Patient Assessment

1. Patient Assessment INITIAL ASSESSMENT

2. Components of the Initial Assessment • Develop a general impression • Assess mental status • Assess airway “A” • Assess the adequacy of breathing “B” • Assess circulation “C” • Identify patient priority

3. Develop a General Impression • Looks for life-threatening conditions • Occurs as you approach the scene and the patient • Assessment of the environment • Patient’s chief complaint • Presenting signs and symptoms of patient

4. Distinguishing Between Medical and Trauma • Determination should come after assessment is finished. • Patients may have traumatic injuries caused by a medical reason. • Initially assume all patients have both medical and traumatic aspects to their condition.

5. Level of Consciousness • A Alert • V Responsive to Verbal stimulus • P Responsive to Pain • U Unresponsive

6. Assessing the Airway (Unconscious) • Open the airway • Head tilt, chin lift technique. • Look, Listen, Feel for breathing for 5 seconds. • If not breathing, give two initial breaths.

7. Assessing the Airway (Conscious) • Look for signs of airway compromise: • Two- to three-word dyspnea • Use of accessory muscles • Nasal flaring and use of accessory muscles in children • Labored breathing

8. Assessing Breathing • Are the patient’s respirations shallow or deep? • Does the patient appear to be choking? • Is the patient cyanotic (blue)? • Is the patient moving air into and out of the lungs as the chest rises and falls?

9. Managing Breathing • If patient is having difficulty breathing re-evaluate airway. • Consider assisting ventilations with a BVM or applying a nonrebreathing mask if patient’s respirations are greater than 24/min or less than 8/min.

10. Unresponsive Patients • Look, listen and feel for breathing about 5 seconds • Consider spinal cord injury. • Provide high-flow oxygen. • Assist ventilations if needed.

11. Assessing Circulation (1 of 2) • Assess the pulse. • Rate, rhythm and strength • Assess and control external bleeding. • Direct pressure • Evaluate skin color. • Cyanotic, flushed, pale or jaundiced

12. Assessing Circulation (2 of 2) • Evaluate skin temperature. • Skin is an organ. • Evaluate skin condition. • Dry or moist • Evaluate capillary refill. • Should be less than 2 seconds

13. Poor general impression Unresponsive Difficulty breathing Signs of poor perfusion (capillary refill) Uncontrolled bleeding Severe pain Severe chest pain Inability to move any part of the body Identifying Priority Patients

14. Goals of Exam • Identify life threatening conditions. • Identify the patient’s chief complaint.

15. The Golden Hour

16. Trauma Assessment • D Deformities • O Open Wounds • T Tenderness • S Swelling

17. D Deformities C Contusions A Abrasions P Punctures/ Penetrations B Burns T Tenderness L Lacerations S Swelling Trauma Assessment

18. Assessing the Responsive Patient • Ask general questions to find out the chief complaint. • If they answer, they are conscious, breathing, and have a pulse. • Listen to the patient.

19. Review

20. The Communication Process • Do what you can to make the patient comfortable. • Listen to the patient. • Make eye contact. • Base questions on the patient's complaint. • Mentally summarize before starting treatment.