# Trauma Assessment and Medical Assessment



## Noctis Lucis Caelum

Whats the difference between Trauma and Medical assessment
during the detailed physical examination?  Beside the fact of "mechanism of injury" and "nature of illness"

Trauma we search for DCAP BTLS
Medical we don't use DCAP BTLS

But two of my instructors in my class says DCAP BTLS in medical is fine.
I'm kinda confuse cause some people failed our primary and secondary assessment testing because of this.


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## rmellish

Since I'm assuming you're talking about skill sheets more than real world assessment...

Medical assessment focuses more on a description (read: specific questions regarding) symptoms. OPQRST for pain and other symptoms. Medical assessment is more subjective and requires more interaction with the patient on a BLS level. 

If you're asking questions more related to real world assessment, then the above does not even approach an answer to your question.


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## Hastings

In terms of physical assessment? Well, it's typically more focused on / dictated by the patient's Chief Complaint. Trauma is the one where you check absolutely everything.

Holding C-Spine would be a clear difference. Other than that, in testing, you can't really be wrong if you do a trauma physical assessment both trauma and medical patients. Just make sure you focus on the CC for a medical.

But then again, I don't think I really understand the question.


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## Ridryder911

Medical assessments are more based upon *subjective *assessments (patients feel, i.e nausea, pain, vertigo, etc) the examiner obtains this through history, history, history. And of course then performing a detailed assessment. 

Trauma is mainly focused upon *objective* data, things the medic can see)angulated fxr arm, open lacceration, arterial bleed). Sure, one needs to obtain an history but one can usually identify the MOI, etc. MVA, GSW, etc.. As well the injuries will be externally/internally, the reason for "hands on examination". 

In real life, it is highly probable to have a mixture need for both assessment techniques. For example AMI causing an MVA, or granny that has a syncopal episode while taking a shower ... 

Now when performing a thorough examination one can and should use both techniques when performing an examination. So yes, DCAP, BTLS can be used. Again, though one should be able to differentiate when it is *appropriate* and *warranted*. 

One would not perform DCAP BTLS on a patient with only c/c of diarrhea and no hx of trauma, etc... 

R/r 911


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## chillyFF

From personally experience always try to do a DCAP-BTLS survey with in reason.  But it will save your butt with nursing home patients or "simple" transfers exspecially.  You might be the one to find a hidden injury or a problem that has been over looked by other providers.


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## Hastings

Can someone explain what DCAP BTLS is? I've never heard of it.


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## chillyFF

Don't carry a patient by their lingerie straps= DCAPBTLS


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## JPINFV

Hastings said:


> Can someone explain what DCAP BTLS is? I've never heard of it.



It is probably one of the worse acronyms ever invented. 

Deformities
Contusions
Abrasions
Punctures, Penetrations
Bleeding/Burns/Bruises
Tenderness
Lacerations
Swelling


Or as I distilled it down to, "if it's not normal, write it down."


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## Hastings

JPINFV said:


> Or as I distilled it down to, "if it's not normal, write it down."



I've always used that method, and will continue to.

Thanks.


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## Noctis Lucis Caelum

Ridryder911 said:


> Medical assessments are more based upon *subjective *assessments (patients feel, i.e nausea, pain, vertigo, etc) the examiner obtains this through history, history, history. And of course then performing a detailed assessment.
> 
> Trauma is mainly focused upon *objective* data, things the medic can see)angulated fxr arm, open lacceration, arterial bleed). Sure, one needs to obtain an history but one can usually identify the MOI, etc. MVA, GSW, etc.. As well the injuries will be externally/internally, the reason for "hands on examination".
> 
> In real life, it is highly probable to have a mixture need for both assessment techniques. For example AMI causing an MVA, or granny that has a syncopal episode while taking a shower ...
> 
> Now when performing a thorough examination one can and should use both techniques when performing an examination. So yes, DCAP, BTLS can be used. Again, though one should be able to differentiate when it is *appropriate* and *warranted*.
> 
> One would not perform DCAP BTLS on a patient with only c/c of diarrhea and no hx of trauma, etc...
> 
> R/r 911





chillyFF said:


> From personally experience always try to do a DCAP-BTLS survey with in reason.  But it will save your butt with nursing home patients or "simple" transfers exspecially.  You might be the one to find a hidden injury or a problem that has been over looked by other providers.




K from R/r and ChillyFF response i understand when they says one would NOT perform DCAP BTLS on a patient which only c/c of diarrhea and no hx of trauma, etc..PERFECTLY understandable

One of my squad members failed the test because it was on "Unknown Medical"  He did everything right, but when he went on to secondary assessment into the detail physical examination.  When he began and stated "Visualizing for DCAP BTLS and scars on the head"

The teacher told him "your responding to a medical'

Again he went on next to the face and stated "visualing for DCAP BTLS and equality of facial muscles"

From that point on, the instructor who was testing him stopped him and the test and he was done from then on and he failed.

