Patient Assessment in Emergency Care

Patient Assessment

• Perform scene size-up to ensure safety and decide whether to activate trauma systems and consider backup.
• The decision to immobilize a patient depends on local protocols, but high-risk mechanisms of injury suggest the possibility of spine injury and indicate the need for spinal mobilization restriction.

High-Risk Mechanisms of Injury

• High-velocity crashes (>40 mph) with severe vehicle damage.
• Unrestrained occupant of moderate to high-speed motor vehicle crash.
• Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space.
• Fall of an adult (>20 ft) or a child (>10 ft) or the height (2-3 times their child's height).
• Penetrating trauma near the spine.
• Ejection from a moving vehicle or a motorcycle crash (>20 mph).
• Other high-impact injuries (e.g., auto-pedestrian or auto-bicycle crash >20 mph).
• Accident with a death of occupant in the same passenger compartment.

Uncertain Risk Mechanisms

• Moderate to low-velocity MVCs (motor vehicle crashes).
• Isolated injuries without positive assessment findings.
• Syncopal events (e.g., patient already seated or supine, or assisted by a bystander).

Primary Survey

• Keep manual stabilization in line position.
• Identify patient's level of responsiveness.
• Conduct primary survey while continuing manual stabilization.
• Focus on identifying and managing life-threatening concerns (e.g., external hemorrhage, airway, and breathing).
• Follow the X ABCDE method.

Airway Management

• Evaluate and monitor level of consciousness.
• Ask patient about symptoms and chief complaint.
• Re-evaluate and record observations.
• Assume unresponsive patients with trauma have spinal injury.
• Clear mouth and suction if necessary.
• Open airway using jaw thrust maneuver if spinal injury is indicated.
• Avoid inserting NPA (nasal pharyngeal airway) if basil or skull fracture is suspected or if there is obvious nasal trauma.

Breathing and Ventilation

• Evaluate breathing and ensure adequate oxygenation and ventilation.
• Administer 100% oxygen via non-rebreather if patient is breathing adequately.
• Ventilate patient to maintain end-tidal CO2 >25.
• Initiate CPR if necessary.
• Control external bleeding with direct pressure or pressure dressings.

History Taking

• Investigate chief complaint.
• Obtain medical history and alert for injury-specific signs and symptoms.
• Perform OPQRST (onset, palliation, quality, radiation, severity, timing) and SAMPLE (signs, allergies, medications, past medical history, last oral intake, events).
• Obtain history from friends, family members, or medical identification jewelry and cards if patient is not responsive.

Secondary Assessment

• Complete secondary assessment on-scene or during transport.
• Obtain vital signs and perform physical exam with patient in a neutral position.
• Apply manual stabilization while asking patient not to move.
• Focus on site of injury depending on chief complaint.
• Monitor patient for any changes in level of consciousness, ICP, and GCS score.

Spinal Injury Management

• Treat patients with suspected spinal injury according to local protocols.
• Use a cervical collar or other immobilization device to provide full body spinal immobilization.
• Avoid moving the cervical spine during patient transfers.
• Monitor patient's condition and provide interventions during transport.

Helmet Removal

• Check ABCs and ensure airway is clear and breathing is adequate.
• Assess whether the helmet can be removed without compromising airway or breathing.
• Consider the type of helmet and whether it can be removed safely.
• Remove the helmet if it is a full-face helmet or causing excessive head movement.
• Consult with medical direction before moving the helmet.

Back Pain Management

• Upright posture places a substantial amount of weight on the lumbar spine.
• Most causes of low back pain are idiopathic.
• Pay attention to patient's medications and pain management.
• Consider degenerative disk disease, spinal tumors, and other causes of back pain.
• Provide palliative care in the absence of trauma.

Patient Assessment

• Ensure safety and decide to activate trauma systems and consider backup during scene size-up.
• High-risk mechanisms of injury suggest the possibility of spine injury and indicate the need for spinal mobilization restriction.

High-Risk Mechanisms of Injury

• High-velocity crashes (>40 mph) with severe vehicle damage.
• Unrestrained occupant of moderate to high-speed motor vehicle crash.
• Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space.
• Fall of an adult (>20 ft) or a child (>10 ft) or the height (2-3 times their child's height).
• Penetrating trauma near the spine.
• Ejection from a moving vehicle or a motorcycle crash (>20 mph).
• Other high-impact injuries (e.g., auto-pedestrian or auto-bicycle crash >20 mph).
• Accident with a death of occupant in the same passenger compartment.

Uncertain Risk Mechanisms

• Moderate to low-velocity MVCs (motor vehicle crashes).
• Isolated injuries without positive assessment findings.
• Syncopal events (e.g., patient already seated or supine, or assisted by a bystander).

Primary Survey

• Keep manual stabilization in line position.
• Identify patient's level of responsiveness.
• Conduct primary survey while continuing manual stabilization.
• Focus on identifying and managing life-threatening concerns (e.g., external hemorrhage, airway, and breathing).
• Follow the X ABCDE method.

Airway Management

• Evaluate and monitor level of consciousness.
• Assume unresponsive patients with trauma have spinal injury.
• Clear mouth and suction if necessary.
• Open airway using jaw thrust maneuver if spinal injury is indicated.
• Avoid inserting NPA (nasal pharyngeal airway) if basil or skull fracture is suspected or if there is obvious nasal trauma.

Breathing and Ventilation

• Evaluate breathing and ensure adequate oxygenation and ventilation.
• Administer 100% oxygen via non-rebreather if patient is breathing adequately.
• Ventilate patient to maintain end-tidal CO2 >25.
• Initiate CPR if necessary.
• Control external bleeding with direct pressure or pressure dressings.

History Taking

• Investigate chief complaint.
• Obtain medical history and alert for injury-specific signs and symptoms.
• Perform OPQRST (onset, palliation, quality, radiation, severity, timing) and SAMPLE (signs, allergies, medications, past medical history, last oral intake, events).
• Obtain history from friends, family members, or medical identification jewelry and cards if patient is not responsive.

Secondary Assessment

• Complete secondary assessment on-scene or during transport.
• Obtain vital signs and perform physical exam with patient in a neutral position.
• Apply manual stabilization while asking patient not to move.
• Focus on site of injury depending on chief complaint.
• Monitor patient for any changes in level of consciousness, ICP, and GCS score.

Spinal Injury Management

• Treat patients with suspected spinal injury according to local protocols.
• Use a cervical collar or other immobilization device to provide full body spinal immobilization.
• Avoid moving the cervical spine during patient transfers.
• Monitor patient's condition and provide interventions during transport.

Helmet Removal

• Check ABCs and ensure airway is clear and breathing is adequate.
• Assess whether the helmet can be removed without compromising airway or breathing.
• Consider the type of helmet and whether it can be removed safely.
• Remove the helmet if it is a full-face helmet or causing excessive head movement.
• Consult with medical direction before moving the helmet.

Back Pain Management

• Upright posture places a substantial amount of weight on the lumbar spine.
• Most causes of low back pain are idiopathic.
• Pay attention to patient's medications and pain management.
• Consider degenerative disk disease, spinal tumors, and other causes of back pain.
• Provide palliative care in the absence of trauma.

Learn about the steps to assess a patient in emergency situations, including scene size-up and identifying high-risk mechanisms of injury. Understand when to immobilize a patient and activate trauma systems.