#trauma assessment

[blspracticalscenarios]

Explained - Secondary assessment: Trauma

Secondary assessment: Trauma

During a full-body trauma assessment, you are looking for 

Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling (DCAP-BTLS)

HEAD 

Scalp: Examine for any bleeding or DCAP-BTLS by palpating the skull

Ears: Look inside the ear for any blood or CSF, behind the ears for     Battle’s signs, palpate the mastoid process

Eyes: Palpate the orbital bones, look for raccoon eyes, determine pupil size and reaction with pen light

Facial areas: Palpate the mandible and maxilla

Oral: Look inside the mouth for any fluids or foreign objects

Nasal: Palpate the bridge of the nose and look inside for any fluid or foreign objects

NECK

Posterior: Palpate cervical spine for step-off

Anterior: Look for tracheal deviation 

Lateral: Look for jugular vein distention 

*Make sure to palpate the cervical spine prior to applying a  c-collar *

CHEST

Inspect: Look for flail chest, sucking chest wounds, unequal     respirations, etc.

Palpate: Clavicles, shoulders, sternum, ribs 

Auscultate: Lung sounds

ABDOMEN

Palpate: All four quadrants separately with flat palms in a rolling motion

Inspect: Do you note any pulsating masses/rebound tenderness/swelling?

PELVIS

Palpate: Push inwards then downwards, noting any instability

  *If  you feel any instability when you push inwards, DO NOT PUSH DOWN*

GENITALS

Verbalize: Checking genitalia with palm facing upward

EXTREMITIES

Palpate: Palpate the entire extremity from most proximal joints downwards. Use a cup-like motion with your hands to feel both the anterior and posterior sides.

Pulse: Radial/dorsalis pedis/posterior tibial

Motion: Test your patient’s ability to squeeze, push, pull, or wiggle fingers/toes

Sensation: Can the patient feel and differentiate between which hand/foot is being touched

POSTERIOR:

Palpate: The posterior spine looking for step-off, instabilities, or     deformities

*Make sure to palpate the spine prior to rolling a patient onto a backboard*

Management of secondary injuries: Bleeding control, splinting, full spinal immobilization, etc.

[familyfirstplaytherapy]

Play Therapy can be a useful support for children and parents. The saying ‘It takes a Village to raise a child’ may have been an old African proverb, but it holds such wisdom which can be applied to today’s family challenges  – big or small – and one that parents should not feel any shame about.

[skyloftian-nutcase]

Four was honestly surprised how many people were here. It was his first big trip, and it was definitely overwhelming. He was usually a loner, but he had to admit… he was thankful he’d asked a friend to come along.

Legend laughed as he texted someone, face glowing with glee. He elbowed Four mischievously. “We should definitely send pictures to Wars.”

“Is that who you’re texting?” Four asked with a smile, enjoying the cheer from his usually grumpier friend. Legend adored education conferences - his friend was nothing if not a lover of learning and exploring new things.

“Oh absolutely,” Legend replied, showing his phone. “He’s upset because I went to the emergency medicine conference and then went to this one. Personally, I think he’s just jealous because I have a cert he doesn’t.”

“Wait, Wars doesn’t have his CCRN?” Four questioned, confused. He figured Warriors, who had everything in his life in order, would have his critical care nursing certification. It was fairly common for nurses in ICU and ED settings.

“Nope!” Legend quipped with delight, obviously ecstatic that he had something over the military nurse.

“Okay, but important question: where are we going to get dinner?”

“Somewhere it doesn’t cost half our paycheck.”

Four glanced around at the skyscrapers. “Uh… not sure we’re going to manage that. I didn’t think the Hebra Mountains had cities like this.”

“Well, then we can contemplate Brugada Syndrome and complicated EKG rhythms while we starve,” Legend supposed.

“Oh, don’t be like that,” Four laughed. “This is a trip, we shouldn’t worry about the cost too much.”

”We don’t make Time’s salary.”

“But we make decent salary.”

Legend bit his lips, stubborn. Four narrowed his eyes analytically. “This isn’t about how much the food costs; it’s because you’ve blown your budget on coffee, isn’t it?”

His friend immediately flushed, guilty as charged. “They charge ten rupees for coffee! Ten!! This place is ridiculous!”

“I told you your caffeine addiction would come back to bite you someday,” Four smiled. “Or, well, more so than it already has.”

