Trauma Assessment and Medical Assessment

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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.
 
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.
 
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
 
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!
Click to expand...

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