New โครงการวิจัยและพัฒนาระบบบริการฯ

 Quality of breathing

◦ Listen to breath sounds on
each side of the chest.

◦ Normal breathing is silent.

◦ You can always hear a
patient’s breath sounds
better from the patient’s
back.

 What are you listening for?

◦ Normal breath sounds
◦ Wheezing breath sounds
◦ Rales
◦ Rhonchi
◦ Stridor

100

 Depth of breathing

◦ Amount of air the patient exchanges depends on

 Rate
 Tidal volume

101

 Depth of breathing

◦ Amount of air the patient exchanges depends on
◦ Inadequate breathing in pediatric patient

 Nasal flaring
 Seesaw breathing

102

 Depth of breathing

◦ Normal breathing

 Effortless process
 Does not affect

 Speech
 Posture
 Positioning

103

 Depth of breathing

◦ Normal breathing
◦ Tripod position

104

 Depth of breathing

◦ Normal breathing
◦ Tripod position
◦ Sniffing position

105

 Administer supplemental oxygen if:

◦ Respirations are too fast
(>20 breaths/min)

◦ Respirations are too slow
(<12 breaths/min)

◦ Respirations are too shallow

106

107

 Assess Pulse:

◦ Rate
◦ Quality
◦ Rhythm

 Identify

◦ External bleeding
◦ Skin color
◦ Temperature
◦ Moisture.

108

Apical

109

 Located over the heart

110

111

 Pulse quality

◦ Stronger than normal pulse

 “bounding”

◦ Weak and difficult to feel

 “weak” or “thready”

112

 Pulse quality
 Pulse rhythm

◦ Regular or irregular.

113

 Evaluate the skin for

◦ Color
◦ Temperature
◦ Moisture

114

 Skin color

◦ Poor circulation will cause the skin to appear
pale, white, ashen, or gray.

115

 Skin color (cont’d)

◦ When blood is not
properly saturated
with oxygen, it
appears bluish.

 May result from
chronic illness.

116

Abnormal Skin Colors

Flushed

117

Abnormal Skin Colors

Jaundiced

118

 Skin temperature

◦ Normal skin will be warm to the touch (98.6°F).
◦ Abnormal skin temperatures

 Hot
 Cool
 Cold
 Clammy.

119

 Skin moisture

◦ Dry skin is normal.
◦ Skin that is wet, moist, or excessively dry and

hot suggests a problem.

120

 Capillary refill

◦ Evaluated to assess the ability of the circulatory
system to restore blood to the capillary system

 <6 years old
 <=2 secs

121

 Assess and control external bleeding.

◦ Bleeding from a large vein

 Steady flow

◦ Bleeding from an artery

 Spurting flow

122

 Controlling external bleeding can be
simple.

◦ Apply direct pressure.
◦ If bleeding from the arms or legs

 Elevate the extremity.

◦ Apply a tourniquet.

123

 Identify and treat life threats

◦ You must determine the life threat and quickly
address it.

◦ Pt’s LOC will decrease

124

 Identify and treat life threats (cont’d)

◦ Jaw muscles become slack

 Leads to airway obstruction.

◦ Pt stops breathing.
◦ Heart cannot function without oxygen.
◦ Brain cells become damaged.

125

 On you phone

 Go to

◦ Respond.cc

 Enter 925413

126

Assessing the Trauma Patient

Is the patient stable?

Yes No
Perform a
Perform a rapid scan
Secondary
assessment or

focused
assessment

127

 Scan the body to identify injuries that must
be managed or protected immediately.

◦ Takes 60-90 secs
◦ Not a focused physical examination
◦ Look for spinal injury

128

Perform Secondary
Assessment
More to come Later

12
9

 How and what to assess:

◦ Inspection

 Look at the patient for abnormalities.

130

 How and what to assess:

◦ Inspection
◦ Palpation

 Touch or feel the patient for abnormalities.

131

 How and what to assess:

◦ Inspection
◦ Palpation
◦ Auscultation

 Listen to the sounds a body makes by using a
stethoscope.

132

 Use the mnemonic DCAP-BTLS.

◦ Deformities
◦ Contusions
◦ Abrasions
◦ Punctures/penetration
◦ Burns
◦ Tenderness
◦ Lacerations
◦ Swelling

133

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦ Deformities
◦C
◦A
◦P

◦B
◦T
◦L
◦S

134

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦ Contusions
◦A
◦P

◦B
◦T
◦L
◦S

135

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦C
◦ Abrasions
◦P

◦B
◦T
◦L
◦S

136

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦C
◦A
◦ Punctures &

Penetrations
◦B
◦T
◦L
◦S

137

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦C
◦A
◦P

◦ Burns
◦T
◦L
◦S

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Rapid Scan and Secondary
Assessment

 Trauma Assessment OUCH!!

◦D
◦C
◦A
◦P

◦B
◦ Tenderness
◦L
◦S

139

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦C
◦A
◦P

◦B
◦T
◦ Lacerations
◦S

140

Rapid Scan and Secondary
Assessment

 Trauma Assessment

◦D
◦C
◦A
◦P

◦B
◦T
◦L
◦ Swelling

141

Rapid Scan of the
Body

 Rapid Scan
◦ The goal is to identify the life threatening
injuries.
 ABC’s
◦ DCAP-BTLS
◦ Use inspection, palpation, auscultation, and the
smell of certain odors

143

Rapid Scan

 Head

144

Rapid Scan

 Face

145

Rapid Scan

 Neck - anterior

146

Rapid Scan

 Neck - posterior

147

Rapid Scan

 Apply cervical collar

148