Trauma Assessment

Sir Young

Sir Young

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Hey ladies and gents! I'm currently about 1/3 the way through my EMT class and just had a simple question for you. I'm taking my lab portion of my class tuesday, and one of the areas being covered is trauma assessment. I was just curious if you folks had any suggestions for remembering the order of assessing a trauma. Thanks! :wacko:

-Mike
 
Sir Young said:
Hey ladies and gents! I'm currently about 1/3 the way through my EMT class and just had a simple question for you. I'm taking my lab portion of my class tuesday, and one of the areas being covered is trauma assessment. I was just curious if you folks had any suggestions for remembering the order of assessing a trauma. Thanks! :wacko:

-Mike
Click to expand...

Go over it. And then go over it. And go over it again. Think about it whenever you have the chance. Go over it before you go to bed, when you wake up, when you eat, whenever. Basically, just run through it as many times as you can. Run through it in your head when you have a free moment.

If you just put your mind to it, honestly, it's not that hard. If you can, find a friend and do it on them.

Good luck!
 
Figure out what they want and memorize it.

Write checklists.
Draw a picture of a pt or something and point to what will do next, first using the checkllist, then check it against the checklist.
Drill with a partner.
Read it on the john, instead of TV, and despite TWITTER, facebook etc.
 
I wrote it down over and over again until I could write it without looking.
 
Thanks for all the replies thus far. I'll keep those i mind while studying. I remember my instructor saying there was a group of people that went thru and taped their entire NREMT-B physical portion on youtube. Anyone happen to remember the name? I want to say it was similar to DCMS or the like.
 
ABC, then head to toe. DCAPBTLS on all parts.


Fix the problems you see and can correct.



ABCs clear?
Palpate the head.
Check pupil reaction
Check for CSF in ears / nose
Palpate the neck, check for tracheal deviation and JVD.
Palpate chest. Check for broken ribs
Ascultate lung sounds
Check the abd... careful about palpation.
If you feel risque, listen to bowel sounds.
Check hips.
Extremeties. Check for CMS.
 
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If you can remember the acronyms

BSI/SS
ABC
SAMPLE (for medical)
DCAPBTLS (head to toe)

you should be fine
 
A fun exercise

Here's a little trick I used to do in training.

a "practice team" of three people
one is the "Patient"
one is the "Examiner"
the third "Observer"

Examiner leaves the room, leaving Observer and Patient alone.

Patient lies in an agreed upon position (Could be sitting, standing, in the midst of a "staged" accident with debris, inaccessibility included...make it FUN!)

Observer places a "booby trap" on the patient...something detectable (start with palpable, like a ping pong ball duct taped to an elbow, simulating a fracture, or a sealed glad bag filled with jelly duct taped over the sternum or ribs...get more elaborate and imaginative as you go)

Examiner is let in (as if coming into a scene blind) Observer watches as the Patient is examined thoroughly, and then is evaluated for "catching' or "missing" the planted injury.

At first, have the Examiner call out each element of the exam until it's rooted in, then go silent. This is a good thing to use on experienced medics, too.
 
Sir Young said:
Hey ladies and gents! I'm currently about 1/3 the way through my EMT class and just had a simple question for you. I'm taking my lab portion of my class tuesday, and one of the areas being covered is trauma assessment. I was just curious if you folks had any suggestions for remembering the order of assessing a trauma. Thanks! :wacko:

-Mike
Click to expand...

Assign a number to each of the tasks and list them 1-35 for example. Start at 1 and end at 35 on a sheet of paper until you can run the whole sheet on a blank sheet of paper (I made a sheet for students). With hands on..repeat. 6-7 times and ya have it down! As you learn more about the assessment if's, and's, what's and why's, you will begin to put it together. Good luck. :)
 
I was just curious if you folks had any suggestions for remembering the order of assessing a trauma. Thanks!
Click to expand...

Just out of curiosity, has your teacher given you any assessment skeletons to use?
ie: SCLABOCAB(LIFE), SABCDEFGHIJKL or anything similar

Go over it. And then go over it. And go over it again. Think about it whenever you have the chance. Go over it before you go to bed, when you wake up, when you eat, whenever. Basically, just run through it as many times as you can. Run through it in your head when you have a free moment.

