BTLS for Emergency Care Providers

    * NEW FOR 2007 *


    - Assessment

    I.  Scene Size-up

    · Recognize hazards to self, rescuers, patient(s), and others at scene

    · Use the appropriate equipment to ensure Body Substance Isolation (BSI) precautions

    · Identify Nature of Illness or Mechanism of Injury and perform spinal precautions if indicated

    · Identify number of patients and initiate triage if necessary

    · Call for assistance, if necessary

    · Emergency transport to the appropriate facility

    · Helicopter utilization, (with ground transport times > 15 minutes)

    · Early notification of the emergency department or appropriate facility

     

    II.  Initial Assessment

    · Obtain general impression of patient

    · Determine Chief Complaint and identify Life Threats

    · Determine responsiveness / level of consciousness using AVPU and / or Glascow Coma Scale

    ·  Assess airway status and maintain patent airway using adjuncts as indicated

    ·  Assess breathing and assure adequate ventilation

    ·  Assess circulation and control major bleeding

     

    Pulses - Peripheral, Central

    PMSC-Pulse, Movement, Sensation and Capillary Refill

     

    ·  Identify priority patient(s) and the need to expedite response / transport

    III. Trauma Patient Assessment

    · Based on information from initial assessment, perform either a rapid trauma assessment or focused and detailed exam

    · Perform exam (DCAP BTLS)

    D

    Deformity

    C

    Contusions

    A

    Abrasions

    P

    Punctures/Penetrations/Paradoxical Movement

    B

    Burns

    T

    Tenderness

    L

    Lacerations

    S

    Swelling

    ·         Obtain Baseline Vital Signs:

    Blood Pressure

    Using a blood pressure cuff that is too small will result in an elevated blood pressure.  The cuff should be one third to one half of the upper arm and the bladder should completely encircle the arm.

    Pulse

    Regular, Irregular, Strong, Weak, Thready, Absent

    Respirations

    Normal, Absent, Labored, Shallow, Abnormal

    Breath Sounds

    Clear, Rhonchi, Rales, Wheezes, Diminished, Absent, Equal Expansion

    Pupils

    PERL, Constricted, Dilated, Unequal

    Skin (PMSC)

    Pulse, Movement, Sensation, Capillary Refill

    Pain

    Scale 0-10

    Pulse Ox

    >90 SaO2

    Blood Sugar

    >60mg/dL

    Glasgow Coma Scale

    Eye Opening, Best Verbal, Best Motor Response

    AVPU

    A=Alert, V=Verbal, P=Pain, U=Unresponsive

    ·                     Obtain SAMPLE history

    S

    Signs and Symptoms, Chief Complaint

    A

    Allergies

    M

    Medications

    P

    Pertinent Past History

    L

    Last Oral Intake

    E

    Events Leading to Injury, Illness

    ·         Base on exam findings, initiate proper interventions

    ·         Transport as soon as possible

    IV. Neurological Evaluation of the Trauma Patient

    Text Box: CRANIAL NERVES  

     

     

     

    Level/Loss of consciousness

     


     AVPU-Alert, Verbal, Painful, Unresponsive

    GCS-Abnormal: confusion, slurred speech,     aphasia, dysphonia, dysarthria 


    I.                    Olfactory                                            

     
    Test smell with spirits of ammonia

     
    II.                   Optic

    III.                 Ocularmotor

    IV.                 Trochlear

    VI.                 Abducens

     
    Have patient look up – down

    Have patient look left – right

    Have patient look diagonally up – down

    Have patient look diagonally right – left

    (six cardinal directions of gaze)

     

    V.                  Trigeminal


    Have patient clench teeth while you palpate the temporal and masseter muscle

    Test sensation by touching the forehead, cheeks, and jaw on each side 
     

     

    VII.                Facial

     
    Notice symmetry, tics, or abnormal movement

    Raise eyebrows, frown, show both upper and lower teeth

    Attempt to open eyes while the patient holds them tight
     

     

    VIII.                          Acoustic

                                     

     
    Hearing acuity

     
    IX. & X.        Glossopharyngeal,    Vagus

     
    Ability to swallow, normal voice sounds

    Have patient hold breath and assess for normal slowing of the heart rate

    Test the gag
     



    V.        MOTOR SYSTEM
     

     

    Muscle Strength


    Upper: Extend the elbow and pull it toward the chest while using opposing resistance

    Lower: Have patient push soles of feet against your palms. Pull toes toward the head while the paramedic provides opposing resistance.
     