So here i'm thinking i don't think he should have failed because did something more than he shouldn't.  But i'm just a student so i would like to hear you guys input, thank you for responding!


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## micsaver

chillyFF said:


> Don't carry a patient by their lingerie straps= DCAPBTLS


ROTFLMAO!!!! that was awesome! Thanks! LOL!

One of the differences between the med exam and the trauma exam on my MA practical was in medical SAMPLE came before VITALS, reasoning was that you may want to work on the sample before the pt becomes unconscious. In the real world one person may be asking the SAMPLE qts while the other person is getting vitals.


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## Noctis Lucis Caelum

Yeah pretty much, delegate baseline vitals to additional resources IE firefighters or extra emt's


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## mycrofft

*Well I never did a med exam under a car slowly sinking in mud.*

"House, MD" would be ashamed of you-all. People lie, especially my people (inmates). 
We (the second ambulance co I worked for) hired a CPR teaching instructor who acted like the one cited above. After one lesson we unspokenly boycotted the next class. 
A third rate instructor subjectively applies an algorithm for evaluation. A second rate instructor applies it strictly. A first rate one know what the algorithm _*means*_ and uses that as the basis for evaluation and instruction, or either discards it entirely, or folds up Resusci-Annie and goes home.
*In time and with experience *you can quickly get a feel for what is likely "up" and look for exceptional signs and symptoms to prove yourself wrong while you zero in on the most dangerous complaint. Sometimes it is not the pt's primary c/o or most vivid presenting affect. My use of this for "medical exams" as it is for field rapid assessments is because I have a doctor to back me up, little time for limitless patients, and I can call the pt back in tomorrow (if he hasn't already returned) to check up on him.
Oh, and I have a grand jury looking over my work every year, too!


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## Scout

On the co worker failing, i could see a senario where the instructer flet he did not listed to what he had been told, ie medical cas, and that maybe the candidate just had a series of steps he was doing without listening?


Maybe if he stated that he realised it was medical he would like to do a fulll trauma assesment to check no other injuries were present or something along those lines.

Sounds strange yto fail thou if he "ticked" the boxes on medical as well as trauma


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## Buzz

These guys have pretty much nailed it. Especially Rid, which is not surprising at all. My all time favorite mixture of the two is having an Abnormal Labs patient that falls during the time you're en route to the facility. Or  a peg tube patient that has a large amount of necrosis and obvious deformity on their foot. It was oozing and obviously needed attention. I tend to always do a quick look over the patient for trauma signs on all medical calls as well, particularly if the patient is a child, psych, or geriatric and something just feels off. When I took my practical exam, I did the medical assessment exactly as it was written and added some extra things I'd make note of but I did that after we were "en route" and I was to the part where you repeat the vitals every 5 or 15 minutes.


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## traumateam1

Medical is 80% questions and 20% physical exam.
Trauma is 80% physical and 20% questions.
That's the difference B)


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## JPINFV

traumateam1 said:


> Medical is 80% questions and 20% physical exam.
> Trauma is 80% physical and 20% questions.
> That's the difference B)



True, but I'm not going to ignore trauma signs (old or new) in a medical patient either. Similarly, I'm not going to ignore medical signs in a trauma patient.


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## BossyCow

Or the 'stomach flu/belly pain' little old lady my husband took in that confessed enroute to being shot in the stomach with a 22 by her husband 3 days prior. (Tiny little hole)


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## traumateam1

JPINFV said:


> True, but I'm not going to ignore trauma signs (old or new) in a medical patient either. Similarly, I'm not going to ignore medical signs in a trauma patient.



Oh don't get me wrong, I wasn't trying to say that at all. I would hope that you wouldnt ignore trauma signs (new or old) in the medical p/t, and similarily I hope you wouldn't ignore the medical signs (new or old) in the trauma patient.


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## Noctis Lucis Caelum

traumateam1 said:


> Medical is 80% questions and 20% physical exam.
> Trauma is 80% physical and 20% questions.
> That's the difference B)



Thank you for that, you sumed up the answer for me or the answer i was looking for.



traumateam1 said:


> Oh don't get me wrong, I wasn't trying to say that at all. I would hope that you wouldnt ignore trauma signs (new or old) in the medical p/t, and similarily I hope you wouldn't ignore the medical signs (new or old) in the trauma patient.



Yes, i wouldn't ignore trauma signs new or old in medical and vice versa during a medical in trauma.  My question was pretty much why would he fail one of my squad member because he assessed for dcap btls during medical call even though he did the medical part also.


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## JPINFV

^
Because people are idiots. Because sometimes the students are more intelligent than the instructors. Because some people can only operate on the same level as Pavlov's dogs. I wish I had a better answer than that, but that's all I can come up with.


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## Meaganbutterflyemt

*Patient Assessment*

*Scene Size Up: BSI, Scene Safety, Additional Resources needed? MOI or NOI number of patients.

