Principles of Patient Assessment in EMS By Bob

Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

Chapter 7 – Focused History & Physical Exam Trauma Patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives n n n Explain how the EMS provider’s assessment of the MOI is critical to the management of the trauma patient. Explain how the EMS provider’s “index of suspicion” relates to the MOI. Describe the two major factors affecting injuries to the body. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) n n Describe how the “golden hour” and the “platinum 10 minutes” pertain to the critical trauma patient. Explain why the SAMPLE history is important to the management of the critical trauma patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) n Explain why the EMS provider should complete a full assessment on the minor trauma patient who appears to be intoxicated or has an altered mental status. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Introduction n In U. S. trauma is the leading cause of death (ages 1 to 44) Many MOI have predictable patterns Evaluation of MOI is essential. Top MOIs: Motor vehicle crashes n Falls n Poisoning n Burns n Drownings n © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Reconsider MOI n n Early evaluation of the MOI should guide the EMS provider to suspect certain injury patterns “Index of suspicion” – injury patterns help the EMS provider anticipate the potential for shock or other problems © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Reconsider MOI (continued) n 2 major factors for injuries are: The amount of energy exchanged with the body n The anatomical structures involved n n Inappropriate identification of MOI may result in incorrect treatment and high mortality rates © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Reconsider MOI (continued) n “Index of suspicion” for a spinal injury: n Cracked windshield n Bent steering wheel n Dented dashboard n Side door intrusion into motor vehicle © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI n n The presence of a significant MOI is a key decision point in the assessment algorithm This key decision point can make a significant impact on the life or death of a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) n Key decisions regarding the MOI should help the EMS provider: Minimize scene time n Quickly perform a rapid trauma assessment n Perform life-saving procedures n Transport to the appropriate facility n © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) n Consider the following questions: How long ago did this happen? n How fast or what velocity was involved? n How hard was the impact or surface impacted upon? n How high did the patient fall from? n How far did the patient travel before stopping? n © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) n n Distracting injuries can keep more serious injuries from being discovered quickly Scene management can also cause delays: Multiple patients n Relatives n Bystanders n Other rescuers n n Minor trauma can appear serious at first © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Significant Trauma n n Detailed observation is key to managing the patient with significant trauma Don’t be distracted by less serious injuries © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Golden Hour n n Time is a critical factor for the patient with a significant MOI Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Platinum Ten Minutes n The maximum time EMS providers stay on the scene for a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) n Quick and systematic exam of these body sections: n n n Head Chest Abdomen Pelvis Extremities Back/buttocks © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) n n n After the RTA obtain baseline VS and a SAMPLE history When the patient is unresponsive obtain the information from bystanders, relatives, or other first responders Do not extend the scene time to obtain info © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) n n Perform a detailed physical exam enroute Transportation destination depends on the needs of the patient and capabilities of a trauma center as well as your local protocols © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) n All your efforts on the scene and enroute may be for naught when a critical trauma patient is transported to an inappropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Ongoing Assessment (OA) n n n Repeat IA, reassess VS, and interventions Repeat OA every 5 minutes on critical trauma patients In cases of short manpower or short transport time – performing the OA takes priority over the DPE © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Minor Trauma n Examples: Isolated extremity injury n Minor burns n Small lacerations or abrasions n n An exception would be a minor injury with an altered mental status or intoxication © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Focused Physical Exam: Assess n n n n D – deformity C – contusions A – abrasions P – punctures/penetrations B – burns T – tenderness L – lacerations S – swelling © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Focused Physical Exam: Assess n n n Range of motion (ROM) Pulse, motor, and sensation (PMS) Skin color, temp. and condition (CTC) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Additional Steps in Minor Trauma Patient Assessment n n n Develop a treatment plan Perform interventions(s) Obtain baseline VS Obtain SAMPLE history Perform OA every 15 minutes © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion n EMS providers can make a significant impact on the life or death of a critical trauma patient by: n Minimizing scene time n Performing a RTA n Performing life-saving interventions n Transporting to an appropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion n The decision point as to the presence of a significant MOI will predicate the extent of exam, speed, priority of transport, and destination © 2003 Delmar Learning, a Division of Thomson Learning, Inc.