Palomar College Medic Prep Guideline
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| Scene Safety | Self, team, victim.
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| Scene Survey | General scene evaluation; MOI; Number of Pt's; Type of incident; Environmental clues
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| Situation | What have you got? What is the expected outcome? What is your plan? What do you need to make it happen?
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| Patient Management Priorities | Rapid assessment management; Rapid Transportation
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| Rapid Assessment Management | Primary Survey; Initial Resuscitation; Secondary Survey; Definitive Field Care
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| Rapid Transportation | Definitive hospital care
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| Primary Survey | Airway (c-spine control); Breathing (ventilation); Circulation (hemorrhage control); Disability (mini-neurological exam); Expose, examine and environment (the Killer Survey).
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| Airway & C-Spine | Early and Aggressive Airway: manual, mechanical, transtracheal. C-Spine.
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| Breathing and Ventilation | Respiratory Rate: <12 = too slow; 12-20 normal; 20-30 = ?Anerobic Metabolism; >30 = hypoxia/acidosis. EARLY VENTILATION SUPPORT! Effective or Ineffective? Assess tidal volume, rise and fall, chest wall integrity, early assessment of breath sounds.
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| Circulation | EARLY CONTROL OF EXTERNAL BLEEDING! PULSE: location (central versus peripheral), rate, rhythm, quality (central versus peripheral); CAPILLARY REFILL: location, time, limitation; SKINS: color, moisture, temperature.
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| Disability | Direct measure of cerebral function; Indirect measure of cerebral oxygenation; AVPU; Pupils
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| Causes of ALOC | AEIOUTIPS: Acidosis or Alcohol, Epilepsy, Infection, Overdose, Uremia, Trauma, Insulin, Psychosis, Stroke.
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| Expose, Examine, Environment (Three E's; the Killer Survey) | Dont just look, listen and feel...; Recognize subtle signs and symptoms of apparent injuries to the HEAD, NECK, CHEST (back) or ABDOMEN.
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| Chief Complaint | DO NOT GO ON WITHOUT IT! In many trauma Pt's much of the Primary Survey can be obtained with simple questions such as where they hurt (Head, back, neck, chest, or abdominal pain? Pain on deep inspiration? Trouble breathing? Loss of consciousness?
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| San Diego County Trauma Assessment | BRIMCARB: Breathing, Response, Eyes (I), Movement/Muscle tone/Motor, Chest, Abdomen, Refill, BP
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| Vital Signs | Prioritize for each Pt; Assess and Reassess (early recognition of subtle trends); DONT JUST GATHER DATA; PROBELLS.
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| PROBELLS | Pulse, Respirations, O2 Saturation, BP, Eyes, Lungs, LOC, Skins
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| Initial Resuscitation | Oxygenation, Ventilation, Circulatory Support! In many acute trauma Pt's further assessment will have to wait.
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| Secondary Survey (consider medical and trauma) | Head, Neck, Chest, Abdomen, Pelvis, Extremities, Back, Neuro Exam.
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| Head | VISUAL EXAM - contusions, abrasions, lacerations, penetrations, blunt trauma; Asymmetry; Eyes; Bleeding: ears, nose, mouth. PALPATION - deformity, depression, deviation.
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| Neck | VISUAL EXAM - Soft Tissue Injury: with damage to underlying organs; Larynx & Trachea: contusions, lacerations, abrasions, deformity; JVD; Muscle Structures. PALPITATION - C-Spine; Deviation; Subcutaneous Emphysema.
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| Chest | BARE CHEST EARLY! BILATERAL BREATH SOUNDS EARLY (prim. survey)! Deep/full sounds? Equal rise & fall? Contusions, lacerations, abrasions; Splinting/guarding; Paradox. Mov. (subtle); Access Musc (bulging/retrac.); Lateral/Anterior comp. SubQ Emphysema
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| Abdomen | Guarding; Distension; Contusions/Abrasions/Lacerations (seatbelt sign 25%); Palpate all 4 Quads: start away from pain; tenderness; rigidity; guarding; time (compensatory mech.). Masses.
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| Pelvis | Potential massive internal hemorrhage; VISUAL - abrasions/contusions/lacerations; fracture; distension; priamism. PALPATE - iliac crest mild pressure (lateral to medial); symphysis pubis. Suspect internal hemorrhage.
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| Extremities | Deformity/Contusion/Abrasions/Lacerations; ROM; Neuro-Vascular Compromise (Six P's).
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| Six P's | Pain, Pulselessness, Pallor, Paresthesias, Paresis, Paralysis.
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| Back | Prior to placing on back board; Equal rise & fall; Contusions/Lacerations/Abrasions; Splinting/guarding; Paradoxical Movement (subtle); Intercostal Muscles (bulging/retracting); Lateral/Anterior Compression; Lumbar Spine; Flank Tenderness.
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| Neuro Exam | Loss of consciousness (chief complaint?); LOC (GSC); Distal Sensory & Motor Function; Pupils
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| GSC | Glasgow Coma Scale - EYES: spontaneous, verbal, pain, none; VERBAL: oriented, confused, inappropriate, incomprehensible, none. MOTOR: obedient, localizes pain, withdraws from pain, flexion/decorticate from pain, extension/decerabrate from pain, none.
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| History | Medical Hx; Medications; Allergies; Last Meal; or (s)AMPLE
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| Packaging & Transporting | Decisions made early in your assessment will impact patient outcome during packaging and transport; assessment determines type of transport for patient and condition/chief complaint.
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