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Chapter 2: Examination and Management of Acute Pathologies

Critical Findings

Table 2-1Findings that Warrant Immediate Physician Referral
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Table 2-1 Findings that Warrant Immediate Physician Referral
Segment Findings
History

Reports of the inability to feel or move one or more limbs (confirm with neurological screen)

Reports of significant chest pain

Reports of difficulty breathing (e.g., anaphylaxis, pneumothorax)
Inspection

Obvious fracture

Obvious joint dislocation

Loss of consciousness

Cyanosis

Unequal chest expansion
Palpation

Disruption in the contour of bone, indicating a fracture or joint dislocation

Malalignment of joint structures
Joint and Muscle Function Assessment Inability of the muscle to produce torque (secondary to spinal cord or peripheral nerve injury)
Joint Stability Tests Gross joint instability
Neurological Tests

Sensory dysfunction

Motor dysfunction

Pathological changes in reflex

Inability to maintain balance, loss of coordination, and other signs and symptoms of brain injury
Vascular Screening

Diminished or absent pulse

Pooling of venous blood, suggesting inhibition of venous return

The On-Field Examination

FIGURE 2-1

Schematic representation of the on-field decision-making process

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Pulses

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Type Characteristics Implication
Accelerated Pulse >150 beats per minute (bpm) (>170 bpm usually has fatal results.) Pressure on the base of the brain; shock
Bounding Pulse that quickly reaches a higher intensity than normal, then quickly disappears Ventricular systole and reduced peripheral pressure
Deficit Pulse in which the number of beats counted at the radial pulse is less than that counted over the heart itself Cardiac arrhythmia
High Tension Pulse in which the force of the beat is increased; an increased amount of pressure is required to inhibit the radial pulse. Cerebral trauma
Low Tension Short, fast, faint pulse having a rapid decline Heart failure; shock

Respiratory Rate and Pattern

  • Rapid, shallow breaths: Rib fracture; internal injury; shock

  • Deep, quick breaths: Pulmonary obstruction; asthma

  • Noisy, raspy breaths: Airway obstruction

Abnormal breathing patterns are further classified based on the tempo and relationship between inspirations and exhalations.

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Type Characteristics Implications
Apneustic Prolonged inspirations unrelieved by attempts to exhale Trauma to the pons
Biot's Periods of apnea followed by hyperapnea Increased intracranial pressure
Cheyne-Stokes Periods of apnea followed by breaths of increasing depth and frequency Frontal lobe or brain stem trauma
Slow Respiration consisting of fewer than 12 breaths per minute CNS disruption
Thoracic Respiration in which the diaphragm is inactive and breathing occurs only through expansion of the chest; normal abdominal movement is absent Disruption of the phrenic nerve or its nerve roots

On-Field History

  • Location of the pain

  • Peripheral symptoms

  • Mechanism of the injury

  • Associated sounds and symptoms

  • History of injury

On-Field Inspection

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