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Flashcards in Trauma Assessment And Management Deck (30)
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1

General impression:

Age
Sex
Weight
General appearance
Position
Purposeful movement
Obvious injuries
Skin colour
LIFE THREATENING BLEEDING

2

LOC

AVPU
Chief complaint / sx

3

ITLS Primary Survey:

Scene size-up
Initial Assessment
MOI: A.) Generalized / Unknown - Rapid Trauma Survey
B.) Localized MOI
Load-and-go situation?
ITLS secondary survey / ITLS ongoing exam

3

AVPU

Alert (alert, orientated, obey commands)
V - Respond to Verbal stimuli (awake but confused, or unconscious but responds in some way to verbal stimuli)
P - Responds to Pain (unconscious but responds in some way to touch or painful stimuli)
Unresponsive (no gag or cough reflex)

5

Airway (with c-spine control)

Snoring
Gurgling
Stridor
Silence

6

Breathing

Present?
Rate
Depth
Effort

6

Abnormal respiratory rates

Adult 24
Small child 35
Infant 60

7

Circulation

Radial / carotid present?
Rate
Rhythm
Quality
Skin colour
Temperature
Moisture
Cap refill
Has bleeding been controlled?

8

Rapid Trauma System

Head and neck
Chest
Abdomen
Pelvis
Lower / upper extremities
Posterior
Vital signs
Pupils
GCS

9

Head and neck

Wounds
Neck vein distention (tension pneumothorax / cardiac tamponade)
Tracheal deviation

10

Chest

Asymmetry (paradoxical motion)
Contusions
Penetrations
Tenderness
Instability
Crepitation
Breath sounds? Present? Equal? If unequal: percussion)
Heart tones

11

Decompress tension pneumothorax if

+ altered mental status
+ cyanotic
+ absent radial pulses

12

Abdomen

Contusions
Penetrations / evisceration
Tenderness
Rigidity
Distention

13

Pelvis

Tenderness
Instability
Crepitation

14

Lower / upper extremities

Obvious swelling
Deformity
Motor and sensory

15

Posterior

Obvious wounds
Tenderness
Deformity

16

Vital signs (if radial pulse present)

Measured pulse
Breathing
BP
HGT (if altered mental status)

17

SAMPLE hx

Symptoms
Allergies
Medications
Past med hx
Last oral intake
Events preceding the incident

18

If altered mental status: Brief neurological exam

Pupils: Size? Reactive? Equal?

GCS: Eyes, voice, motor

19

Focused exam

Focused exam of identified injury. Also evaluate the spine if distracting injury and any possibility of spinal injury.
If radial pulse present: Vital signs
If altered mental status: Brief neurological exam

21

Transport immediately:

Initial assessment: altered mental status / abnormal breathing / abnormal circulation
Signs during rapid trauma survey: penetrating wounds to torso / abnormal chest exam / tender, distended abd / pelvic instability / bilat femur #
Significant MOI and/or poor gen health

22

Priority patient

Dangerous MOI
High-risk group
Hx revealing: LOC / Difficulty breathing / severe pain of head, neck or torso
Initial assessment reveals: Altered mental status / abnormal breathing / abnormal circulation

23

ITLS Ongoing Exam done?

Every 5 min for critical patients
Every 15min for stable pt
Each time pt is moved
Each time an intervention is performed
Any time the pt's condition worsens

24

Procedure of ITLS Ongoing Exam

1. Complete SAMPLE hx.
2. Reassess mental status.
3. Vital signs (pulse, RR, BP, Pulse Oximeter, cardiac monitor, CO2 monitor, T)
4. Reassess ABCs:
- Airway (recheck patency / inhalation injury in burn victim)
- Breathing
- Circulation (skin colour, condition, temperature, cap refill)
5. BLEEDING STILL CONTROLLED?
6. Neck (obvious wounds, tenderness, swelling / JVD, tracheal deviation)
7. Chest (Asymmetry, contusions, penetrations, tenderness, instability, creps)
8. Breath sounds (present, equal, heart sounds)
9. Reassess abdomen (contusions, penetrations or evisceration, tenderness, rigidity, distention)
10. Check each injury.
11. Check interventions.
12. Recheck monitors.

25

ITLS Secondary Survey Procedure:

1. Repeat initial assessment.
2. Consider monitors.
3. Record vital signs again.
4. Brief neurological exam.
5. Detailed head-to-toe exam.

26

ITLS Secondary Survey Procedure:
Initial assessment:

General impression ( better, worse, unchanged)
LOC
Airway
Breathing
Radial pulse - carotid if no radial
BLEEDING STILL CONTROLLED

27

ITLS Secondary Survey Procedure:
Detailed Exam:

1. Pt hx (SAMPLE)
2. Vital signs
3. GCS
4. Head (DCAP-BLS, TIC) - pupils, Battles sign, Raccoon eyes, drainage from nose/ear
5. Neck (DCAP-BLS, TIC) - JVD, tracheal deviation
6. Chest (DCAP-BLS, TIC) - asymmetry
7. Breath sounds
8. Abdomen
9. Pelvis (DCAP-BLS, TIC)
10. Lower / upper extremities (DCAP-BLS, TIC) distal PMS
11. Posterior (DCAP-BLS, TIC)

28

Glascow Coma Scale:

Eye opening
- 4: spontaneous
- 3: to voice
- 2: to pain
- 1: none
Verbal:
5 - oriented
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - silent
Motor:
6 - obeys commands
5 - localizes pain
4 - withdraws
3 - abnormal flexion
2 - abnormal extension
1 - no movement

29

DCAP-BLS

Deformity
Contusions
Abrasions
Penetrations
Burns
Lacerations
Swelling

30

TIC

Tenderness
Instability
Crepitus