TRAUMA
The Trauma Assessment:
Unlike the medical assessment which places emphasis on the patient history and subjective data, the trauma assessment is focused on identification of life threats, rapid physical assessment, and early transport to a trauma centre. The goal in trauma management is to limit scene times to 10 minutes, with the optimal time from contact to surgery being 60 minutes or less (often referred to as the “Golden Hour” of trauma management).
Scene assessment:
Upon arrival at a trauma scene we follow the acronym EMCAP, to identify:
-Environmental/scene safety
-The mechanism of injury
-Number of casualties
-Additional assistance that will be required
-Application of appropriate PPE
Initial impression:
As we approach our patient we want to note:
-Position
-Obvious bleeding
-Movement
-Skin colour
-Visible respirations
IF WE SEE A LIFE THREATENING BLEED WE CORRECT IT HERE
Primary assessment:
Primary assessment is aimed at identifying life threats and correcting them as they are encountered.
The primary assessment for the major trauma patient includes: Assessment of LOA (AVPU), Airway, Breathing, Circulation, and C-Spine management. The final component is the Rapid Trauma Survey, which is a head to toe physical examination, identifying and correcting life threats prior to extrication and transport. The entire primary assessment has the following format:
C-Spine:
Have a partner maintain C-Spine and apply a collar when appropriate.
LOA:
Assess if the patient is alert, alert to verbal, alert to pain, or unresponsive.
ABC/CAB (in unresponsive patients begin with circulation):
Is the airway patent? Do you need to suction? Is an adjunct required?
Is the patient breathing? Is it adequate? If not have a partner initiate PPV or apply oxygen.
Does the patient have a pulse? Is cap refill <2 seconds? What is the patient's skin condition/colour (are they in shock)?
Rapid Trauma Survey:
Head: Assess for Contusions, Lacerations, Abrasions, swelling, deformity? Is there any evidence of ottorrhea, rhinorrhea, periorbital ecchymosis, or mastoid bruising? Are pupils PERRL?
Neck: Note any tenderness, instability, crepitus, or step deformity. Look for CLAPSD.
Chest: Palpate for tenderness, instability, crepitus, and subcutaneous emphysema. Look for CLAPSD, or paradoxical movement. Auscultate for adventitious sounds or diminished/absent breath sounds. Be aware of and address open chest wounds.
Abdomen: Palpate for tenderness, asymmetry, rigidity, and distension. Look for periumbilical ecchymosis, or flank discolouration. Assess for CLAPSD, evisceration or external bleeding.
Pelvis: Palpate medially for stability. Look for obvious priapism in males. Note bleeding.
Femurs: Palpate for stability and look for CLAPSD, or reported TICS.
Lower limbs: Palpate for TICS, look for CLAPS.
Upper limbs: Palpate for TICS, look for CLAPSD.
Correct life threats that are found.
Make a transport decision:
How are we extricating? Is there anything we need to do first?
Once in the ambulance:
Perform vitals, and additional treatments such as IV cannulation, fluid resuscitation, and pain management. Perform a detailed assessment of the patient including history of the event, past medical history, medications, and a detailed physical. Further splinting and dressing of less severe injuries can happen at this point as well.
The major takeaway here is that life threats need to be corrected, and the patient needs to be transported rapidly. Ultimately these patients need surgery, which we cant do for them. Time is something we can give them.
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