Question

The bells for a trauma alert just went off. You are the therapist covering the ER. When you enter the trauma room the patient is unresponsive; you also realize he is a head and chest trauma. In order from head to toe, explain in detail what you will be assessing and what action are you most likely going to do? What equipment are you getting ready for the doctor?

Answer 1

• • 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
  • 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?
  • What is the general skin color and temperature?
• CONTROL BLEEDING
• ASSESS THE HEAD
  • Deformity
  • Contusions
  • Abrasions
  • Punctures/penetrations
  • Burns
  • Tenderness
  • Lacerations
  • Swelling
• Assess the NECK
  • 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
  • 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
  • Firm or Soft
  • Distended
• Expose, inspect and palpate pelvis with gentle pressure downward and inward
• Expose, inspect and palpate LOWER EXTREMITIES
  • Distal pulses

• 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

• EQUIPMENT'S

• Nasal or oral airway
• Suction machine
• Suction tubing
• Laryngoscope
• Endotracheal tube
• Magill forceps
• Oxygen cylinders
• Nasal prongs
• Syringes
• Pulse oximeter
• Bag valve mask
• Mechanical ventilation
• Chest lids
• Blood pressure cuff
• Urinary catheters
• Nasogastric tube
• Splints
• Fluids
• IV access equipment
• Sutures