Warning: This
presentation
has extremely
graphic
pictures!
Initial Assessment
Trauma
Physical Exam
HOSP
Detailed Ongoing
Physical Exam Assessment
Scene Size-Up
Initial Assessment
Trauma
Physical Exam
HOSP
Detailed Ongoing
Physical Exam Assessment
Assessing the Trauma Patient
Gunshot wounds
Mechanism of Injury
Velocity
Low velocity–knife
Medium velocity–handgun, shotgun
(generally less than 2,000 feet-per-minute)
High velocity–rifle (generally greater than
2,000 feet-per-minute)
Thorax:
Vasular: Blood and muscle is more dense than
lung tissue, therefore it is more susceptible to
shock waves in addition to the bullet track.
Injuries include damage to the aorta and the
superior vena cava as well as injury to the heart
muscle.
Penetrating Trauma Injuries
Thorax:
Gastrointestinal: The esophagus is located in
the thorax and may be injured by the bullet track
Injuries include damage to the esophagus as
well as spilling any contents into the thoracic
cavity which can lead to infection.
Punctures/Penetrations (Gunshot wounds)
Penetrating Trauma Injuries
Abdomen:
Solid organs: The solid organ of the abdomen
are very susceptible to direct injury as well as
injury from the shock wave.
Injuries include direct and shock wave
damage to all of the solid organs such as the
liver, spleen, pancreas, and the kidneys in the
retroperitoneal space. Let’s not forget about the
bladder, uterus, ovaries, gall bladder, and major
blood vessels such as the vena cava and the
aorta.
Penetrating Trauma Injuries
Abdomen:
Bones: The pelvis is a very vascular organ.
Fracture of the pelvic due to a gunshot wound
can lead to major blood loss
Injuries are generally limited to direct bullet
track damage. The bone fragments may
become secondary missiles and cause
additional damage.
Shotgun Wounds
D = Deformities B = Burns
C = Contusions T = Tenderness
A = Abrasions L = Lacerations
P = Punctures/ S = Swelling
Penetrations
Significant Mechanism
of Injury
...is serious!
Blood Loss
Uncontrolled bleeding or
significant blood loss leads to
shock (hypoperfusion) and
possibly death!
Do not wait for signs and
symptoms to appear before
beginning treatment!
Internal Bleeding
Signs & Symptoms
of Internal Bleeding
Significant MOI
Pain, tenderness, deformity, swelling,
discoloration
Bleeding from the mouth, rectum, or
vagina
Tender, rigid, or distended abdomen
Maintain airway; administer oxygen.
Control external
bleeding.
Elevate lower extremities 8-12 inches.
Prevent loss of
body heat.
Transport immediately.
• 10. As you monitor the patient that you believe is going into shock, one of
the last signs you should expect to see is:
• A. An increased pulse rateC. Increased respirations
• B. Decreased blood pressure D. Cool, clammy, pale skin
Contact Information
Renee Anderson
andersr@inhs.org
509-232-8155