Rapid Trauma Assessment/Assessing and Prioritizing Fractures
Downloadable Instructor's Guides
Session Reference: 2
Topic: Rapid Trauma Assessment/Assessing and Prioritizing Fractures
Level of Instruction: 3
Time Required: 2 Hours
Materials:
- Drill Transparencies/Blackboard
- Overhead Projector
- Screen
- Live Victims
- BSI
References:
- EMT-B Bridge Student Guide, Lesson 1
- Brady Emergency Care (9th ed.)
Preparation
Motivation: Upon arrival on the scene, EMT-B's sometimes mistake dramatic fractures for life threatening injuries. The intent of this drill is to remind rescuers that extremity trauma rarely causes a life threatening situation. In cases where significant MOI exits, ABC's and Rapid Trauma Assessment is your first action.
Objective (SPO): The student will demonstrate a basic understanding of rapid trauma assessment, and prioritizing fractures.
Overview: Rapid trauma assessment, and assessing and fractures
- Introduction
- Rapid PA
- Prioritizing fractures
- Principles of treating fractures
Rapid Trauma Assessment/Assessing and Prioritizing Fractures
-
SPO 1-1
Describe the indications for performing a rapid trauma assessment
EO 1-1
Describe in order how to perform a rapid trauma assessment.
EO 1-2
Describe how to prioritize fractures.
EO 1-3
List the general principles for the management of suspected fractures or dislocations
Instructional Guide
Introduction
- EMT-B's responding to incidents with a report of significant Mechanism of Injury, should be prepared to perform the following basic objectives:
- Scene Survey
- Simultaneous Actions (LOC, c-spine, jaw thrust)
- Assessment of the airway
- Assessment of breathing
- Possible support of ventilation/supplemental 02
- Assessment of circulation
- Control bleeding
- DCAP-BTLS patients entire body (Fx assessed and stabilized)
- Determine if patient is a critical trauma
- Load and go/ or treat patient at scene
- Baseline vitals
- SAMPLE HISTORY
- Detailed physical exam
- Ongoing assessment(en route to trauma center)
Rapid patient assessment
- SCENE SURVEY
- Body substance isolation
- Scene safety/ Hazards
- Determine MOI or NOI (mechanism of injury or nature of illness).
- How many victims?
- Are other resources needed?
- SIMULTANEOUS ACTIONS
- Determine LOC using the following scale:
- A=Alert
- V=Responds to verbal stimulus
- P=Responds to painful stimulus
- U=Unresponsive
- Manually immobilize C-spine
- Jaw thrust to establish airway if necessary
- Assessment of AIRWAY
- Jaw thrust needed?
- Is airway open?
- Inspect for foreign bodies
- Need suctioning?
- Consider airway adjunct
- Assessment of BREATHING
- Is it present?
- Approximate rate
- Character of respirations
- Are respirations adequate?
- Supporting VENTILATIONS
- Give 15 lpm O2 via NRB if rate is greater than 8 and breathing is adequate
- Bag Valve Mask w/reservoir and 15 lpm O2 at 24 per minute if:
- Respiratory rate less than 8
- Breathing is inadequate
- Head trauma is suspected
- Assessment of CIRCULATION
- Carotid pulse
- Present?
- Approximate rate?
- Character?
- CONTROL BLEEDING
- ASSESS THE HEAD (quickly through) DCAP-BTLS for obvious injury (inspect and palpate)
- Deformity
- Contusions
- Abrasions
- Punctures/penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
- Assess the NECK (anterior and posterior) DCAP-BTLS
- Trachea: midline or deviated?
- Jugular veins distended or flat?
- Any signs of trauma?
- Stoma?
- Medic Alert Tag?
- Apply a cervical spinal immobilization collar
- Assess the CHEST
- Expose, inspect and palpate the chest DCAP-BTLS
- Auscultate Chest Bilaterally
- Mid-clavicular
- Mid-axillary
- Compare sounds from side to side
- Heart sounds
- Present?
- Same rate as pulse?
- Expose, inspect and palpate abdomen DCAP–BTLS
- Firm or Soft
- Distended
- Expose, inspect and palpate pelvis with gentle pressure downward and inward DO NOT ROCK! DCAP-BTLS
- Expose, inspect and palpate LOWER EXTREMITIES DCAP-BTLS
- Distal pulses
- Motor function
- Sensory function
- CRITICAL TRAUMA SITUATIONS appropriate to LOAD and GO.
- Stabilize patient on a spine board. Treat non-life threatening injuries en route. Do not waste time on the scene.
- ASSESS BASE LINE VITALS, but do not delay critical treatment or transport. They can be done en route.
- Pulse
- Respirations
- Blood pressure
- Skin color, temperature, moisture
- Pupils
- SAMPLE HISTORY
- Symptoms and signs
- Allergies
- Medications
- Past illness
- Last Meal
- Events prior
- Detailed Physical Examination en route to trauma center (old secondary survey).
- Repeat and record findings of initial assessment every five minutes
Prioritizing and assessing extremity fractures
- Problems that demand care before joint and bone injuries
- Airway
- Breathing
- Circulation
- Disability
- Shock
- Neck and spinal injuries
- Open chest wounds
- Open abdominal wounds
- Serious burns
- Priority of care for fractures
- Fractures of the spine
- Fractures of the head, rib cage, and pelvis
- Fractures of the extremities
- Priority of care for extremity fractures
- Lower extremities before upper extremities
- Pelvis
- Femurs
- Joints
- Long bones
General Principles for management of suspected fractures or dislocations
- Assessment and treatment of the fracture
- Calm and reassure the patient.
- Recognize and assess fracture or dislocation.
- Cut away clothing and remove jewelry from the injury site.
- Splint fractures in a manner that immobilizes the joint above and below the fracture site.
- All fractures should be splinted in the position of function without using excessive force or causing the patient to experience extreme pain.
- Distal pulses and neurological function should be checked before and after splinting.
- Straighten angulated fractures of long bones with gentle traction prior to splinting.
- Cover all open wounds with sterile dressings prior to application of a splint.
- Pad all splints to prevent excessive pressure.
- Apply cold packs to ischemic fractures, from site of injury to distal end.
- Immobilize fractures prior to movement of the patient.
- Leave fingers and toes exposed if possible.
- Wrap extremities distal to proximal.
- Splints should not impair circulation
- Elevate the extremities following immobilization where possible (not if the patient has a potential c-spine injury).
- kling is used for upper extremity fractures, and 6" kling is used for lower extremity fractures.
- When in doubt, SPLINT.
Summary
Review: Rapid Trauma Assessment/Assessing and Prioritizing Extremity Fractures
- Introduction
- Rapid PA
- Prioritizing fractures
- Principles of treating fractures
Remotivation: EMT-B's responding to incidents with a report of significant MOI should be prepared to triage, and do rapid patient assessment. Remember that extremity trauma may look dramatic, however, it is rarely life threatening.
Assignment: Create mock situations giving victims significant mechanism of injury. Assign each victim two life threatening injuries, and four extremity fractures.
Evaluation Students should demonstrate a rapid trauma assessment, and tell the instructor the priority of all fractures found during the assessment.
Copyright © 2002 Maryland Fire and Rescue Institute. All rights reserved.
