Choosing the right asessment

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FirstAidMan

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Hey guys. Im a little confused about what kind of asessment you would preform on a trauma patient. I learned and practiced the Rapid Trauma Assessment. What cases would you do an RTA in and what cases would you just examine where the injury is?


Thank you, John
 
First you have to determine where the or "all the" injuries are. Hence head to foot exam, history, and observation.
 
say a closed tibia fracture, head to toe?
 
In the field if the patient is unconscious (normally when trauma is suspected) then a Rapid trauma assessment will be preformed.

If its a minor injury like a fracture to the tib/fib normally just a focused assessment will be preformed and the usual questions of head/neck/back pain? Any other pain? Did you hit your head? Did you fall? Etc.
 
It depends on how reliable your patient is. If they are alert and can localize where their pain is, then do a focused assessment. If they are altered or "hurt all over" then you would be better doing a rapid head to toe. Don't over think it.

Example: fell off a horse, says "my leg freaking hurts. That's the only place." Focused assessment.

Rollover with ejection, combative, doesn't follow orders or answer questions, rapid trauma assessment.

This is obviously very simplified, but as you see more patients and get more comfortable assessing then you will have an easier time deciding what to focus on.
 
You do the same assessment for all patients; all patients get a primary and a secondary survey plus whatever system examinations are appropriate.

For a trauma patient you just tailor what you are looking for based upon history of mechanism and their presentation; but you do the same for all patients, so I say its the same, just what you ask or look for will be different, that however can only come with knowledge and experience.

As an example; checking the cervical spine on secondary survey and doing a neuromotor examination on somebody whose primary problem is myocardial ischaemia is not appropriate, just like doing a focused cardiovascular examination looking for myocardial ishcaemia on somebody who has been in a road crash is not appropriate.

Hope this helps dear :)
 
Clare said:
You do the same assessment for all patients; all patients get a primary and a secondary survey plus whatever system examinations are appropriate.

For a trauma patient you just tailor what you are looking for based upon history of mechanism and their presentation; but you do the same for all patients, so I say its the same, just what you ask or look for will be different, that however can only come with knowledge and experience.

As an example; checking the cervical spine on secondary survey and doing a neuromotor examination on somebody whose primary problem is myocardial ischaemia is not appropriate, just like doing a focused cardiovascular examination looking for myocardial ishcaemia on somebody who has been in a road crash is not appropriate.

Hope this helps dear :)
Click to expand...

But what if the myocardial ischemia caused the road crash? ;)
 
Always do a primary exam, then a secondary exam for every patient.. That never changes. But don't get sidetracked with a "distraction injury", and like Clare said --the mechanism..

Closed tibia fracture, yes it hurts, yes it's obvious, but it's also mesmerizing to the HCP.. You can get "wrapped up" (:rofl:) making a splint and caring for that injury.

One of the first things you learn in trauma is to consider the mechanism of the injury.. Did they break their tibia when a car backed over it, or when they fell down a flight of stairs? The first scenario makes it less probable that there are other injuries..

Do a primary trauma assessment/blood sweep, identify injuries and treat the life threatening ones. Patients rarely die from extremity injuries, but they do die from injuries to the head, neck, chest, pelvis and abdomen.

Then reassess every five minutes.. Reassessing is just as important, is the patient a different color then they were 2 minutes ago? BP dropping? Are their respirations increasing?
 
when memory aides get too complicated...

The purpose behind all the names of these assessments is to give structure to the techique of physical exam, they are really not seperate "assessments" one can choose.

I am not a big fan of mechanism, not only have studies shown it is unreliable, it takes experience to have any level of accuracy. (which totally defies the point of trying to teach it to students)

I often tell providers of all levels that I encounter, if you look at a person and think "that's messed up" then you are probably right. (some call it the "general impression") look for bleeding, assess/treat ABCs, and then do the full naked head to toe exam to make sure you don't miss anything serious.

When a patient reports an isolated injury (because the only isolated injury that would cause them to be unconscious is a head injury or major bleed, which are serious) you can usually choose to examine that area only. It is often very obvious the injury is isolated. Fingers in doors, falls on out-stretched hands, etc.

Even when doing a "focused" exam, it is generally a good idea to at least ask about more major issues like difficulty breathing, etc.

The names of these "memory aid" exams change every few years. If you understand the principles of what you are doing, it won't really matter what they are called.
 
In class, you will do a Rapid trauma Assessment for a significant MOI on scene.

For a more minor injury, you will do a focused exam, load and while en route do a detailed exam which will mimic a rapid trauma assessment.
For testing purposes, you will always do a head to toe for all trauma. 2 for significant MOI, one on scene, one more detailed and for a more minor injury, a focused exam on scene then a detailed en route
 
FirstAidMan said:
Hey guys. Im a little confused about what kind of asessment you would preform on a trauma patient. I learned and practiced the Rapid Trauma Assessment. What cases would you do an RTA in and what cases would you just examine where the injury is?


Thank you, John
Click to expand...
You should determine significant mechanism of injury ie. Unconscious, fall from 15 feet, MVA roll over/ejection/impact intruding into passenger area, things that affect multiple body systems. Vs a insignificant mechanism such as isolated trauma
 
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