TRAUMA ASSESSMENT (PED)
On-scene time for a traumatic injury should be no more than 10 minutes, unless there are extenuating circumstances such as extrication, hazardous conditions, or multiple victims.
GOLDEN RULE: Life-threatening conditions should be corrected during the initial assessment. Transport should not be delayed; Focused history and detailed physical should be done enroute.
Arrival On Scene
1. Ensure scene safety
2. General Impression (“Across the Room” Assessment)
3. Determine Life Threatening Condition
a. Airway – complete or severe airway obstruction
b. Breathing – apnea, significant work of breathing, bradypnea
c. Circulation – absence of detectable pulses, poor perfusion, hypotension, bradycardia
d. Disability – Unresponsiveness, decreased LOC
e. Exposure – significant hypothermia, significant bleeding
4. AIRWAY
a. Open airway using modified jaw thrust
b. Suction as necessary
c. Consider OPA, NPA if airway cannot be maintained with
• NPA is contraindicated in the presence of facial trauma
5. BREATHING
a. Assess for symmetry of chest expansion, breath sounds, chest rise and trauma
b. Obtain SpO2 and EtCO2 reading.
c. If breathing is INADEQUATE
• Assist ventilation with BVM with high flow oxygen
• If airway cannot be maintained place SGA/EGA. LMA preferred.
d. If breathing is ADEQUATE
• Place the child in a position of comfort (consider spine stabilization) and administer high flow oxygen as necessary. Use a non-rebreather mask or blow-by oxygen as tolerated.
e. ABSENT/DIMINISHED BREATH SOUNDS/Severe Respiratory Distress
• Suspect hemothorax or pneumothorax
• Perform needle decompression using an 18 gauge catheter.
• Insert the needle in the mid-clavicular line at the 2nd intercostal space, or 5th intercostal space anterior axillary line
6. CIRCULATION
a. Control obvious bleeding using direct pressure, pressure dressing or wound packing
b. Consider tourniquet use
c. Check capillary refill
d. Place on cardiac monitor
e. Increased or decreased heart rate may be an indication of shock, head, or spinal trauma
f. Obtain vascular access and administer NS TKO.
• Do not delay transport to obtain vascular access.
g. If there is evidence of shock, initiate vascular access in two sites. If IV access cannot be obtained in a child proceed with IO access.
• Administer a fluid bolus of normal saline at 20 ml/kg
7. NEUROLOGICAL STATUS
A. Assess Level of Consciousness
B. Pediatric Glasgow Coma Scale (GCS) and AVPU
C. Restlessness, agitation, and lethargy may be due to hypoxia and decreased cerebral perfusion.
D. Unresponsiveness and coma may be due to prolonged hypoxia, shock, head injury, metabolic disorders, or other causes.
E. Consider the H’s and T’s for reversible cause
F. Immobilize the patient as appropriate.
8. Expose the child only as necessary to perform assessments. Maintain the child’s body temperature throughout the examination.
9. Splint obvious fractures of long bones.
10. Perform focused history and detailed physical examination IN-ROUTE elicit personal history
11. Vital Signs (See Addendum for Normal Ranges)
A. Remember to use appropriate B/P cuff size for accuracy!
B. CAUTION: Children tend to compensate very well for blood loss and may have perfect vital signs in late stages of shock. Watch for other indicators of decompensation – such as pallor, delayed capillary refill and decreasing LOC
12. SECONDARY ASSESSMENT
13. Focused History
A. SAMPLE:
• Signs and Symptoms
• Allergies
• Medications
• Past Medical History
• Last meal
• Event
14. Focused Physical Exam
A. Medical or minor trauma – perform body check pertinent to chief complaint Major trauma – perform total body check
B. Complete Head-to-Toe Examination Note paralysis and paresthesia
C. Full spinal immobilization with notation of circulation, motor, and sensory function before and after immobilization
On-scene time for a traumatic injury should be no more than 10 minutes, unless there are extenuating circumstances such as extrication, hazardous conditions, or multiple victims.
GOLDEN RULE: Life-threatening conditions should be corrected during the initial assessment. Transport should not be delayed; Focused history and detailed physical should be done enroute.
Arrival On Scene
1. Ensure scene safety
2. General Impression (“Across the Room” Assessment)
3. Determine Life Threatening Condition
a. Airway – complete or severe airway obstruction
b. Breathing – apnea, significant work of breathing, bradypnea
c. Circulation – absence of detectable pulses, poor perfusion, hypotension, bradycardia
d. Disability – Unresponsiveness, decreased LOC
e. Exposure – significant hypothermia, significant bleeding
4. AIRWAY
a. Open airway using modified jaw thrust
b. Suction as necessary
c. Consider OPA, NPA if airway cannot be maintained with
• NPA is contraindicated in the presence of facial trauma
5. BREATHING
a. Assess for symmetry of chest expansion, breath sounds, chest rise and trauma
b. Obtain SpO2 and EtCO2 reading.
c. If breathing is INADEQUATE
• Assist ventilation with BVM with high flow oxygen
• If airway cannot be maintained place SGA/EGA. LMA preferred.
d. If breathing is ADEQUATE
• Place the child in a position of comfort (consider spine stabilization) and administer high flow oxygen as necessary. Use a non-rebreather mask or blow-by oxygen as tolerated.
e. ABSENT/DIMINISHED BREATH SOUNDS/Severe Respiratory Distress
• Suspect hemothorax or pneumothorax
• Perform needle decompression using an 18 gauge catheter.
• Insert the needle in the mid-clavicular line at the 2nd intercostal space, or 5th intercostal space anterior axillary line
6. CIRCULATION
a. Control obvious bleeding using direct pressure, pressure dressing or wound packing
b. Consider tourniquet use
c. Check capillary refill
d. Place on cardiac monitor
e. Increased or decreased heart rate may be an indication of shock, head, or spinal trauma
f. Obtain vascular access and administer NS TKO.
• Do not delay transport to obtain vascular access.
g. If there is evidence of shock, initiate vascular access in two sites. If IV access cannot be obtained in a child proceed with IO access.
• Administer a fluid bolus of normal saline at 20 ml/kg
7. NEUROLOGICAL STATUS
A. Assess Level of Consciousness
B. Pediatric Glasgow Coma Scale (GCS) and AVPU
C. Restlessness, agitation, and lethargy may be due to hypoxia and decreased cerebral perfusion.
D. Unresponsiveness and coma may be due to prolonged hypoxia, shock, head injury, metabolic disorders, or other causes.
E. Consider the H’s and T’s for reversible cause
F. Immobilize the patient as appropriate.
8. Expose the child only as necessary to perform assessments. Maintain the child’s body temperature throughout the examination.
9. Splint obvious fractures of long bones.
10. Perform focused history and detailed physical examination IN-ROUTE elicit personal history
11. Vital Signs (See Addendum for Normal Ranges)
A. Remember to use appropriate B/P cuff size for accuracy!
B. CAUTION: Children tend to compensate very well for blood loss and may have perfect vital signs in late stages of shock. Watch for other indicators of decompensation – such as pallor, delayed capillary refill and decreasing LOC
12. SECONDARY ASSESSMENT
13. Focused History
A. SAMPLE:
• Signs and Symptoms
• Allergies
• Medications
• Past Medical History
• Last meal
• Event
14. Focused Physical Exam
A. Medical or minor trauma – perform body check pertinent to chief complaint Major trauma – perform total body check
B. Complete Head-to-Toe Examination Note paralysis and paresthesia
C. Full spinal immobilization with notation of circulation, motor, and sensory function before and after immobilization