“I swear, if you bring up the SVT episode one more time—”

[foxx-queen]

i keep thinking about the datamined conversation between halsin and minthara and what gets me about it is that if you side with halsin and turn minthara away, thats objectively the bad choice.

like at this point, you've rescued minthara from moonrise. you know now that she was being controlled to act against her will. you've gone to the trouble of rescuing her from her tormentors, and you've experienced what it felt like as they tried to destroy her mind. you know what will happen to her if you turn her away. and if you do, you're willingly condemning her to that fate. you've essentially allowed her to experience freedom, to regain her sense of self, only to tear that away from her again.

whereas if you side with minthara, and halsin leaves, that's the only consequence he experiences. that he's not a companion anymore. at this point, we've saved the grove, we've saved him, and we've lifted the shadow curse. we've helped him achieve what hes been hoping to do for over a century. leaving your party won't see him lose his free will. he can return to the grove and live his life.

the choice is essentially either condemn someone to a fate worse than death, knowing exactly what that entails vs not letting someone travel with you anymore. its pretty clear cut to me.

its just interesting to me that they've switched the morality of it around given that minthara is considered the 'evil' companion by so many.

[luinhealthcare]

Does Hyrule mind teaching how to assess a patient??👉👈

"You... want to learn how to assess patients?" Hyrule asked hesitantly.

Wild shrugged. "What if I want to be an EMT?"

"You also said you wanted to be a chef in the hospital."

"I can do both, you know."

Hyrule laughed. "I suppose so. Well... we'll need a patient for this to work."

Wild immediately snatched Sky, who yelped as his friend snaked a hand around his wrist. "Sky's the patient, heaven knows he needs to be looked over anyway."

"Look who's talking, Mr. I-Have-Seizures-and-Don't-Tell-Anybody," Sky grumbled as he was manhandled to sit between the other two.

"Well, everyone knows now."

Hyrule and Sky gave Wild a scalding look. Adequately apologetic, Wild shrugged sheepishly.

"Anyway," Hyrule sighed, shifting his focus to Sky. "Assessments come in different forms. You've got a primary and a secondary assessment. Primary is kind of a general overview and checking for life threatening stuff, secondary is in-depth on what the issue actually is. Make sense?"

Wild nodded.

"Great!" Hyrule continued with a smile. "Okay. Sky's our patient. Sky, you got shot once, right?"

Sky nodded, and Wild balked. "He what?!"

"It was a long time ago," Sky waved a dismissive hand.

"Okay, so that's our scenario," Hyrule said, standing. "We're dispatched for a 21-year-old male with a GSW--"

"That means gunshot wound, right?"

"Yeah. GSW, conscious patient. That's all we've got. So, you get on scene, and the very first thing you do is check for scene safety. If the scene isn't safe, we're not going in. First thing you're taught in EMS - your own safety comes first, because if you're shot you can't help the patient. It's you, your partner, then the patient."

"How often do you actually listen to that rule?" Sky asked, raising an eyebrow.

"That's not what we're learning today," Hyrule waved off easily. It was pretty common knowledge that while he would never put his partner's life at risk, he'd gotten himself into dicey situations before. But he knew how to get himself out of those situations too. "So, we determine the scene is safe. Next, is our primary assessment. The purpose of this assessment is to check for life threatening things, and an overview of major body systems. Neuro status, bleeding, and your ABCs: Airway, Breathing, Circulation.

"The situation is pretty dynamic, like sometimes you walk up and somebody's got an arterial bleed and spurting blood everywhere, your assessment stops right there and you go fix that bleed. But generally you'll have time to do the entire primary assessment."

"Okay, so neuro and ABCs?"

"Yeah. And the good thing is that most of it happens all at once, you know? You walk up to Sky and he looks at you, then boom, you've got a good neuro - he's awake, he's alert. He may not be oriented, but you can figure that out by just talking to him. And by this point you can tell if there's life threatening bleeding. Then it's ABCs - is his airway patent, or open? Is he breathing, and is he doing so normally? Is his skin warm, dry, and normal tone for him? You can literally do al these things by just walking into the room and looking at him for five seconds. The primary assessment is done really fast and, the more times you do it, basically automatically."

"What would be an example of something being wrong?" Wild askd.

Hyrule glanced at him. "When I got on scene for your crash, you were unconscious and unresponsive--in other words, you were not only unconscious, but nothing would wake you up--and your breathing was gurgling sounding because you had blood in your airway."

Glancing at Sky, Hyrule said, "Sky can give us an example of a not great primary assessment, I'm sure."

Helpfully, Sky immediately flopped off the chair he was sitting on, collapsing to the ground with a crash. Wild laughed, and footsteps rushed from upstairs into the living room.

Twilight immediately froze in the entranceway, eyes wide and fixed on Sky. "Sky, what the--guys what the hell is hap--"

Sky perked up immediately. "Oh, sorry! I'm just helping Hyrule teach Wild!"

