Assessment of the Patient

1. Assessment of the Patient Concepts of Emergency Medicine Pam Knepp, RN BSN

2. Assessment of the Patient • Scene Size-up • Initial Assessment • Focused History and Physical Exam • Vital Signs • Hand-off to EMTs

3. Patient Assessment Bergeron, J. David & Chris Le Bandour. (2009). First Responder. 8th Edition. Pearson Prentice Hall. Upper Saddle River:NJ.

4. Patient Assessment Bergeron et al. (2009). First Responder. 8th Edition. Pearson Prentice Hall. Upper Saddle River:NJ.

5. Scene Size-up • Every patient assessment begins with scene size-up, which includes: • Taking BSI precautions (body substance isolation) • Determining if the scene is safe • Identifying the MOI (mechanism of injury) or nature of illness • Determining the number of patients • Identifying any additional resources needed

6. Scene Size-up • BSI precautions Rescuer wears protective eye wear.

7. Scene Size-up • BSI precautions Rescuer dons gloves.

8. Scene Size-up • BSI precautions Rescuer wears both a gown and a simple surgical mask.

9. Scene Size-up • BSI precautions Rescuer wears a HEPA mask. (filters the air so less allergens or pollutants are being inhaled)

10. Scene Size-up *Scene Safety: An assessment of the scene and surroundings will provide valuable information to the First Responder and will ensure the well-being of the First Responder.

11. Scene Size-up • Scene Safety: • Personal protection • Protection of the patient • Protection of bystanders **If the scene is not safe, make it safe. Otherwise, DO NOT ENTER.

12. Scene Size-up • Unstable situation • HazMAT situation • Violent situation

13. Scene Size-up *Identify Mechanism of Injury: • In trauma situations • An evaluation of the forces that caused an injury • May be beneficial in determining the presence of internal injuries • Determined from the patient, family, or bystanders, and inspection of the scene

14. Scene Size-up *Identify Mechanism of injury Trauma patient

15. Scene Size-up *Identify mechanism of injury Impact #1 “A car collides head on with a tree.”

16. Scene Size-up *Identify Mechanism of injury Impact #2 “The car collision causes the drivers chest to hit steering wheel.” “The steering wheel causes damage to the chest area and broken ribs.”

17. Scene Size-up *Identify mechanism of injury Impact #3 “The impact of the steering wheel to the drives chest area cause additional damage to inner organs.”

18. Scene Size-up *Identify nature of illness: • In medical situations • Determined from the patient, family, or bystanders • Why was EMS called?

19. Scene Size-up *Identify nature of illness

20. Scene Size-up • Determine the number of patients and additional resources needed: • It is important to account for all patients involved. • Request additional resources if needed: • Fire department • Police • ALS crews (Advanced Life Support) • Rescue • Utilities • Call for resources early.

21. Initial Assessment • Form a general impression of the patient. • Assess the patient’s mental status. • Assess the patient’s airway. • Assess the patient’s breathing. • Assess the patient’s circulation. • Make a decision on the priority the patient (notify dispatch)

22. Initial Assessment The initial assessment is completed to assist the First Responder in identifyingImmediate Threats to Life.

23. Initial Assessment • Form a General Impression of the Patient Based on the First Responder’s immediate assessment of the environment and the patient’s chief complaint.

24. Initial Assessment • Form a general impression of the patient • Assess the Patient’s Mental Status: • Classify the patient’s mental status into one of the following categories: • Alert • Verbal • Painful • Unresponsive

25. Initial Assessment *Assess the patient’s mental status. Assessing the apparently unresponsive patient

26. Initial Assessment *Assess the patient’s mental status Assessing the apparently responsive patient

27. *Assess the patient’s airway Head-Tilt; Chin-Lift Initial Assessment

28. *Assess the patient’s airway Jaw-thrust maneuver (with suspected neck injury) Initial Assessment

29. Initial Assessment *Assess the patient’s airway Suction of needed

30. Initial Assessment *Assess the patient’s airway Insert an airway adjunct as needed

31. Initial Assessment *Assess the patient’s breathing • Look at the effort of breathing. • Look, listen, and feel for presence of ventilations. • Ventilate as needed.

