 Welcome to Nursing School Explained and this video on emergency and trauma assessment. Now when it comes to emergency and trauma assessment, we always have to make sure that we first of all triage the patient correctly and assign them an appropriate emergency severity index, but you can watch the details about that in my other video about triaging. Now here in the emergency and trauma assessment, really who's very good at this are our EMS, our first responders and paramedics. And when it comes to especially trauma assessment, a lot of acronyms are used. So this video is heavy in acronyms. And really all you have to do is remember the letters of the alphabet because we go from A through I and then we have some L through P as well here. And for emergency and trauma assessment, we always do the primary survey first and then move on to the secondary survey. So in the primary survey, we always start with our airway and C spine. So this is particularly important if this is a patient who was in some sort of a traumatic event, whether it was a motor vehicle crash or maybe a fall of a high building, anything where we suspected that could be a neck injury, we always have to make sure to stabilize their cervical neck because as we know the nerves from the C spine control the breathing. And if there was an injury that may be incomplete and we don't stabilize their C spine, we might cause more injuries and now the patient might be paralyzed. So C spine stabilization is always super important and most likely the patient will already arrive on a backboard with a neck brace on that the first responders have already applied. Now with this airway and C spine in the A category still, usually there are four categories and again this acronym AFPU applies. So this is a very brief assessment of the patient's neurologic status. Are they alert? Are they verbal? Do they respond to verbal stimuli? Do they respond to pain? Are they unresponsive? So depending on where they are alert of course being the least critical and then unresponsive being the most critical. And the most important part here is if we identify an abnormality within their airway, so maybe now the patient is unresponsive and they are unable to maintain an open airway then we have to intervene. The B anything else does not matter we have to intervene when we find an abnormality just like you're learning basic life support. Right? If the patient is not breathing so they are unable to maintain an open airway then we have to intervene. The B anything else does not matter we have to intervene when we find an abnormality just like you learn in basic life support. right? If the patient is now breathing, you give them rescue breaths before starting CPR or depending on the scenario. So keep that in mind here. Now under B for breathing, that refers to really the ventilation. So that would be the movement of the chest. We would assess the breathing rate, their pattern, the chest movement. Is it symmetrical? Is it asymmetrical? Is there any obvious trauma to the chest area? Again, if we find an abnormality here, so if we maybe find asymmetrical chest movement, maybe because of a hemo or pneumothorax, we have to intervene right here before even worrying about the circulation. Now C stands for circulation and control the bleeding and the way that we do this is we assess for central pulses and those are either the carotids or the femoral pulses because it might be difficult to obtain a peripheral pulse that serves a radial pulse. Typically if the patient's blood pressure is 80 or below, you might not be able to assess a radial pulse because it might be so weak. So we need to get more to the central circulation and assess the carotids and femoral pulses to see how they're doing in terms of their circulation. And as always with circulation, we want to look at the patient's overall skin, color, moisture, temperature, capillary refills. So those would be the things that fall into the circulation here. And of course if there is hemorrhage, if the patient had an injury to an artery and now blood is gushing out of them, we want to control the bleeding by applying manual pressure to that site. D stands for disability and that really entails their numerological evaluation including a Glasgow coma skill. So make sure that you're familiar with how to categorize the patient here as well as their pupillary assessment because now if this was a patient with a traumatic head injury, we might be able to see differences in the pupil dilation or responsiveness in general from one site to the other and then evaluate and go from there. E stands for exposure and environment. So exposure means that we have to expose the patient, so we have to cut off all their clothing to see what all injuries we're dealing with because we might not have seen their laceration on their forearm if we wouldn't get the clothing up. So exposure is very important and then environment, the environmental control. Trauma patients suffer greatly from hypothermia. So if the ambient room temperature is too cold, they typically have bad outcomes. So we need to make sure we keep the patient nice and warm, cover them with one blanket, maybe even bump up the temperature in the room to control the environment. So this ABCDE completes the primary survey. Once the primary survey has been completed and we have intervened any step of the way that we found an abnormality, then we move on to the secondary survey which goes from the letter F to I. So F, full set of vital signs. So we've already assessed the patient at the great length here. We haven't even taken a full set of vital signs. The circulation assessment here does not include assessment of heart rate and blood pressure. It's just to control obvious bleeding by assessing the central pulses and skin color. So F, full set of vital signs and then family presence. And that depends on where you work. If they allow or do not allow family presence during an exam like this because it can be very traumatic for the family. And then maybe they have an emotional outburst or maybe they faint and I have two patients to deal with. So depending on the situation and your policy, just make sure that you are aware of this. G stands for give comfort measures or get monitoring devices. And the get monitoring devices continues here in our LM and OP. So monitoring devices or really diagnostic studies would be any kind of lab studies that we at this point draw. Monitor is to put the patient on the cardiac monitor. NG or OG2 specifically so if the patient needed to be intubated up here because now we need to decompress their stomach and prevent aspiration. We need to put them on O2 if we haven't already done that. But if they're intubated we might need to monitor the entire CO2, the capnography. And then P is for pain control which kind of goes along with give comfort measures here. And we want to be very careful here because we know that narcotics, opioids, benzodiazepines might affect the patient's mental status. So depending on what we found up here in our primary survey in terms of their disability and maybe if there's a head injury we might not want to give them opioids that will decrease their level of consciousness. So we can detect any changes that might occur that are due to their injury rather than the narcotics that we provide for the patients. H stands for head to toe assessment and the patient's history. So head to toe assessment now again we started the head just like you're used to in your head to toe assessment. You start at the head, you look for any injuries, any bleeding, scratches, bruises, open fractures, lacerations, anything that you can find here. And again you're going this very methodical way from head to toe. And then history. So important things of the history are if this is a traumatic event, what kind of traumatic event was this. If this let's say was a motor vehicle collision, was the patient, was it a head-on collision? How fast were they driving? Did the airbags deploy? Did they wear a seat belt? How many other people were injured? What's the damage to the car? There's a lot of history that needs to come from the pre-hospital providers that are very important for us to know to determine the patient's extent of the injuries. And then for I is inspecting the posterior upper surfaces because remember that most likely the patient will be on a backboard and with a neck brace and if we do the head to toe survey, we've only looked at the front side. So now we need to make sure we get the team to log all the patients to their side while maintaining the C spine stabilization and look at their back because maybe they have an injury to their kidneys, maybe there's some bleeding, maybe there's an obvious deformity to their spine, maybe there's some stool incontinence that we haven't seen here. So it's very important to complete the assessment to also inspect the posterior surfaces. So this concludes the secondary survey. So really A, B, C, D, E, F, G, H, I and then of course there will be frequent reassessments because the patient now might need to go for a CAT scan. We've already sent labs and probably get some basic x-rays that we can do at the bedside but now we need to accompany the patient to the CAT scan and then bring them back and reassess them if they were intubated, maybe reevaluate that chest x-ray for two placement, assess their breathing if we've placed them on a ventilator, maybe get some ABGs. So this is a continuous process that we need to make sure we care for these patients in the appropriate fashion and keep in mind that at any time if we detect an abnormality we have to intervene before we move on, particularly so in this primary survey. So thank you for watching this video here on Nursing School Explained about Emergency and Trauma Assessment. I hope that has helped you clarify how we methodically go about assessing a patient that is critically ill and how to use these acronyms that you really just have to memorize and then go buy them in this methodical way so that you care for each patient safely and that they get the best outcome that they can. Thanks for watching Nursing School Explained. See you soon.