Expanded Trauma Assessment

Remember, a trauma assessment generally comes after your primary, but if done rapidly can find issues with ABCs. Control life threats and move on.

This is NOT meant to be a comprehensive secondary assessment, therefore there are many physiological problems that will not be mentioned; only traumatic problems and solutions will be mentioned (ex. SVT would theoretically be found in the chest and, if unstable, cardioversion would be indicated before BLS treatment. As SVT is a medical problem, it will not be discussed).

In Depth Trauma Assessment[edit | edit source]

First things first, fully expose your patient if you're doing a full trauma assessment. If you are just doing a secondary assessment, then make sure you can visualize as much as comfortable. Make sure you look/listen before you palpate to avoid aggravation of any existing injuries. For all of these assessments, make sure to identify and correct life threats immediately, otherwise delegation can take care of many non-life-threatening problems. Bold text indicates a potential trauma problem that would require immediate ALS intervention before BLS treatment or further assessment. Italicized text indicates why are we looking here (what could be wrong) if it is not obvious like DCAPBTLS. It is NOT comprehensive but covers common pathophysiology.

Next to each category in parenthesis is an example of specialized equipment outside of normal wound care/stop the bleeding/splinting supplies that may be needed as an intervention.

ALWAYS check for Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Laceration, Swelling if appropriate.

Head (FB Immobilization kit, Morgan's Lens, Suction, OPA, LMA, ETT)

• Skull
  • Look/Feel: Run your hands through the patient's hair, checking for any blood on your gloves periodically. If you fully run your hands through their hair, you may know that they are bleeding, but not where. This is primarily intended to help you get close to the source of the bleeding, not locate it.
  • Feel: Palpate the skull looking for any soft spots, deformities, pain, depressions. Many cerebral issues including epidural and subdural hematomas, skull fractures. Concussion.
• Face
  • Look: Asymmetries and obvious DCAPBTLS.
  • Look for battle signs/racoon eyes. Basilar skull fractures.
  • Feel: If facial trauma suspected, you may check for LeFort fractures. Facial fractures.
• Eyes
  • Look: Check the pupils for any abnormalities, keeping in mind that around 10% of the general population has benign anisocoria. Conjugate gaze: Lesions/damage at the cellular level. Dysconjugate gaze: Brainstem injury. Single blown pupil: Pressure on CN III. Pinpoint non-reactive pupils: potential pons damage.
  • Look: Check for impaled objects, foreign bodies/chemicals or prosthetics. Prosthetics will not react to light but may look quite realistic.
  • Look: You may check the palpebral conjunctiva (inside of the lower eyelid) for dryness and pinkness if dehydration is suspected. Dehydration.
• Ears
  • Look: Check with a penlight in each ear for any blood or CSF/clear fluid visible. Especially important if there was any head trauma. Increased ICP & increased cerebral damage.
• Nose
  • Look: Check with a penlight in each nostril for any blood or CSF/clear fluid visible. Especially important if there was any head trauma. Increased ICP & increased cerebral damage.
• Mouth
  • Look: Check with a penlight in the mouth for any obstruction/swelling/edema. Broken teeth/blood from mouth trauma.

Neck (Cricothyroidotomy kit, C-Collar, Occlusive dressing)

• Throat
  • Look: Check for JVD, medical alert necklace, tracheal deviation, accessory muscle use. Possible airway compromise. ALS needle/surgical cricothyroidotomy. Pericardial tamponade or late-stage pneumothorax. Accessory muscle uses this high up can denote massively increased respiratory effort.
• Spine
  • Look: For any obvious deformities.
  • Feel: Palpate C-spine for deformities, tenderness, step-offs, tenderness/pain. Potential C-Spine precautions.

Chest (Pleural Decompression Kit, Occlusive dressing)

• Clavicles
  • Look: For asymmetries/obvious breaks.
  • Feel: Palpate both clavicles at the same time. Deformities may be noted bilaterally and have a high chance of being normal if no pain is noted. Potential need for immobilization.
• Chest
  • Look: For paradoxical rise/fall, accessory muscle use, flail segments, shallow respirations. Pneumothorax, flail chest segment.
  • Listen: For unequal or abnormal lung sounds. Possible airway/breathing compromise. ALS needle decompression. Pneumothorax.
  • Feel: Have the patient take a deep breath to assess for pain/guarding before performing a Barrel-Hoop test to find soft tissue or bony crepitus. Broken/fractured ribs.

Abdomen (Occlusive dressing)

• Abdominal Contents
  • Look: For any pulsating mass, distension, guarding, Cullen's signs, Grey-Turner's signs. Aortic dissection/rupture/aneurysm, ascites, internal bleeding. Retroperitoneal bleeding for Grey-Turner's sign.
  • Feel: Palpate first lightly, then deeply, in all quadrants looking for pain/tenderness, rigidity or guarding.

Pelvis (Pelvic Binder if available)

• Pelvic Girdle
  • Look: For priapism, incontinence, bleeding. Neurogenic shock (spinal shock), Pelvic fracture.
  • Feel: Perform a Barrel-Hoop test in two axes to assess for pelvic stability. Fractured pelvis.

Extremity (Tourniquet, Junctional Tourniquet if available, Traction Splint)

• Lower Extremity
  • Look: For shortening or other asymmetry, evidence of closed mid-femoral fracture, DCAPBTLS. Hip fracture/dislocation.
  • Feel: Offset palpation for each long bone. Check CSM bilaterally. Palpate each joint and examine range of motion if necessary. Fracture or dislocation.
• Upper Extremity
  • Look: For asymmetry, DCAPBTLS.
  • Feel: Offset palpation for each long bone. Check CSM bilaterally. Palpate each joint and examine range of motion if necessary. Fracture or dislocation.

Back (Radio-translucent Spinal Board with Straps and Head Bed)

• Spine & Buttocks
  • Look: For DCAPBTLS.
  • Listen: For lung sounds if needed. If previous lung sounds were difficult to hear/inconclusive.
  • Feel: Palpate the spine all the way to the buttocks looking for deformities, step offs, tenderness/pain. Potential spinal precautions.

Rapid Trauma Assessment (30-90 seconds)[edit | edit source]

ALWAYS check for Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Laceration, Swelling if appropriate.

1. Head- Fingers through the hair and palpate skull. Check eyes, ears, nose, mouth with penlight.
2. Neck- Check for JVD, tracheal deviation, accessory muscle use. Palpate down C-spine for deformities, step offs, tenderness/pain.
3. Chest- Look, listen and feel for crepitus or diminished/absent lung sounds.
4. Abdomen- Look for pulsating mass/Cullen's/Grey-Turner's signs. Palpate all four quadrants. Feel for rigidity, distension.
5. Pelvis- Barrel-hoop to assure stability. Look for incontinence, bleeding, priapism.
6. Extremity- Offset palpation for each long bone. Check CSM.
7. Back (May be moved earlier if patient positioning permits)- Palpate down spine ALL the way to the buttocks looking for deformities, step offs, tenderness/pain.