Twilight froze a moment and then sighed heavily, pinching the bridge of his nose and grumbling under his breath.

Hyrule smiled, pointing at Twilight. "He just perfectly showed a good primary assessment looks like! He walked in and saw the patient down on the ground, tried to figure out a neuro by calling out to him, and when Sky woke up he immediately could tell he was fine. Neuro intact, not bleeding, had a patent airway because he's talking, breathing normally, and skin looks normal."

"I hate all of you," Twilight groaned, walking out of the room.

"Okay, but by skin looking normal... what does it mean when it doesn't?" Wild asked.

"Your skin can tell a story," Hyrule explained. "If you're diaphoretic, which means sweating, something is likely wrong. Though it depends on context - if your patient's sweaty but they were just exercising, it makes sense. If Sky's sweaty on the ground after being shot, he's in shock. If the skin is cool, the body isn't circulating well - that can sap the color right out of your skin - the lighter your skin tone the more notable it is, but darker skin tones can become paler too. A lot of times with darker skin tones you'll want to look at their palms or their lips, that'll help you determine it. Another color is grey - that usually means cardiac and it's bad. So skin can tell you a lot!"

"How did my skin look?" Wild questioned, curious.

"Pale," Hyrule immediately answered. "Anyway. Sky's your patient. Look him over."

"Okay," Wild blew out a breath, approaching Sky and kneeling beside him. "So he's unconscious, that's my neuro so far."

"Can you arouse him at all?"

Wild poked Sky in the neck. Sky flinched. Wild poked again and Sky giggled. Wild's eyes widened in realization, and a mischievous smile crossed his face.

"Wild, wait--"

Sky started laughing hysterically as his friend tickled him, wiggling and trying to shove him away.

"Get--off of m--Wild you jerk--"

Hyrule chuckled. "Well, we're not taught to tickle our patients, but that works."

[emohorseboy]

thinking about it it’s very telling that the only thing i said that my recent psych worker was willing to believe without twisting my words so far beyond recognition that she may as well have just never met me and made the whole thing up was when i said that i feel like i alienate people. i meant that i feel like i am an inherently evil person who hurts people just by association and but she asked no further questions, wrote that i ‘alienate people with [my] behaviour’, and recommended a structured ‘personality disorders assessment’. fucking sinister that the only thing i said they were willing to even slightly believe was the bit where i said i was a terrible person lmao.

needless to say that is the last time i will ever be talking to a psych ‘professional’ of any kind. this last stint under mh services has truly broken me and at long last i have learned my fucking lesson.

[liminalweirdo]

source

[lilacxquartz]

How do u manage ur work life along with ur passion of writing fanfiction?

i work part time from home as a python & js dev so i can technically never touch grass again if i really wanted to

[hurricanesfollowyou]

I’ve got an assessment with mental health services in the morning. just a 30 minute call, nothing diagnostic. another attempt to get primary care services to listen to me about how fucked up I am and how much I can not handle being fobbed off with CBT and group therapy again.

I should not still have to be reliving the worst parts of my childhood, it’s bad enough that I have so many years of being misunderstood to grieve the loss of.

If you’re the praying kind, or like to send good vibes, I’d appreciate either in about 10.5 hours.

[baladric]

therapist trying to help me feel calmer about the pressure of being a full-time teacher this summer as a person with an increasingly low masking/communication threshold, her like "i have observed that when i ask a lot of people on the spectrum when they've felt most alive, there's a fairly frequent response that it happens while they're giving lectures on topics they know about, because of the guaranteed space to exercise their minds and interests��does that resonate with you?" and i had to be like absolutely fucking not, i hate public speaking, nothing makes the mean old man in my head louder on the Hating Myself front, no matter how confidently learned i am on the topic at hand, the two key things that make me feel Alive™ are singing in operas or full concerts, and receiving feedback from people who've had emotional reactions to something i wrote, and my therapist was like "ah... Well" like yes 40 hours a week of teaching children is probably going to be a very bad and possibly harmful job fit, unfortunately i need money desperately

[hesbuckcompton-baby]

the jump from writing I'm Your Man to writing Better Off is so funny to me like... if you thought the build-up to Frankie and Rosie was painful you might need to sit this one out because I have created the most uncommunicative awkward couple of all time and it is actually decaying my brain as we speak

[familyfirstplaytherapy]

Child Psychotherapy Play Therapy

Child Psychotherapy Play Therapy focuses on helping children and teens by using evidence based techniques which include Cognitive Behaviour Play Therapy (CBPT), Theraplay®, Child Centered Play Therapy, Dyadic Developmental Psychotherapy, Filial Therapy as well as play based strategies including art and sandtray. Certified Play Therapists let children explore, act and practice new ways of coping and managing their emotions in a safe and supportive environment.

