REFERENCE Trauma Score Revised Trauma Score Respiratory Rate 10 24/min 4 – 24 35/min 3 – > 36/min 2 1 9/min 1 – None 0 Respiratory Expansion Normal 1 Retractive 0 Systolic Blood Pressure > 90 mmHg 4 70 89 mmHg 3 – 50 69 mmHg 2 – 0 49 mmHg 1 – No Pulse 0 Capillary Refill Normal 2 Delayed 1 Points to add to the RTS based on the GCS 14 15 5 – 11 13 4 – 8 12 3 – 5 7 2 – 3 4 1 – REFERENCE Glasgow Coma Scale Eye Opening Spontaneous 4 Opening to voice 3 Response to pain 2 None 1 Verbal Oriented 5 Verbal confused 4 Inappropriate 3 Incomprehensible sounds 2 None 1 Motor Obeys commands 6 Localizes pain 5 Withdraws (pain) 4 Flexion 3 Extension 2 None 1
REFERENCE Trauma Score Revised Trauma Score Respiratory Rate 10 – 24/min 4 24 – 35/min 3 > 36/min 2 1 – 9/min 1 None 0 Respiratory Expansion Normal 1 Retractive 0 Systolic Blood Pressure > 90 mmHg 4 70 – 89 mmHg 3 50 – 69 mmHg 2 0 – 49 mmHg 1 No Pulse 0 Capillary Refill Normal 2 Delayed 1 Points to add to the RTS based on the GCS 14 – 15 5 11 – 13 4 8 – 12 3 5 – 7 2 3 – 4 1 REFERENCE Glasgow Coma Scale Eye Opening Spontaneous 4 Opening to voice 3 Response to pain 2 None 1 Verbal Oriented 5 Verbal confused 4 Inappropriate 3 Incomprehensible sounds 2 None 1 Motor Obeys commands 6 Localizes pain 5 Withdraws (pain) 4 Flexion 3 Extension 2 None 1
TN-Protocol-07282016.docx