 10

Verbalize reassessment of vital signs.

Front 11

What do you do AFTER you verbalize re-assessment of vitals?

Back 11

Tell the evaluator that you're going to begin transport on this priority patient, and en route to the hospital you're going to perform a detailed physical exam. Wait for prompt from evaluator.

Front 12

What are the critical fails?

Back 12

1) Did not take or verbalize BSI

2) Did not determine scene safety

3) Did not initially consider/provide stabilization of spine

4) Administered a dangerous or inappropriate intervention

5) Did not provide high-concentration oxygen with appropriate mask

6) Did not find or manage problems with ABCs (shock)

7) Did not differentiate patient's need for transportation vs. continued assessment at the scene

8) Did focused history/exam BEFORE assessing ABCs

9) Did not transport patient within 10-minute limit