Rapid Trauma Assessment/Assessing and Prioritizing Fractures

Rapid Trauma Assessment/Assessing and Prioritizing Fractures

Article Oct 30, 2005

Downloadable Instructor's Guides

Session Reference: 2

Topic: Rapid Trauma Assessment/Assessing and Prioritizing Fractures

Level of Instruction: 3

Time Required: 2 Hours

Materials:

  • Drill Transparencies/Blackboard
  • Overhead Projector
  • Screen
  • Live Victims
  • BSI

References:

  • EMT-B Bridge Student Guide, Lesson 1
  • Brady Emergency Care (9th ed.)

Preparation
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Motivation: Upon arrival on the scene, EMT-B's sometimes mistake dramatic fractures for life threatening injuries. The intent of this drill is to remind rescuers that extremity trauma rarely causes a life threatening situation. In cases where significant MOI exits, ABC's and Rapid Trauma Assessment is your first action.

Objective (SPO): The student will demonstrate a basic understanding of rapid trauma assessment, and prioritizing fractures.

Overview: Rapid trauma assessment, and assessing and fractures

  • Introduction
  • Rapid PA
  • Prioritizing fractures
  • Principles of treating fractures

Rapid Trauma Assessment/Assessing and Prioritizing Fractures

    SPO 1-1
    Describe the indications for performing a rapid trauma assessment

    EO 1-1
    Describe in order how to perform a rapid trauma assessment.

    EO 1-2
    Describe how to prioritize fractures.

    EO 1-3
    List the general principles for the management of suspected fractures or dislocations


Instructional Guide

Introduction

  • EMT-B's responding to incidents with a report of significant Mechanism of Injury, should be prepared to perform the following basic objectives:
    • Scene Survey
    • Simultaneous Actions (LOC, c-spine, jaw thrust)
    • Assessment of the airway
    • Assessment of breathing
    • Possible support of ventilation/supplemental 02
    • Assessment of circulation
    • Control bleeding
    • DCAP-BTLS patients entire body (Fx assessed and stabilized)
    • Determine if patient is a critical trauma
    • Load and go/ or treat patient at scene
    • Baseline vitals
    • SAMPLE HISTORY
    • Detailed physical exam
    • Ongoing assessment(en route to trauma center)
    Note: It is important to do a scene size up prior to starting patient care. Depending on the number of victims, and the MOI, your treatment can drastically change from incident to incident.

