Trauma Patient Assessment and Management

Trauma is a major contributor to global mortality and morbidity with a notable difference
between low income countries (LIC) and high to moderate income countries (HMIC). The
modality of trauma differs globally; however, the most notable cause is pedestrian vs. vehicle
and road traffic collision respectively. It is imperative that patients who have sustained a
traumatic injury are managed in an appropriate and timely manner.

Rapid Trauma Assessment (RTA) is an essential protocol for every EMT or EMS professional to
learn and become an expert in. The RTA is used on major mechanism of injury patients or
unconscious patients with an unknown mechanism injury to rapidly obtain a quick inventory of
all the body systems that may be injured on your patient.

After watching the video, I learned a lot with a Do’s and Don’ts of a being in a rapid Trauma
assessment team.

First, upon arriving on scene, make considerations about the patient’s mechanism of injury, or
nature of illness, based on information from the dispatch or from bystanders, as well as from
looking around the scene. Using that information you’ll determine if you need additional
resources and what kind of spinal precautions you’ll need to take. Just like any assessment, the
Rapid Trauma Assessment begins with an assessment of your patient’s mental status. If your
patient is responsive, you would ask them questions to determine how alert and oriented they
are. The A&O Scale is: Alert and Oriented to Person, Place, Time, and Event. So a patient who
does not remember what happened to them would be considered A&O 3/4. An A&O score of
4/4 would indicate no concerns about the patient's mental status. If the patient appears to be
unresponsive you can start by shaking and yelling—something like "Sir, sir! Hey can you hear
me?" This helps establish responsiveness and connection with the patient.

If you don't have any visible or auditory response you should move onto a painful stimulus.
Let’s imagine the patient is groaning when you do a sternal rub. That’s excellent feedback about
what may be going on. Alternatively, you could pinch the trapezius muscle pretty sharply
behind the shoulders.

After you check the patient’s mental status it's time to go into ABCs. ABC stands for Airway,
Breathing and Circulation. Circulation comes first in the instance of major, life threatening
hemorrhage. Any problem you find with the patient's airway, breathing, or circulation you'll fix
and manage until it's stable. To assess the patient's ABCs you'll do a visual inspection for major
bleeding. You'll also want to inspect the airway to ensure it is patent. Find the center, or distal
pulse. Remember to look, listen, and feel for respirations.

After assessing and managing any issue with the ABCs, you'll move on to a full head to toe exam
to take a quick inventory of any body system that may be injured. Any injury you find here,
you'll expose and inspect as you discover it, but you don't want to treat it yet. You want to see
everything that's going on before you make your determination of what needs to be treated,
how, and when.

Next is Performing a full head to toe exam. To perform this, you'll want to start with the head,
inspecting and palpating for DCAP-BTLS: D-Deformities, C-Contusions, A-Abrasion, P-Punctures-
B-Burns, T-Tenderness, L-Laceration, S-Swelling.

Next we'll check down the neck for JVD (Jugular Vein Distension) or tracheal deviation, check
that the eyes are PERRL (Pupils Equal, Round, and Responsive to Light) , as well as the facial
muscles. Look in the mouth and nose, ears, palpate down the back, sides, and front of the neck.
Check the shoulders and chest wall for instability. You may want to pause here and feel for a
breath, looking for frequent breath reps. Then move to the abdomen and palpate all 4
quadrants separately, rocking your palm. NOTE: Start with the core first and save the
extremities for last. Finally, examine the pelvis and legs using opposing force to check for
instability. NOTE: When you find the source of the injury, (from clear bleeding or the patient
telling you directly or through groans of pain/discomfort, for example), you'll expose the injury
accordingly. This may mean adjusting clothing or cutting off clothing completely.

An RTA (Rapid Trauma Assessment) is called Rapid which means fast wherein we should take
less than 60 seconds to perform.
But as been mentioned on the video sometimes the detailed Physical Assessment was done
upon arrival at the emergency unit of a respective hospital.

As a part of an Emergency response team, one should note the most important thing, which is
the critical criteria. We should watch for BSI precautions, scene safety, spinal precautions and
protection, oxygenation, find and manage life threatening conditions, prioritizing assessment,
limit on-scene time and prioritizing transport, and above all have your eagerness to save the
patient, alertness to do all things right and courage in full peak .