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Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ansFull Set of VS & Family Presence G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ansGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL
- Makes no sounds
- Makes sounds
- Words
- Confused, disoriented
- Oriented, converses normally MOTOR
- Makes no movements
- Extension to painful stimuli (decerebrate)
- Abnormal flexion to painful stimuli (decorticate)
- Withdrawal to painful stimuli
- Localizes painful stimuli
- Obeys commands H (Secondary Survey) - ansHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury.
H: Head and Face Head to Toe Assessment (secondary survey) - ansSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9- 12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ans1. Preparation and Triage
- Primary Survey
- Reevaluation
- Secondary Survey
- Reevaluation Adjuncts
- Reevaluation and Post Resuscitation Care
- Definitive Care or Transport Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment of abdomen. Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr meningococcal and pneumococcal vaccines. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ansSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ansA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ansBreathing and Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathing present: NRB. Determine if ventilation effective: etCO2 35 - 45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ansCirculation and Control of Hemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein. Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ansFull Set of VS & Family Presence G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ansGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL
- Makes no sounds
- Makes sounds
- Words
- Confused, disoriented
- Oriented, converses normally MOTOR
- Makes no movements
- Extension to painful stimuli (decerebrate)
- Abnormal flexion to painful stimuli (decorticate)
- Withdrawal to painful stimuli
- Localizes painful stimuli
- Obeys commands H (Secondary Survey) - ansHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury.
H: Head and Face Head to Toe Assessment (secondary survey) - ansSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9- 12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ans1. Preparation and Triage
- Primary Survey
- Reevaluation
- Secondary Survey
- Reevaluation Adjuncts
- Reevaluation and Post Resuscitation Care
- Definitive Care or Transport Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment of abdomen. Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr meningococcal and pneumococcal vaccines. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ansSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ansA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ansBreathing and Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ansCirculation and Control of Hemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein. Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ansFull Set of VS & Family Presence G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ansGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL
- Makes no sounds
- Makes sounds
- Words
- Confused, disoriented
- Oriented, converses normally MOTOR
- Makes no movements
- Extension to painful stimuli (decerebrate)
- Abnormal flexion to painful stimuli (decorticate)
- Withdrawal to painful stimuli
- Localizes painful stimuli
- Obeys commands H (Secondary Survey) - ansHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury.
H: Head and Face Head to Toe Assessment (secondary survey) - ansSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9- 12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ans1. Preparation and Triage
- Primary Survey
- Reevaluation
- Secondary Survey
- Reevaluation Adjuncts
- Reevaluation and Post Resuscitation Care
- Definitive Care or Transport Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment of abdomen. Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr meningococcal and pneumococcal vaccines. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ansSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ansA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ansBreathing and Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ansCirculation and Control of Hemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein. Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ansFull Set of VS & Family Presence G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ansGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL
- Makes no sounds
- Makes sounds
- Words
- Confused, disoriented
- Oriented, converses normally MOTOR
- Makes no movements
- Extension to painful stimuli (decerebrate)
- Abnormal flexion to painful stimuli (decorticate)
- Withdrawal to painful stimuli
- Localizes painful stimuli
- Obeys commands H (Secondary Survey) - ansHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury.
H: Head and Face Head to Toe Assessment (secondary survey) - ansSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9- 12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ans1. Preparation and Triage
- Primary Survey
- Reevaluation
- Secondary Survey
- Reevaluation Adjuncts
- Reevaluation and Post Resuscitation Care
- Definitive Care or Transport Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain
