4/15/2024 0 Comments Battle signs traumaLower extremities - Pulse, movement sensation intact?.Upper extremities - Pulse, movement, sensation intact? Are pulses equal? (Aortic injury - especially in rapid deceleration accidents).Rectal - Blood? (GI injury) In males, is there a "high-riding prostate?" (urethral injury) Is sphincter tone normal? (Spinal injury) There are only 2 reasons for a medical student not to do a rectal exam: The student has no finger or the patient has no rectum.Genitals - Blood from the urethra? (Urinary tract injury).Back - Don't ever forget- all patients must be rolled, using spinal precautions if necessary.Abdomen - Tenderness, rigidity, guarding? (Hemoperitoneum).Cardiac - Are the sounds muffled? (Cardiac tamponade).Lungs - Are breath sounds present and equal?.Chest - Any chest wall tenderness, paradoxical movement (Flail chest), subcutaneous air? Consider chest tubes if indicated.Subcutaneous air? (Pneumothorax or airway injury) Is the trachea midline? (Tension pneumothorax) Palpate carotid pulses. Neck - Deformity or tenderness? JVD? (Cardiac tamponade).Throat - Is there any oral trauma (Blood and broken teeth are serious airway hazards).Nose - Is there any trauma or is there any fluid draining? (Again, clear fluid is CSF until…).Is there any bruising around the ears? (Battle's sign of basilar skull fracture). (Blood behind the tympanic membrane is a basilar skull fracture until proven otherwise). Ears - Is there any fluid draining out? (If it is clear, it is CSF until proven otherwise.) Look in the canals.Look for bruising around the eyes, so-called “Raccoon eyes” (may indicate basilar skull fracture). Eyes - Pupillary response to light (Altered response may be a sign of brain injury or toxicologic emergencies).Head - Palpate the head and feel for any crepitation or step-off (a step-off deeper than the thickness of the skull is a neurosurgical emergency).(In parentheses is why the particular part of the exam is important.) This starts at the head and works down to the feet, including the entire body surface. Secondary Survey (45 seconds) - The goal of the secondary survey is to identify all of the patient's injuries. Vitals - Pulse, blood pressure, respirations, temperature (core), and pulse ox.All patients must have all of their clothing removed. Then cover the patient with warm blankets. E - Exposure – Remove the patient's clothing quickly.D - Deformity – Are there obvious injuries?.Is capillary refill less than 2 seconds? Is there any obvious bleeding needing immediate control? C – Circulation - Are there pulses? Radial, Femoral, Carotid.Are they bilateral? If not consider pneumothorax and attempt needle decompression. This can oxygenate the patient and buy time during intubation attempts. B - Breathing – Yes or no? If not, begin ventilating (Bag Mask Ventilation) with 100% oxygen.Have suction and intubation supplies ready. If the patient can talk, it is probably clear. Open airway with jaw thrust if necessary. A - Airway – Assess for patency/obstruction.
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