Trauma assessment

Perform an integumentary assessment, including a burn assessment Perform a pain assessment Perform a trauma assessment from head to toe Perform a mental status assessment, including a Glasgow Coma Scale... 

Melvin, J.W, King, A.I., and Alem, N.M., AATD System Technical Characteristics, Design Concepts, and Trauma Assessment Criteria, AATD task E-F Final Report, DOT-HS-807-224, US Department of Transportation, National Highway Traffic Safety Administration, Washington DC, 1988. 

The Clinical Presentation of Toxic Trauma Assessment and Diagnosis... 

A general survey of the patient also is necessary. It is important to look for additional symptoms of shock, such as cool skin, cyanosis, diaphoresis, and a change in the level of consciousness. Other assessments may be necessary if the hypotensive episode is due to trauma, severe infection, or blood loss. 

Bir, C.A. and Viano, D.C. Design and injury assessment criteria for hlunt ballistic impacts, J. Trauma, 57, 1218, 2004. 

Assess patient What precipitated the episode (non-compliance, infection, trauma, infarction, cocaine) Initiate appropriate work-up for precipitating event (cultures, CXR, ECG). 

Major risk factors include current smoker, low body weight (<127 lb in postmenopausal women), history of osteoporotic fracture in a first-degree relative, and personal history of low-trauma fracture as an adult. Other independent risk factors include age, high bone turnover, low body mass index (<19 kg/m2), rheumatoid arthritis, and glucocorticoid use. Decision tools may help identify individuals who should undergo BMD testing, such as the Osteoporosis Risk Assessment Instrument and the Simple Calculated Osteoporosis Risk Estimation. 

Assessment of the patient s status should focus on the search for risk factors (e.g., increased age, major surgery, previous VTE, trauma, malignancy, hypercoagulable states, and drug therapy). Signs and symptoms of DVT are nonspecific, and objective tests are required to confirm or exclude the diagnosis. 

Recent guidelines entitled Non-clinical Local Tolerance Testing of Medicinal Product from the CPMP refer to the murine local l)unph node assay as a method for the assessment of the induction phase of skin sensitisation. This method measures the ability of compoimds to induce proliferative responses in skin-draining lymph nodes. This method uses fewer animals than alternative in vivo methods and reduces the trauma to which animals are potentially subjected. ... 

A targeted biopsychosocial developmental history from key informants should be included in the initial assessment. In addition to the information contained in Figure 31.1, a history of stress and trauma should also be gathered. In children and adolescents this includes caretaker absence, neglect, physical, sexual, and emotional abuse, as well as transfer to a foster home, divorce, or psychiatric disorder in a close family member. 

The assessment of pediatric PTSD must be bound in a developmental framework that is sensitive to the child s social context and the type of trauma. At present there is no generally agreed upon gold standard instrument for the assessment of childhood PTSD. Several of the most commonly used instruments will be discussed as they relate to screening, formal diagnosis, and symptom monitoring in response to medication treatment. The interested reader is referred to a more comprehensive exposition on PTSD assessment in youth (i.e., March, 1999). 

Medical and neurological evaluations of an aggressive youth (to rule out toxins, infections, medical conditions, substance use, seizure disorders, and head trauma) followed by a full psychiatric assessment... 

The Davidson Trauma Scale (DTS) is a 17-item self-rated instrument that allows the patient to assess the level of distress caused by various symptoms. Patients are asked to rate both the frequency and severity of each item on a scale of 0 4, with a higher numeric rating reflecting a greater degree of distress (Davidson et al.. 1997). 

Before commencing the sessions the patients were assessed by physical examination and full medical history including age, sex, occupation, residence, special habits of medical importance with particular emphasis on the history of the underlying disease including duration of ulcer, mode of onset, ulcer pain, history of deep vein thrombosis or varicose veins, trauma, lump, varicosities, contact dermatitis and symptoms suggestive of ischaemia. Photographic reference of ulcer and ulcer area measurements were carried out at the commencement of treatment and during the follow up laser therapy, which continued for 6 months. 

Your emotional well-being is influenced by what you do with your time, where you live, and the relationships you have with friends and family. (These are all covered in later chapters in Part 4, Relationships. ) Planning for retirement gives you an opportunity to assess these issues and make whatever changes may be necessary. You can ease the trauma of retirement by attending to any concerns in advance so that there is minimal change when retirement becomes a reality. 

The second example is from a mixed biological/physical problem. It deals with the probability that blunt trauma to the chest or abdomen would be lethal to man. It has been used to assess the hazard of large ballistic projectiles moving at moderate velocity, the hazard behind body armor which has stopped a handgun bullet, etc. 

The first major task faced by planners is to assess the current state of the EHS system. Significant variability exists in the components of the EHS system. Planners must know the exact capabilities of each component. For the EMS dispatch system, how is dispatch performed and how can it be used to make triage decisions For EMS, how many ambulances and EMS providers exist How many can be requested from surrounding regions How are the destinations of EMS patients determined For EDs, how many can handle major trauma Minor trauma Intensive care patients How can a massive influx of patients be handled What alternate sites for care exist What transportation resources are available for distributing treated patients efficiently to maintain ED inflow and outflow What alternate shelter sources exist What preparations for mass decontamination are in place This survey must be continually repeated to ensure that the latest data are available to planners. 

The SAVE triage was developed to direct limited resources to the subgroup of patients expected to benefit most from their use. The SAVE assesses survivability of patients with various injuries and, on the basis of trauma statistics, uses this information to describe the relationship between expected benefits and resources consumed. Because early transport to an intact medical system is unavailable, this information guides treatment priorities in the field to a level beyond the scope of the START methodology (Benson et al., 1996). 

When the primary survey is complete, a thorough head-to-toe evaluation is conducted to assess for other injuries. This may be done at the scene if time and resources permit or at the first receiving hospital. The secondary survey should include getting an accurate history—the circumstances of the injury and medical history—conducting a complete examination to evaluate for other traumas such as fractures, pneumothoraces, contusions, shrapnel, corneal injury and closely reexamining the burn wound size and depth. 

Initial treatment of casualties of an explosion or blast is the same as for those with injuries from motor vehicle accidents, gunshots, falls, burns, and other major traumatic mechanisms. Vaughan (2005, n.p.) states the immediate focus in the event of an explosion is maintaining life and limb. The principles of Advanced Cardiac Life Support (ACLS), Advanced Burn Life Support (ABLS), Advanced Trauma Life Support (ATLS), and Advanced Ttauma Care for Nurses (ATCN) should also be applied in this situation. Each of these certification programs discusses assessment in reference to primary and secondary surveys, progressing... 

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