     

    Coordination

     
    Asses the patient’s ability to perform rapid alternating movements (touch finger to the nose using alternating hands)

    Gait: walk heel to toe, walk on toes, walk on heels, hop in place, shallow knee bend, rise from a sitting position without assistance
     

     
    Sensory

     
    Pain, temperature, position, vibration and touch
     

    Cervical Spine

     
    Flexion: Touch chin to chest

    Rotation: Touch chin to each shoulder

    Lateral bending: Touching each ear to each shoulder

    Extension: Tilting the head backward

     

    Range of Motion

     
    A normal range of motion should occur without pain, deformity, limitation or instability
     



    VI.       Medical Patient Assessment

     

    · Based on information from initial assessment, perform either a rapid medical assessment or focused and detailed exam

    · Assess history of present illness

    O

    Onset

    P

    Provocation

    Q

    Quality

    R

    Radiation

    S

    Severity

    T

    Time

     

    ·         Obtain SAMPLE information
     

    S

    Signs and Symptoms, Chief Complaint

    A

    Allergies

    M

    Medications

    P

    Pertinent Medical History

    L

    Last Oral Intake

    E

    Events Leading to Illness

    ·         Obtain Baseline Vital Signs

    Blood Pressure

    Cuff size 2/3rds the size of arm

    Pulse

    Regular, Irregular, Strong, Weak, Thready, Absent

    Respirations

    Normal, Absent, Labored, Shallow, Abnormal

    Breath Sounds

    Clear, Rhonchi, Rales, Wheezes, Diminished, Absent, Equal Expansion

    Pupils

    PERL, Constricted, Dilated, Unequal

    Skin (PMSC)

    Pulse, Movement, Sensation and Capillary Refill

    Pain

    Scale 0-10

    Pulse Ox

    >90 SaO2

    Blood Sugar

    >60 mg/dL

    Glasgow Coma Scale

    Eye Opening, Best Verbal, Best Motor Response

    AVPU

    A=Alert, V=Verbal, P=Pain, U=Unresponsive

    ·         Orthostatic Vital Signs

                 

                Indications

    ·         Potential for hypovolemia (hypoperfusion)
    ·                 Abdominal pain
    ·                 Internal hemorrhage 
    ·                 Syncope
    ·                 Abdominal / chest trauma

     Precautions / Notes

    · Does not apply to trauma patients due to potential spinal injuries

    · Be prepared for syncope

    · Orthostatic vital signs are not valid if the sequence below is reversed
       Or, if the patient’s legs are not dangling over the edge of seat

    · If the patient stands up and is faint, they are probably orthostatic, don’t make them stand up any longer than necessary

    · Young patients tend to compensate for a much greater period of time

    ·  Elderly patients, on the other hand, do not compensate well

    · Beta blockers may affect the response to hypovolemia

    Technique

    · Patient should be in supine position initially, for a minimum of three minutes

    · Obtain pulse and blood pressure

    · Have patient stand, obtain pulse and blood pressure

    · If patient is unable to stand, have patient sit upright with legs dangling

    · Significant changes include:

    · Increase in pulse greater than 20 beats per minute

    · Decrease in blood pressure greater than 20 mmHg (systolic)

    · Pallor, diaphoresis, faintness

    VII. Ongoing Assessment

    ·         Repeat assessment and vital signs every 15 minutes for stable patient and every 5 minutes for the unstable patient

    ·         Check interventions

    VIII. Communication / Documentation

    ·         Verbal report to transport unit enroute and on scene

    ·         Written Medical Report

     

    Patient Assessment Flow Chart

     

    Scene Size-up

                                               

    ê

    Initial Assessment

     

     
                                              í                                    î

     

    Unstable Patient

    Rapid Assessment/ Physical Exam

     

    Stable Patient

    Focused Exam

                                          î                                    í

    Detailed History and Physical Exam

     

     

    ê

    Ongoing Assessment

    Treatment/Check Interventions

     

     


    ê

    Communication and Documentation

     

     

     

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