[ashes-in-a-jar]

The Sheridan Tapes episode 59

[viperwhispered]

So, as much as I love a dom Jamil, I do also love the idea of him calling me you mistress/master in bed.

Whether he'd be actually willing to do that is another matter, though.

So, I'm curious. Assuming an established relationship where they're comfortable exploring kinks together,

And to clarify: I'm not asking if he'd try it once, but rather if it's something he'd have be a part of their repertoire with his s/o, so to speak.

[hofftrans]

also to add to that last post it's such a huge point of frustration for me that people get like... uncomfortable and judgemental when you describe your own trauma in a blaze or god forbid funny way.

Like I'm so sorry that the terrible things that happened to me make you uncomfortable????? Am I supposed to break down and sob like a shakesperian actor everytime I describe my life story? If I do that I'll be considered hysterical. Like there's no winning

[dontmeantobepoliticalbut]

The U.S. Secret Service has released a first-of-its-kind report that analyzes 173 mass attacks that took place in the country from 2016-2020.

It's the first time the agency has put together trends collected from five years of data; the report examines everything from when in the year the attacks took place, to behavioral changes exhibited in the attackers. The report, which comes from the agency's National Threat Assessment Center, looked at attacks that harmed at least three individuals, not including the attacker.

The report comes just days after two shootings in California in Monterey Park and Half Moon Bay killed a total of 18 people. So far in 2023, there have been 39 mass shootings.

Lina Alathari, chief of the National Threat Assessment Center, said she hopes the research and guidance provided in the report can help prevent future mass attacks.

"We must do everything we can to prevent these, which is why we're putting out this research for you. There is no community that is immune from this," Alathari said.

TOP DATA POINTS FROM THE REPORT

• LOCATION: Most of the attacks took place in a variety of public and semi-public spaces across 37 states, and Washington, D.C. The most common locations for an attack were businesses, including restaurants and retail.

• TYPE OF WEAPON USED: 126 of the attacks, or 73%, involved the use of one or more firearms. In nearly 1/4 of the attacks involving firearms, at least one of the firearms was acquired illegally by the attacker.

• DEMOGRAPHICS OF ATTACKERS: 96% of the attackers in the study were male. The USSS says that this finding is consistent with previous analyses of mass attacks. 57% were white and 34% were Black.

• CRIMINAL HISTORY: 64% had a prior criminal history, not including minor traffic violations. 41% of the attackers were found to have a history of domestic violence, but only 16% if those individuals faced domestic violence charges.

• ONLINE PRESENCE: A majority of the attackers had a identified presence online, and nearly one-quarter were found to have conveyed "concerning communications" such as threats, and posts about suicidal ideations, previous mass shootings, violent content and hatred toward a specific ethnic group.

• STRESSORS: Nearly all the attackers experienced "at least one significant stressor" within five years of the attack, most of which were issues with family and romantic relationships. 20% of the attackers experienced some kind of childhood trauma, including physical or sexual abuse, entering foster care, living in a refugee camp, or the death of a parent, the report says.

• FINANCIAL AND HOUSING INSTABILITY: 72% of the attackers experienced a financial stressor some time before the attack, and over half experienced it within five years. The report describes some financial stressors as bankruptcy, eviction, foreclosure and loss of income. 39% of the attackers also experienced unstable housing within 20 years of their attack, including homelessness and impending evictions.

CONCERNING BEHAVIORS AND MENTAL HEALTH SYMPTOMS AMONG THE ATTACKERS

The report says that of the 180 attackers examined in the report, 58% experienced mental health symptoms prior to or at the time of their attack, some of which included depression and suicidal thoughts, and psychotic symptoms such as paranoia and delusions.

The report makes it clear that mental health factors should not be considered causal explanations for why these attacks occurred.

"Mental illness is not a barometer for dangerousness and it is not a correlation for mass attacks. The vast majority of individuals with mental illnesses in this country will never be violent. In fact, often, they are the victims of violence," Alathari said.

The agency says violence like mass attacks are rarely spontaneous and almost always have some warning signs in the attacker. The report doesn't offer any kind of road map to prevent future mass attacks, but the agency recommends that "community systems" be set up to help identify and intervene when someone reports concerns about another person.

With the roll out of the USSS's report, they are also holding a virtual event, and Alathari said 21,000 people signed up to attend from all 50 states and 80 countries.

"Everyone has a role to play in prevention, it's [not] just one person's responsibility or one organization's responsibility. It is a community-wide, multi-disciplinary effort," Alathari said.