If you just put your mind to it, honestly, it's not that hard. If you can, find a friend and do it on them.
Click to expand...

Repetition is what really worked for me.

I would write it out 3 times a day. After breakfast, then before lunch and dinner.
Compare it to my original skeleton and then write in and highlight the steps I missed.

Eventually it became second nature and I could pretty much visualize the whole process.
 
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This the way I learned it, up to you if you want to use it -

1) BSI!

2) PENMAN (Scene Size Up)
- Personal/Partner/Patient Safety
- Environmental Hazards
- Number of Patients
- Mechanism of Injury/Nature of Illness
- Additional Resources Needed
- Need for Extrication/Spinal Immobilization

3) ABCDEF (Primary Assessment)
- Airway
- Breathing
- Circulation
- Disabilities/Deformities
- Expose Chief Complaint
- Formulate Field Plan (Treatment/Transport)

4) SAMPLE/OPQRST/DCAPBTLS (Secondary Assessment)
- Everyone gets a SAMPLE
- Medical patients get an OPQRST (may be used for trauma if necessary)
- Rapid/Detailed Full Physical for Major Trauma or Unconscious Medical
- Focused Pysical on Minor Trauma or Conscious Medical

5) Ongoing Assessment & Ongoing Vitals
 
I met my study group in our lab before class a couple times a week and we ran trauma and medical scenarios over and over until we could assess forward and in one exceptionally funny case, backwards. Three out of four of my study group got a perfect score, including myself on our skills test :P
 
Raziel said:
I met my study group in our lab before class a couple times a week and we ran trauma and medical scenarios over and over until we could assess forward and in one exceptionally funny case, backwards. Three out of four of my study group got a perfect score, including myself on our skills test :P
Click to expand...

Trying to run it backwards is actually a good idea. It shows you really know what you're doing.
 
Start at the head, work your way down to the legs/feet. Do the arms/hands last.

At the head, palpate the scalp and cheeks/facial bones/neck. Examine the eyes with a penlight, the mouth, nose, and ears. Palpate the clavicles, the sternum, listen for breath sounds. Palpate the abdomen, test the stability of the pelvis...press down towards the ground, then in from both sides. Feel down both legs, anterior and posterior. Check the feet for PMS. Then go up and check the arms anterior and posterior, and check the hands for PMS. Check the back last...you may have to do this when you log-roll your patient.
 
I passed. Woo! I missed checking the genitalia for incontinence. Other than that I was spot on. Thanks for all the suggestions, they worked. :)
 
They don't mention smelling do they?

Good for detecting incontinence, ketones, BO, aftershave...actually, it makes you suspicious to look into something more or suspect it.
 
This is something that really takes practice and repetition to get good at. Just remember, for all assessments (medical or trauma) you do the scene size up at the beginning, not matter what.

Scene Sizeup:
BSI
Scene safety
# of patients
MOI/Nature of illness
Needed resources
Consider C-Spine

and than, the General Impression is gathered and the LOC and ABCs are evaluated, making sure to stop and correct any issues with the ABCs like snoring respirations or absent heartbeat, etc.

After that, you must verbalize the patient's priority for transport. (Up until this point, you are following the same thing as you would for trauma or medical, and now you split off and go down the trauma route)

Does this patient need a rapid whole body exam for a generalized MOI, or a focused history and physical for a localized MOI and complaint? Example: falling from a ladder gets a rapid trauma exam, while cutting oneself on a saw blade and being sure nothing else was injured would probably get a focused history and physical.

Make sure now to gather vital signs and history, transport the patient, and preform you detailed and ongoing assessments in route while treating to your capacity at your license level.


After you read my post, it is time to start writing out word for word the national registry skill sheet onto another piece of paper. Verbalize an entire assessment in the shower or while driving. Practice on a stuffed animal and have a friend make sure you hit all the points. We all went through it and lots of people are able to do it every semester so don't worry.
 
In paramedic school they aren't allowing us to verbalize with abbreviations anymore. For BSI we must say Body Substance Isolation, and for DCAP-BTLS we must say Deformity, Contusion, Abrasion, Puncture, Burn, Tenderness, Laceration and Swelling. You just say it that once then you can abbreviate, it was found people didn't know what it stood for because they were just use to the abbreviation.
 
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