Rapid patient assessment

  • SCENE SURVEY
    • Body substance isolation
    • Scene safety/ Hazards
    • Determine MOI or NOI (mechanism of injury or nature of illness).
    • How many victims?
    • Are other resources needed?
  • SIMULTANEOUS ACTIONS
    • Determine LOC using the following scale:
      • A=Alert
      • V=Responds to verbal stimulus
      • P=Responds to painful stimulus
      • U=Unresponsive
    • Manually immobilize C-spine
      • Jaw thrust to establish airway if necessary
  • Assessment of AIRWAY
    • Jaw thrust needed?
    • Is airway open?
    • Inspect for foreign bodies
    • Need suctioning?
    • Consider airway adjunct
  • Assessment of BREATHING
    • Is it present?
    • Approximate rate
    • Character of respirations
    • Are respirations adequate?
  • Supporting VENTILATIONS
    • Give 15 lpm O2 via NRB if rate is greater than 8 and breathing is adequate
    • Bag Valve Mask w/reservoir and 15 lpm O2 at 24 per minute if:
      • Respiratory rate less than 8
      • Breathing is inadequate
      • Head trauma is suspected
  • Assessment of CIRCULATION
    • Carotid pulse
      • Present?
      • Approximate rate?
      • Character?
      What is the general skin color and temperature?
  • CONTROL BLEEDING
  • ASSESS THE HEAD (quickly through) DCAP-BTLS for obvious injury (inspect and palpate)
    • Deformity
    • Contusions
    • Abrasions
    • Punctures/penetrations
    • Burns
    • Tenderness
    • Lacerations
    • Swelling
  • Assess the NECK (anterior and posterior) DCAP-BTLS
    • Trachea: midline or deviated?
    • Jugular veins distended or flat?
    • Any signs of trauma?
    • Stoma?
    • Medic Alert Tag?
    • Apply a cervical spinal immobilization collar
  • Assess the CHEST
    • Expose, inspect and palpate the chest DCAP-BTLS
    • Auscultate Chest Bilaterally
      • Mid-clavicular
      • Mid-axillary
      • Compare sounds from side to side
    • Heart sounds
      • Present?
      • Same rate as pulse?
  • Expose, inspect and palpate abdomen DCAP–BTLS
    • Firm or Soft
    • Distended
  • Expose, inspect and palpate pelvis with gentle pressure downward and inward DO NOT ROCK! DCAP-BTLS
  • Expose, inspect and palpate LOWER EXTREMITIES DCAP-BTLS
    • Distal pulses
    • Motor function
    • Sensory function
  • CRITICAL TRAUMA SITUATIONS appropriate to LOAD and GO.
    • Stabilize patient on a spine board. Treat non-life threatening injuries en route. Do not waste time on the scene.
  • ASSESS BASE LINE VITALS, but do not delay critical treatment or transport. They can be done en route.
    • Pulse
    • Respirations
    • Blood pressure
    • Skin color, temperature, moisture
    • Pupils
  • SAMPLE HISTORY
    • Symptoms and signs
    • Allergies
    • Medications
    • Past illness
    • Last Meal
    • Events prior
  • Detailed Physical Examination en route to trauma center (old secondary survey).
  • Repeat and record findings of initial assessment every five minutes

Prioritizing and assessing extremity fractures

  • Problems that demand care before joint and bone injuries
    • Airway
    • Breathing
    • Circulation
    • Disability
    • Shock
    • Neck and spinal injuries
    • Open chest wounds
    • Open abdominal wounds
    • Serious burns
  • Priority of care for fractures
    • Fractures of the spine
    • Fractures of the head, rib cage, and pelvis
    • Fractures of the extremities
  • Priority of care for extremity fractures
    • Lower extremities before upper extremities
    • Pelvis
    • Femurs
    • Joints
    • Long bones

General Principles for management of suspected fractures or dislocations

  • Assessment and treatment of the fracture
    • Calm and reassure the patient.
    • Recognize and assess fracture or dislocation.
    • Cut away clothing and remove jewelry from the injury site.
    • Splint fractures in a manner that immobilizes the joint above and below the fracture site.
    • All fractures should be splinted in the position of function without using excessive force or causing the patient to experience extreme pain.
    • Distal pulses and neurological function should be checked before and after splinting.
    • Straighten angulated fractures of long bones with gentle traction prior to splinting.
    • Cover all open wounds with sterile dressings prior to application of a splint.
    • Pad all splints to prevent excessive pressure.
    • Apply cold packs to ischemic fractures, from site of injury to distal end.
    • Immobilize fractures prior to movement of the patient.
    • Leave fingers and toes exposed if possible.
    • Wrap extremities distal to proximal.
    • Splints should not impair circulation
    • Elevate the extremities following immobilization where possible (not if the patient has a potential c-spine injury).
    • kling is used for upper extremity fractures, and 6" kling is used for lower extremity fractures.
    • When in doubt, SPLINT.

Summary

Review: Rapid Trauma Assessment/Assessing and Prioritizing Extremity Fractures

  • Introduction
  • Rapid PA
  • Prioritizing fractures
  • Principles of treating fractures

Remotivation: EMT-B's responding to incidents with a report of significant MOI should be prepared to triage, and do rapid patient assessment. Remember that extremity trauma may look dramatic, however, it is rarely life threatening.

Assignment: Create mock situations giving victims significant mechanism of injury. Assign each victim two life threatening injuries, and four extremity fractures.


Evaluation Students should demonstrate a rapid trauma assessment, and tell the instructor the priority of all fractures found during the assessment.

Copyright © 2002 Maryland Fire and Rescue Institute. All rights reserved.

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