Trauma assessment and management of life threats:
Upon arrival on scene, perform EMCAP, observing for potential environmental threats, and mechanism of injury to the patient. Call for additional resources needed if they are not already on scene.
Form a general impression of the patient, noting LOA, positioning, work of breathing, skin colour and condition. Note any obvious life threatening hemorrhage and correct it now.
Upon patient contact, perform the primary survey, assessing LOA, applying C-spine precautions, and assessing airway patency, adequacy of respirations, and checking pulse and cap refill. Make corrections required prior to moving forward.
For isolated trauma patients, perform a focused assessment of the affected area, obtain baseline vitals, stabilize injured extremities, and extricate to the ambulance, obtaining HPI, PMHx, Medications, Allergies, and last ins/outs during preparation for and intra-transport.
For multi-system trauma/significant MOI, perform a rapid trauma survey assessing the patient from head to toe:
Head/neck: Assess the skull for tenderness, instability, crepitus, symmetry/deformity. Note any fluid leaking from the ears, nose or mouth. Assess pupils. Palpate the cervical spine for point tenderness, instability, crepitus, or step deformity. Note any contusions, lacerations, abraisions, penetrating injuries, or subcutaneous emphysema. Dress impaled objects in place, DO NOT remove unless they interfere with airway management. Cover any open neck wounds with an occlusive dressing, DO NOT use circumferential neck dressings.
Chest: Observe for CLAPSD, palpate for TICS, auscultate breath sounds, and look for any paradoxical movement. Treat impaled objects as above. If a sucking chest wound is noted, cover it with commercial chest seal or 3 sided occlusive dressing. If pneumothorax is suspected, monitor for the development of a tension pneumothorax, hemothorax, or pneumomediastinum.
Abdomen: Palpate for tenderness, asymmetry, rigidity, or distension. Observe for CLAPSD. Cover eviscerations with moist sterile dressings. Treat impaled objects as above. Treat penetrating wounds with pressure dressings. DO NOT place hemostatic dressings or packing into open abdominal cavity.
Pelvis: Palpate for stability, and note the presence/absence of priapism in males. If an unstable pelvis is encountered, use commercial binder or sheet wrap.
Femurs: Palpate for stability. Note CLAPSD and TICS. If gross bleeding is occurring, apply direct pressure, digital pressure, tourniquet, and lastly hemostatic dressings as needed. If midshaft femur fracture is present, use traction splint.
Lower limbs and upper extremities: Palpate for TICS, observe for CLAPSD. Treat bleeding per BLS, and splint deformites as close to anatomical position as possible. If amputated extremities are present, apply moist sterile dressing to stump, and wrap with dry dressing/bandage. Place amputated parts in plastic bag and immerse in cool water for transport.
6.Obtain baseline vitals once life threats have been corrected.
7. Make a transport decision and notify air ambulance if needed.
8. Initiate transport, and perform a detailed secondary assessment e-nroute. During this time attempt to obtain HPI, PMHx, Medications, Allergies, and last ins/outs.
9. Monitor for signs of deterioration and manage as needed (Ventilation, IV fluid therapy, analgesic, defibrillation, etc.).
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