32. Initial Assessment • Assess the patient’s circulation • Check for a pulse (carotid artery in adults and brachial artery in infants). • Check for serious bleeding (control bleeding). • Check skin color.

33. Initial Assessment • Make a decision on the priority of the patient and alert dispatch. High priority: • Poor general impression • Unresponsiveness • Breathing difficulties • Severe bleeding or shock • Complicated childbirth • Chest pain • Severe pain

34. Focused History and Physical Exam

35. Focused History and Physical Exam • Trauma Patient—Significant MOI: • Significant mechanisms of injury include: • Ejection from a vehicle • Death of another passengers in a MVC • Falls greater than 15 feet • Rollover vehicle collision • High-speed vehicle collision • Vehicle-pedestrian collision • Motorcycle crash • Unresponsiveness or altered mental status • Penetrations of the head, chest, or abdomen

36. Focused History and Physical Exam * Trauma Patient—Significant MOI: • Significant mechanisms of injury in a child include: • Falls greater than 10 feet • Bicycle collision • Medium-speed vehicle collision

37. Focused History and Physical Exam * Physical Exams or Assessments: • Deformities • Contusions • Abrasions • Punctures and Penetrations • Burns • Tenderness • Lacerations • Swelling

38. Focused History and Physical Exam • Trauma patient – Rapid trauma assessment Stabilize the head and neck, and check the head (scalp and face).

39. Focused History and Physical Exam * Trauma assessment – rapid trauma assessment Check the neck and apply a cervical collar (if trained to do so). Note any swelling or tenderness.

40. Trauma patient – rapid trauma assessment Check the chest Check each quadrant of the abdomen (note any abnormalities, tenderness, or foreign bodies) Focused history and physical exam

41. Focused History and Physical exam • Trauma Patient—Rapid Trauma Assessment Check the pelvis, pressing gently down and inward.

42. Focused History and Physical Exam * Trauma Patient—Rapid Trauma Assessment Check the extremities, legs, and then arms (look for any deformity, swelling, or discoloration).

43. Focused History and Physical Exam * Trauma Patient—Rapid Trauma Assessment Check for distal pulse, motor function, and sensation in each extremity.

44. Focused History and Physical Exam * Trauma Patient—Rapid Trauma Assessment Check the back and buttocks while maintaining c-spine immobilization: • keep arms close to center of body and patient is moved keeping the entire body aligned while rolling patient on his side. • the patient is rolled on the count of the person holding c-spine.

46. Focused History and Physical Exam * Trauma Patient—No Significant MOI: • Steps of assessment include: • Perform a focused trauma assessment. • Take vital signs. • Gather SAMPLE history. S-signs/symptoms A-allergies M-medication P-past history L-last oral intake E-events prior

47. Focused History and Physical Exam * Trauma Patient—Focused Trauma Assessment • Examine the area that is injured. • Take vital signs. • Provide appropriate care (i.e. stabilize any injuries, control bleeding, dress wounds)

48. Focused History and Physical Exam • Trauma Patient: • SAMPLE History: • Signs and symptoms • Allergies • Medications • Pertinent past medical history • Last oral intake • Events leading to the illness or injury

49. Focused History and Physical Exam * Medical Patient—Unresponsive: • Steps of assessment include: • Perform a rapid physical exam (head-to-toe). • Take vital signs (pulse, respirations, blood pressure – if equipment available, mental status). • Gather SAMPLE history.

50. Focused History and Physical Exam * Medical Patient—Responsive: • Steps of assessment include: • Gather SAMPLE history. • Take vital signs (pulse, respirations, blood pressure-if equipment available, mental status) • Perform a focused physical exam. • Area of chief complaint **Note any medical identification devices (i.e. allergy bracelets)