The following two important concepts to remember pertain to patient assessment:
- Only expose the patient for as long as is needed to assess their injuries, and then cover them back up with dry blankets. Keep them as warm as possible for as long as possible; and
- Remember that trauma resuscitation is a fluid and dynamic process and the patient's condition can change rapidly and with little warning. EMS providers must be obsessive about reassessment of their trauma patients, constantly checking for continued bleeding after an intervention, adequate respirations and airway patency, and any changes in mental status.
During assessment of the patient suspected of suffering from hemorrhagic shock, the EMS provider should be looking for early signs of shock vs. later signs of shock. This starts with identifying all major sources of bleeding. The following are the five places that trauma patients can bleed enough to cause them to begin to suffer from hemorrhagic shock:
- Chest;
- Abdomen;
- Areas surrounding the long bones (humerus and femur)
- Pelvis / retroperitoneum, and
- External (obvious bleeding from penetrating trauma) [22]
Four out of the five areas that have the potential for life threatening hemorrhage can remain unnoticed if the subtle signs of vascular injury are not assessed and found. [22] The chest can contain a large hemothorax from a large vessel transection. The abdomen can contain bleeding from any number of ruptured organs or vessels in the abdominal cavity, particularly the liver and spleen. The pelvis can hold several liters of blood, and a patient can exsanguinate into the retroperitoneal cavity. These types of injuries can be found with complete or partial vessel disruptions, meaning that the vessel is completely "cut in half" or it can have a small hole or cut in which the vessel maintains some of its structural integrity. These signs are described as hard signs and soft signs.
| |
