Patient Assessment

Patient Assessment

Scene Size - Up • Scene safety / BSI • Mechanism of injury / Nature of the illness • Number of patients • Consider need for additional manpower or specialized resources

Primary Survey • Goal of primary assessment • To identify and initiate treatment of immediate or potentially life threatening problems • Whether the patient’s Chief Complaint is trauma or medical related we begin with the primary assessment.

Primary Assessment Steps • Form a general impression • Introduce yourself and ask for patients chief complaint • Determine patients Level of Consciousness • Conscious unaltered LOC • Conscious with altered LOC • Unconscious • AVPU • Glascow Coma Scale

Glasgow Coma Scale

Airway Responsive Patient • Are they talking to you or crying? • Does patient exhibit any signs of dyspnea? • Is breathing noisy? • Unresponsive Patient • Assume trauma unless confirmed not to be trauma related • Open airway with either modified jaw thrust or head tilt chin lift • Address foreign body obstruction • Apply airway adjuncts if indicated • Suction if indicated • Assist ventilations if needed • If airway is clear, move to next step

Breathing • Is spontaneous breathing present? • Is breathing adequate or inadequate? • How do we tell the difference?

Circulation • Does patient have a pulse • Carotid • Radial • Brachial (pediatric) • Femoral • Any bleeding that needs to be controlled • Skin condition

Decision Time • After primary assessment we decide • Does this patient have a medical problem? • Does this patient have trauma injuries? • Does this patient have both? • Is this patient a load and go? • Do we need ALS support

Load and Go Patients • Rapid trauma assessment • Head to toe exam while maintaining C spine stabilization • Note any obvious findings • Assess any areas that will be inaccessible after immobilization (Neck / Back) • Support and treat any life threats

Assessment Acronyms • DCAP BLS TIC • OPQRST • SAMPLE • FAST • GEMS Diamond

Assessment Tools • BP Cuff • Stethoscope • Pulse Oximeter • Pen light • Glucometer • AED • Senses • Look listen and feel

Trauma Patient • Once loaded and enroute start secondary assessment • Head to toe using DCAP BLS TIC • Assess any previous treatments performed • Bandaging and splinting • Note any abnormal findings • Notify medical command of assessment and ETA

Key Point • Trauma patients may have an underlying medical problem that is exacerbated by the injury OR • A Medical problem may have resulted in a traumatic injury

The Medical Patient • Focus assessment on chief complaint • Cardiac • Respiratory • Abdominal complaints • Neurological complaints • Perform interventions as indicated • Notify medical command of findings, treatment, and ETA

Reassessment • Every 5 minute for unstable patients • Every 15 minute for stable patients

Changes in Condition • Check previous interventions • Start over with primary assessment

Assessment Challenges • Geriatrics • Pediatrics • Special needs patients • Language barrier • Multiple patients

Skills Practice • Review hands on assessments both medical and trauma using WVOEMS approved skills sheets as a guide

Patient Assessment