Remembering everything we have to do from a medical perspective in an emergency situation can be challenging. The emergency medical services has developed a bunch of mnemonics that will help you keep everything straight. DCAP-BTLS is one of them.
DCAP-BTLS was developed as a way to help us remember what to look for during a physical exam. Every part of the body should be examined for DCAP-BTLS. Here's the run down:
D stands for Deformities. Deformities in this case basically mean gross deviations from what is normal for the patient you're examining. Some examples might include:
As with all things medical, Deformities are relative. If possible, be sure to ask your patient if a given deformity is normal for them. Some deformities are "congenital" meaning they were born with it, or the result of some previous trauma.
C stands for Contusions. Contusion is just a fancy word for a bruise. The location, the time it takes for a bruise to appear, and the shape of a cruise may all be clinically significant findings. A bruise ring around the umbilicus (known as Cullen's sign), for example, can be one indication of abdominal trauma. Bruising around the eyes, commonly known as raccoon eyes - or bruising to the occipital region of the skull, commonly known as a battle sign, may be an indication of a skull fracture.
A stands for abrasions. An abrasion is damage to the skin - usually no deeper than the dermis. When a motorcycle rider wearing no protective clothing (long pants and/or a motorcycle jacket) falls, the rider slides along the pavement and is usually a poster child for abrasions.
P stands for Punctures / Penetrations. Getting stabbed with an ice pick, shot by a firearm or impaled by a fence are all good examples of penetrations. An important thing to remember about penetrating injuries - particularly gunshot wounds - is that you much also check for exit wounds. Exit wound from gunshots are typically larger than the entrance wound. This is due to cavitation of the projectile and other factors like expansion and rotation. If something went in, you should always wonder if it came out again - or if it is still in your patient's body. Punctures / impalements are usually treated by stabilizing the object and transporting to definitive (and often surgical) care. There isn't much we can do in the field if we pull out the knife and the knife was the only thing keeping the patient from bleeding out.
B stands for Burns. Burns can be chemical, environmental, radiological, or thermal. They are measured in degrees: 1st degree through fourth degree. The higher the number, the deeper the burn has penetrated the body. These are also measured by the total body surface area affected. We typically use what's called "The Rule of Nines" to report total body surface area affected.
T stands for Tenderness. You need the patient's help to determine this one. As you palpate the abdomen, for example, does the patient describe tenderness in one of the four quadrants? It it sharp (point) tenderness or more diffuse tenderness?
L stands for Lacerations. These are basically cuts. If you notice a deep laceration, let's say to the side of the neck or the inner thigh, treat any life threatening bleeding on the spot. CPR or oxygen are meaningless if the patient runs out of blood.
S stands for swelling. Bee stings, burns and trauma's to the body usually swell. This is the body's way of coping with the injury. It sends fluid to the spot to injury to cool it off, to carry away toxins, to fight infection or to stop bleeding. Swelling can also be caused by certain medications or medical conditions. Congestive Heart Failure or diabetes, for example are examples of disease processes that can cause swelling in the ankles or abdomen.
Now that you know what DCAP-BTLS stands for, commit this mnemonic to memory and use it the next time you conduct your patient assessments. Each body part being examined should be evaluated for DCAP-BTLS. When you're all done, you'll have lots of good stuff to put in your report!
David, Thanks so much for this! Anything that helps to remember the process is a good thing indeed.
We use the Sample assessment, for a situation where some information can be obtained on history, occurrences; that sort of thing; then we do the simplified check for DOTS (Deformities, Open Wounds, Tenderness, and Swelling) that's part of a full body check, conscious (and consenting) or unconscious. That's a full manual check from head to toe, then extremities. The specific types of injuries are so hammered into us in the training (and in my life experience) that I couldn't forget them if I tried :-) I like your DCAP-BTLS, though, as a memnomic.