hmmmmm... systematically,like it should be.
scene assesment
1)Personal protective equipment
2)MOI?significant?
3)fire,wire,glass,wire?hazards?
4)Will i require back up?additional resources?
4)how many pt's?
5)do you have all the right equipment stocked,sterile,ready to go,ready to use
6)weather conditions?
7)rapid pt access...
As you approach the pt.....
general impression..
a)Pt's level of distress?
b)skin?color?condition?
c)are their any visible angulated fx?
d)incontinence?
e)can you see blood pooling?is blood visible?cerbrospinal fluid?
f)emesis?
g)bystanders
So the MOI is obviously great,just from the description given. So I would introduce myself and my partner as EMR's from whatever EMS department and say If you could please not move while my partner stabilizes your neck....So at this point is the pt concious?What is the pt's level of conciousness?Alert?Only responds to verbal?Responds only to pain such as a sternum rub or trapezius squeeze? After assesing the need for stabilization of the neck,assessing the LOC,then I would asses the airway for patency?clear of fluids?clear of emesis?Assess breathing by listening to apices and bases. What is the pt's rate?rythm?quality?stridor?rales?wheezing?etc...next I would do a deadly bleed check to see if there are any severe bleeding as that is a part of the PRIMARY....and lastly expose anything that is bleeding or injured if you can. Load and go situation?Does the pt fit the load and go criteria?
update EMS dispatch...
next...
DCAP-BLS-TIC....
deformities,contusions,abrasions,penetrations,burns,lacerations,swelling. you are always using the method palpation(feel) for tenderness,instability and crepitus. Visually you are also looking for racoon eyes,battle's signs,csf fluid leakage. After assesing the head,you move to the neck...
DCAP-BLS-TIC....
You are feeling for any irregularities..etc..If trauma is ruled out you may release manual stabilization but in this case,this dude gets a fresh collar.Trachea midline?deviated?JVD?
chest
DCAP-BLS-TIC....
same as above...this is a rapid trauma assesment folks....can you feel and here subcutaneous emphysema?EXPOSE the chest. Scars?pacemakers?id necklace?
DCAP-BLS-TRD......
thats right. tenderness,ridgity. soft upon palpation?tender?bruising??
pelvis..
DCAP-BLS-TIC...
unstable?incontinence?priaprism?
Extremities: legs
DCAP BLS TIC...
neurological response in the lower ext?
DCAP BLS TIC..
neurological response in the upper ext?
RAPID EXTRICATION....
im not going through each individual step of extrication because i am tired as hell but assess the back when you are doing the move.....
I will finish this scenario when I get LOC,ABCDE,resps,pulse from you Anthony.....
sorry its short. im tired