2. Auscultate Chest Bilaterally
c. Compare sounds from side to side
3. Heart sounds
b. Same rate as pulse?
K. Expose, inspect and palpate abdomen DCAP–BTLS
1. Firm or Soft
L. Expose, inspect and palpate pelvis with gentle pressure downward and inward DO NOT ROCK! DCAP-BTLS
M. Expose, inspect and palpate LOWER EXTREMITIES DCAP-BTLS
1. Distal pulses
2. Motor function
3. Sensory function
N. 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.
O. ASSESS BASE LINE VITALS, but do not delay critical treatment or transport. They can be done en route.
3. Blood pressure
4. Skin color, temperature, moisture
P. SAMPLE HISTORY
1. Symptoms and signs
4. Past illness
5. Last Meal
6. Events prior
Q. Detailed Physical Examination en route to trauma center (old secondary survey).
R. Repeat and record findings of initial assessment every five minutes
III. Prioritizing and assessing extremity fractures
A. Problems that demand care before joint and bone injuries
6. Neck and spinal injuries
7. Open chest wounds
8. Open abdominal wounds
9. Serious burns
B. Priority of care for fractures
1. Fractures of the spine
2. Fractures of the head, rib cage, and pelvis
3. Fractures of the extremities
C. Priority of care for extremity fractures
1. Lower extremities before upper extremities
5. Long bones
IV. General Principles for management of suspected fractures or dislocations
A. Assessment and treatment of the fracture
1. Calm and reassure the patient.
2. Recognize and assess fracture or dislocation.
3. Cut away clothing and remove jewelry from the injury site.
4. Splint fractures in a manner that immobilizes the joint above and below the fracture site.
5. All fractures should be splinted in the position of function without using excessive force or causing
the patient to experience extreme pain.
6. Distal pulses and neurological function should be checked before and after splinting.
7. Straighten angulated fractures of long bones with gentle traction prior to splinting.
8. Cover all open wounds with sterile dressings prior to application of a splint.
9. Pad all splints to prevent excessive pressure.
10. Apply cold packs to ischemic fractures, from site of injury to distal end.
11. Immobilize fractures prior to movement of the patient.
12. Leave fingers and toes exposed if possible.
13. Wrap extremities distal to proximal.
14. Splints should not impair circulation
15. Elevate the extremities following immobilization where possible (not if the patient has a potential
16. 3" kling is used for upper extremity fractures, and 6" kling is used for lower extremity fractures.
17. When in doubt, SPLINT.
Rapid Trauma Assessment, Assessment and Prioritizing Extremity Fractures
• 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.