Clinical Presentations for Medics to consider when filling out TCCC cards: It is best to have a syndromic approach to the initial work up, Protect self and team. Don PPE.
Initial overview: R/O trauma and need TCCC intervention.
Vital signs: Note presence of Fever, elevated Respiratory and heart rates, Oxygen saturation (qSOFA or NEWS).
Airways: Ventilation/oxygenation: access oropharynx and upper airways, R/O tension pneumothorax and flail chest. Interstitial process?
General: Level of consciousness (alert and oriented, walking, talking without assistance). Level of effort to survive. Note any variation from the norm. Presence of fever, chills, nausea, vomiting, malaise.
Respiratory: Rate, depth of breathing, ventilation, cough (productive or not), lung/breath sounds.
Circulation: R/O major hemorrhage or bleeding, general volume status, capillary refill, note presence of lymphadenopathy.
Neurological: Timing (acute vs. insidious changes), mental status (GCS), Paralysis, Paresthesia’s, Central vs peripheral weakness. Seizure activity or history of seizure activity?
Skin: dry/wet/sweating, Rash: localized or generalized, ecchymosis or bleeding from mucus membranes (eyes, nose, ears, mouth or gums, anus, penis or vagina) are there petechia (generalized or focal) color of the skin, is jaundice present, check the conjunctiva and note findings. Are there bullae or blisters (generalized or focal)?
Gastroenterology: Vomiting (address and prevent aspiration, note hematemesis, etc. of vomitus), access presence of a surgical abdomen. Organomegaly vs. distension. Diarrhea (frequency, contents).
Musculoskeletal: R/O gross trauma and address. Weakness, spasm, fasciculations.