Trauma Scenario: BSI, Scene Safe?, MOI/NOI, # of pt., ALS on Standyby, Consider C-Spine. Now moving on to the patient. Form a general impression. Poor or Stable. Patient is poor. Now assess AVPU. patient is COAx0. Now do a gross blood sweep. Nothing found. Check Airway by opening mouth, nothing found. Apply 15L/min NRB. Check Breathing, nothing found. Check circulation in carotid, and radial pulses, nothing found. Now a rapid trauma assessment. You will cut off all your patients clothing and cover and un cover them as needed. Check the head for DCAPP-BTLS (Deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling). Nothing noted. Check the neck for DCAPP-BTLS as well as step offs in C1 through c7. Also noting any JVD or TD. Next apply a C-Collar. Move down to the chest and palpate using the y formation midclavicular forming the intersection right in between the 3rd and 4th intercostal space and going down to the xiphoid process. After that place both hands on sides of patients rib cage and press inwards. Nothing noted. Move down to the abdomen. Palpate using both hands overlapping each other and in a wave motion once in all four regions. Note for any distension, rigidity, or masses. Also note if patient is responsive to this. Nothing noted, moving onward. If patient is CAO > 1 then ask if the pelvic region hurts. if yes dont touch it. If not palpate by applying firm pressure on both sides of the pelvic bone and pressing inwards and upwards at the same time. Nothing noted. Check genitalia if needed. (Please note during all phases of your rapid trauma assessment we are looking for DCAPP-BTLS as well if i forgot to mention if before moving on to a different area of the body). Next we go to the legs. Doesn't matter which one is first. Check for DCAPP-BTLS, Pedial Edema, PMS, and foot skin color in both legs. Ask patient if CAO > 0 if they can feel you touching them, and if they can wiggle their toes. Nothing noted. Next is the arms. DCAPP-BTLS on the arms, then check PMS in both arms. Nothing noted. If there WAS anything noted it would have been taken care of if the injury was either life threatening or was obstructing the airway. Now board em and go. Make sure that you are maintaining C-Spine precautions at all times INCLUDING WHILE putting the CID's on the head. Now in the ambulance try and get a focused physical exam which includes everything from the rapid trauma exam but in more detail. Check ears for spinal fluid, check eyes for PERRL, check nose for obstructions. Check chest, and abdomen and further. etc etc. Obtain a SAMPLE history, OPQRST, and see if anyone in the general area is family first. then bystanders.
Do this all in 10 minutes. kgo.
