# rapid trauma question



## TriednTrue (Mar 22, 2010)

I've got a question regarding which path to take in regards to a rapid trauma vs a focused. If a patient were to fall from a ladder, say the 3rd or 4th ladder rung and all the LOCs cleared and is complaining of head trauma/pain, would you still just do a focused physical rather than a rapid trauma? I've heard two different answers, just wondering which is the correct one.


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## mississippimedic (Mar 22, 2010)

Why not just do both of them?


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## JPINFV (Mar 22, 2010)

I'll be honest, when I examine patients I don't seperate focused assessments into a "this is a medical assessment" and "this is a trauma assessment" mindset.


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## MrBrown (Mar 22, 2010)

Why don't you do a proper primary and secondary survey vs this rapid / focused nonsense


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## CAOX3 (Mar 22, 2010)

MrBrown said:


> Why don't you do a proper primary and secondary survey vs this rapid / focused nonsense



Sombodys old 

That is how I was taught also pmary and secondary assessment.


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## triemal04 (Mar 23, 2010)

CAOX3 said:


> Sombodys old
> 
> That is how I was taught also pmary and secondary assessment.


Not that old hopefully; I was taught primary and secondary too...does that make me old?  Crap...wait...what were we talking about...I can't remember...


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## mycrofft (Mar 23, 2010)

*Prime example of learning mode intruding on real life mode.*

To get priniciples across, teaching mode never does anything simultaneously. THEN they go so far as to prioritize what you do (oops, just fell off the reality table), when in real life you do more than one at once, like getting the ketchup while you're in the fridge for the milk.


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## MRE (Mar 23, 2010)

JPINFV said:


> I'll be honest, when I examine patients I don't seperate focused assessments into a "this is a medical assessment" and "this is a trauma assessment" mindset.




Along the same lines, even in a trauma type situation like this, don't forget that there could also be a medical that caused the accident.  You don't want to miss that a patient is hypoglycemic and headed for diabetic coma because you were concentrating on a possible broken arm and a bruise to the forehead.


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## EMSLaw (Mar 23, 2010)

W1IM said:


> Along the same lines, even in a trauma type situation like this, don't forget that there could also be a medical that caused the accident.  You don't want to miss that a patient is hypoglycemic and headed for diabetic coma because you were concentrating on a possible broken arm and a bruise to the forehead.



Right.  Especially with a fall victim, you generally always want to ask questions to try and figure out not only if they're hurt, but why they fell in the first place.  There's plenty of trauma behind medical and medical behind trauma going on out there.  In the real world, people don't fit into neat categories.  

Anyway, to try and answer the OP's question - I'm going to do a trauma exam of your fall victim, since the neck pain might be a distracting injury, and they're at risk for other things.  If time allowed, I'd do a detailed physical exam (secondary survey) once they were in the rig.


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## Veneficus (Mar 23, 2010)

*i don't know how to link the post so copy and paste*

a history and physical exam is not a hard concept.

Some time ago, some cretin (I like this word, From the French root of Christian and used to mean: too stupid to sin) started making an artificial separation between trauma and medical problems.

I guess this was done as a memory aid originally but then the facts were lost and only the memory aid persisted.

ALL trauma is a medical problem. 

ALL Medical problems have a traumatic component.

the only distinction is which one was the cause and which was the effect.

Take for example the National Registry position. Look at the skill sheets.

You are tested on:

"Trauma assessment" which is really nothing more than a physical exam. (a poor one at that)

You are separately tested on "medical assessment," which is really the history taking component of a patient interview.

a history without a physical exam is worthless. A physical without a history is the minimum you need to go on during a patient encounter. 

I suggest consider the mechanism of pathology on all patients to create an index of suspicion of what could be wrong. the physical exam and history are interchangeable, you have to manage life threats as you find them. Since not all are apparent you have to be very diligent to know what occult conditions there are and take special care to make every effort to explore for them. It is also important to know which conditions occur over time and during reassessment making checking those a priority.

Start from scratch. The reason the ED staff assess patients from square one isn’t because they don't trust you or your report was bad. The benefits of this to the patient and provider are overwhelming.

If you are an EMT you should reassess a patient a MFR or lay person hands you from the beginning. Your assessment is more detailed. A paramedic should do the same when receiving a patient from an EMT. I can assure you the doctor starts from the beginning when a paramedic drops off a patient at the ED. Just like the intensivist reassesses the emergency physician's patient.

If somebody is reassessing the patient you hand off, do your part and don't take it personally. It is not about you. 

The patient will start to get agitated from this. It sometimes helps to explain to them why everyone keeps asking the same questions and doing the same thing. I have found a patient you explain things to is a happy patient.


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## mycrofft (Mar 23, 2010)

*Veneficus, yes yes yes. Ditto EMSLAW.*


(BTW, anyone ever hear about a "slow trauma" question").
Cultural succession:
PHASE ONE: (Early formalized EMS): Experienced people identify problem, divide care into quanta/modules/chapters or routines to teach them to someone who has no experience (as was the goal in the early Seventies, to rapidly disseminate the info).
PHASE TWO: (The Eighties): people who underwent phase one who write the textbooks are either deskjockey EMS REMF's, or are trying to rectify errors they've seen, by reinforcing the separation and sequencing of skills/operations to allow studfents to get their heads around them.

RESULT: sort of like learning piano by mail. You may be a terror at scales, pedal and seventh diminished minor chords, but if yoj can't do them all at once, or insist on doling them one at a time, it isn't music.
There is an art. Science is taught and updated, art is learned and practiced.


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## CAOX3 (Apr 18, 2010)

mycrofft said:


> RESULT: sort of like learning piano by mail. You may be a terror at scales, pedal and seventh diminished minor chords, but if yoj can't do them all at once, or insist on doling them one at a time, it isn't music.
> There is an art. Science is taught and updated, art is learned and practiced.



Very good analogy, I like it.


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