Scene Size-Up / PENMAN
P - PPE procedures.
E - Environment/scene safety.
N - Number of patients?
M - MOI?
A - Additional resources?
N - Need for C-Spine?
Initial Patient Assessment
1) Form a general impression. 2) Assessing mental status
3) Assessing airway. 4) Assessing breathing
5) Assessing circulation. 6) Determining priority of patient for treatment and transport to the hospital.
Initial Assessment - Airway Steps Significant MOI
While your partner has the patients head stabilized, look/listen/feel. Then he/she will open the airway by performing a jaw thrust or a head tilt chin lift, and insert an OPA or NPA.
Initial Assessment - Breathing Steps Significant MOI
Once the airway is open, administer oxygen at 15 L/m by a NRB. Then take two lung sounds mid-axillary.
Initial Assessment - Circulation Steps
Check for a radial pulse, skin - color, temperature, and condition, blood scan or sweep, and capillary refill
Focused History and Physical exam
1)Focused or rapid physical exam 2)Obtain SAMPLE history. 3) Obtain or direct assistance to obtain baseline vital signs
Identify if the patient is a HIGH or LOW priority then make a decision for transportation.
Rapid Trauma Assessment
DCAP-BTLS. Assess the: head, neck, chest, abdomen/pelvis, extremities, and the posterior. DCAP-BTLS
Detailed Physical Exam - Assessing the Head
DCAP-BTLS. Inspect and palpate the scalp and ears, assess the eyes, assess the facial areas including: oral and nasal areas.
Detailed Physical Exam - Assessing the Neck
DCAP-BTLS. Inspect and palpate the neck to check for: JVD, Tracheal deviation. Check the shoulders and clavicles then PUT A C-COLLAR ON THE PATIENT.
Detailed Physical Exam - Assessing the Chest
DCAP-BTLS. Steps (Inspect and palpate): go down the sternum, check the ribs (with both hands), check for bilateral symmetry, and take four breath sounds. The four breath sounds for the chest are: 2 mid-clavicular and 2 at the bases.
Detailed Physical Exam - Assessing the Abdomen/Pelvis
DCAP-BTLS. Inspect and palpate. Look for tenderness, pulsating masses, etc. At the pelvis push inward and outward and check the genitals to make sure everything is normal.
Detailed Physical Exam - Assessing the Four Extremities
DCAP-BTLS. Inspect and palpate. Check EACH for a pulse and medic alert. Assess for motor, sensory, & circulation function.When you are at the feet ask the patient if he/she can push or pull and when and when you have both hands ask the patient to squeeze your fingers.
Detailed Physical Exam - Assessing the Back
DCAP-BTLS. Inspect and palpate. You must log roll the patient and take 6 breath sounds which are at: the apices, mid-range, and the bases. Put the patient onto a backboard.
What is DCAP - BTLS
D - Deformities
C - Contusions
A - Abrasions
P - Punctures/Penetrations
B - Burns
T - Tenderness
L - Lacerations
S - Swelling
1) Manage secondary injuries and wounds appropriately.
2) Reassess: Initial Assessment, Interventions, and Vitals
How do you reassess your interventions?
• Is oxygen delivery adequate? - skin color • Are artificial ventilations adequate? - chest rises & falls • Changes in Oximetry readings? • Signs of bleeding? - new blood? need more bandages? • Check splinted extremities for CSM