Prehospital Trauma Life Support

Lesson

Patient Assessment

Developed by the

National Association of Emergency Medical Technicians

In cooperation with

The Committee on Trauma, American College of Surgeons

This slide presentation is intended for use only in approved PHTLS courses.

3-1B

Lesson 3 Objectives

Define the global evaluation. Investigate the use of the primary survey. Identify life-threatening injuries. Define transportation and definitive care.

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Global Evaluation
You respond to a two-car collision on a

three-lane highway. One car is off the

road, and the other has struck a tree. Your unit arrives first.

What are your priorities? What are your SAFETY concerns at this scene?
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As you pull up, what concerns you most at this scene?

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What does this scene tell you about potential injuries?

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Primary Survey
Your patient is the 44-year-old male driver of a van which has struck a tree. When you move the airbag, you note a deformed steering wheel. This is your only patient, and he was not wearing a seat belt. What steps are you going to take in the assessment of this patient?
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Primary Survey
A - Clear. B - Rapid, shallow. Breath sounds clear. C - Weak, rapid radial pulse. Delayed capillary refill. No external hemorrhage. D - Responsive to verbal stimuli, anxious & confused. PEARL. E - No gross findings. Patient cold & shivering.
What do these findings suggest?
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Resuscitation
A - Airway compromise.

B - Inadequate ventilation, oxygenation.

C - Uncontrolled bleeding, tunnel vision. D - Decreased LOC, spinal involvement. E - Hypothermia.
Shock or impending shock? When would you manage these conditions?
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You may never get past the primary survey if the patients status is acute.

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Breathing
How would this

presentation affect
your priorities?

Pitfall: Waiting until the secondary survey to auscultate the lungs.

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Circulation
What would your priorities be here?

Pitfall: Not looking for other causes of shock when obvious bleeding is present.
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Disability
List your priorities.

Pitfall: Not treating for shock when the patient has an obvious head injury.
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Airway

What would your priorities be in caring for this patient?

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Expose
What would your priorities be in the care of this patient?

Pitfall: Not exposing a patient and thereby missing a potential life-threat.

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The goal of the primary

survey is to find and treat

life-threatening problems.

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Vital Signs
These vital signs are obtained for you.

Pulse 120. BP 116/90. RR 24. Skin cool and moist.

What is the importance of these vital signs? Would you treat the patient?
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Secondary Exam (Focused Exam)

Findings:
Negative Minor GCS

except for pain on palpation of left lower abdomen. lacerations of left leg. is 13.

When would you perform the secondary exam? Do these findings match the mechanism of injury? Would these findings alter your care?
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Secondary Survey Pitfalls

Completing a secondary survey on a patient before managing life-threats.

Failing to complete a secondary on a critical trauma patient after managing life-threats. Failing to complete a secondary on a stable patient.
Not obtaining the medical history on a trauma patient when possible.
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Trauma Triage
Based on:

Physiologic criteria.
Anatomic findings.

Mechanism of injury.

What are the criteria in your area?

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Transportation of the Critical Patient

Most timely method to get patient to definitive care:

Ground unit. Helicopter.

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Communication to Receiving Facility

Medical control.

Patient condition.
Current management. Potential complications.

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Pitfalls
Late notification -- Notification should take place as soon as possible, even if a detailed exam has not been completed. Failing to react to patient changes -Assess continuously during transport.
Notify receiving facility as soon as possible of significant changes in patient condition!
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Trauma Score
Respiratory Rate 10-24/min 24-35/min 36/min or greater 1-9/min None Normal Retractive 90 mm Hg or greater 70-89 mm Hg 50-69 mm Hg 0-49 mm Hg No pulse Normal Delayed None

continued...
4 3 2 1 0 1 0 4 3 2 1 0 2 1 0
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Respiratory Expansion Systolic Blood Pressure

Capillary Refill

Trauma Score
GLASGOW COMA SCALE Eye Opening Spontaneous To Voice To Pain None Oriented Confused Inappropriate Words Incomprehensible Words None Obeys Command Localizes Pain Withdraw (pain) Flexion (pain) Extension (pain) None

contd.

4 2 1 5 4 3 2 1 6 5 4 3 2 1
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Verbal Response

Motor Response

Trauma Score
Total Glasgow Coma Scale Points 14 - 15 = 11 - 13 = 8 - 10 = 5-7= 3-4= TOTAL TRAUMA SCORE 5 4 3 2 1

contd.

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Written Documentation
Well written.
Legal protection.

Case review.
Part of QI.

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Patient Assessment Summary

You cant TREAT what

you dont FIND.

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