Initial Assessment: General Impression, Mental status(AVPU) ABC's Treatment and Transport Priority.*

*Rapid Assessment & Physical Exam - Trauma (Significant MOI) 
From Scene Size up and Initial assessment *
1. Spinal stabilization 
2. Rapid assessmnet = Inspect and palpate each body area (DCAP-BTLS) 
Head, Neck (stablize) Chest, Abdomen, Pelvis, Extremities, Posterior
3.Basline Vital Signs
4. Sample History if possible. 

If Stable do a Detailed physical Exam then do ongoing assessment


If not stable Transport detailed exam enroute. If stable ongoing assessment; if unstable transport ongoing assessment enroute.


*Rapid Assessment Physical Exam- Medical: Unstable
From Scene Size up and Initial assessment

1. Perform interventions
2. Foucused Physical Exam 
3. Inspect and palpate complaint area
4. History of Present Illness (Chief complaint - NOI)
5. Focused History if possible
SAMPLE
6. Baseline Vital signs.

Detalied Physical Exam 
Ongoing assessment 


Focused History and Physical Exam- Trauma No Significant MOI
From Scene Size up and Initial assessment

Chief Complaint

1. Focused Physical Exam Inspect and palpate sites
2. DCAP-BTLS
3. Focused History 
SAMPLE

Detailed physical exam
Ongoing Assessment

Focused History and Physical Exam - Medical:Stable
From Scene Size up and Initial assessment

History of present illness(chief complaint - NOI)
1. Foucused History 
SAMPLE

Focused Physical Exam Inspect and palpate complaint area 
Basline vital signs.


If Stable do a Detailed physical Exam then do ongoing assessment


If not stable Transport detailed exam enroute. If stable ongoing assessment; if unstable transport ongoing assessment enroute.

Change Patient Status from low to high or high to low priority at any point nessary during assessment

Perform interventions as needed throughout assessment
Contact communications to request secial/additional personnel/equipment, consult medical control for direction etc.*


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## Ridryder911

Here we *again*. Unfortunately, we * again* are polluting and confusing medicine as to break down into segments. Alike BLS and ALS.

In medicine there really is not a a quote medical exam nor trauma.. an assessment is an assessment. We have developed general forms or methods to ensure a systematic and flow of an assessment is performed, so one does not miss a crucial area. Yes, technically one could perform a toe to head and still be right, but is much easier and correct life threatening problems if one does the opposite. 

If one was performing an assessment on a geriatric patient and that was c/o chest pain, then finds an angulated extremity would it be a trauma or medical assessment? 

Does one not listen to heart tones when performing a trauma assessment? Does one not examine for bruising on a medical assessment? Certainly.

Now, whit that saying. One will generally focus upon the chief complaint or MOI. In other words, one is not to take the time initially to listen to bowel sounds (which technically takes 3-5 minutes per quadrant) in a true trauma patient. Not saying, it won't be done later on when the patient is more stabilized, but again priority is examined. 

Should the student describe and say DCAP BTLS .. probably not. It was a medical exam and the point is to be able to differentiate the two. Wrong, not really but again it just demonstrates the student did not understand the differential or be able to prioritize properly. 

R/r 911


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## EMT-P633

Senbonzakura said:


> K from R/r and ChillyFF response i understand when they says one would NOT perform DCAP BTLS on a patient which only c/c of diarrhea and no hx of trauma, etc..PERFECTLY understandable
> 
> One of my squad members failed the test because it was on "Unknown Medical"  He did everything right, but when he went on to secondary assessment into the detail physical examination.  When he began and stated "Visualizing for DCAP BTLS and scars on the head"
> 
> The teacher told him "your responding to a medical'
> 
> Again he went on next to the face and stated "visualing for DCAP BTLS and equality of facial muscles"
> 
> From that point on, the instructor who was testing him stopped him and the test and he was done from then on and he failed.
> 
> So here i'm thinking i don't think he should have failed because did something more than he shouldn't.  But i'm just a student so i would like to hear you guys input, thank you for responding!



That is one of the differences from the school / test world and between the real world.


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## BossyCow

I hate the curriculum that teaches the students how to test. How to perform a set task to a set of criteria. There is little or no understanding of why something is done a certain way or what happens if...

Unfortunately, you have to learn to pass the practicals according to the instructor who is evaluating.


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## Meaganbutterflyemt

In Maryland Exam we are required to say DCAP-BTLS then explain what they are. As going through the assessment while checking each thing again we are to say im looking for DCAP-BTLS.


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## mycrofft

*Some folks need that acronym when all else is going west.*

(or "South" to us Yanks).
I like Rid's input.
 My spin is that by "trauma" maybe they mean "field EMS"? You need to avoid being too fast or too focused so you don't miss the "unobvious yet important", which we are prone to do when tired, new, or burned out. Like dancing, you need to learn the steps, but you get good when you have a good partner and lots of practice. And there is always that loose floorboard waiting for you.
I'd love to read or hear the theories about this sort of instruction. I'm taking a course to be certified as an adult instructor in a sheriff's academy next month, if I learn anything good I'll bring it back. (Other than "Sometimes you just HAVTA empty the whole magazine", that is).


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