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Section 3: Patient Assessment

Section 3: Patient Assessment. Chapter 8. Patient Assessment. Objectives (1 of 9). Scene Size-up Describe the importance of recognizing potential hazards Describe common hazards found at the scene Determine if the scene is safe to enter

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Section 3: Patient Assessment

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  1. Section 3: Patient Assessment

  2. Chapter 8 Patient Assessment

  3. Objectives (1 of 9) Scene Size-up • Describe the importance of recognizing potential hazards • Describe common hazards found at the scene • Determine if the scene is safe to enter • Discuss identifying the number of patients at the scene • Explain the need for additional help or assistance Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  4. Objectives (2 of 9) Initial Assessment • Summarize the reasons for forming a general impression • Discuss methods of assessing altered mental status • Discuss methods of assessing the airway • State reasons for managing the cervical spine • Discuss methods for assessing if a patient is breathing Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  5. Objectives (3 of 9) • State what care should be provided to a patient with adequate breathing • State what care should be provided to a patient without adequate breathing • Describe methods used to obtain a pulse • Discuss the need for assessing for external bleeding Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  6. Objectives (4 of 9) • Describe normal and abnormal findings when assessing skin color • Describe normal and abnormal findings when assessing skin temperature • Describe normal and abnormal findings when assessing skin condition • Describe normal and abnormal findings when assessing capillary refill • Explain the reason for prioritizing a patient for care and transport Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  7. Objectives (5 of 9) Focused History and Physical Exam: Trauma • Discuss reasons for reconsidering the MOI • State the reasons for performing a rapid trauma assessment • Describe the rapid trauma assessment and what should be evaluated • Differentiate when the rapid assessment may be altered to provide patient care Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  8. Objectives (6 of 9) Focused History and Physical Exam: Medical Patients • Describe the need for assessing a patient with a specific complaint and no known history • Differentiate between the assessment for responsive patients without a history and responsive patients with a history Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  9. Objectives (7 of 9) • Describe the unique needs of assessing an unresponsive patient • Differentiate between the assessment performed on an unresponsive patient and other medical patients Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  10. Objectives (8 of 9) Detailed Physical Exam • Discuss components of the detailed physical exam • Explain what additional care is provided during the detailed physical exam • Distinguish between the detailed exam on a trauma and medical patient Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  11. Objectives (9 of 9) Ongoing Assessment • Discuss the reason for repeating the initial assessment • Describe the components of the ongoing assessment • Describe trending of assessment components Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  12. Scene size-up Initial assessment Provide spinal immobilization Identify and treat life threats Focused history and physical exam Provide transport if needed Detailed physical exam Reassess vital signs Ongoing assessment Patient Assessment Process Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  13. The Patient Assessment Process Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  14. Body Substance Isolation • Assumes all body fluids present a possible risk for infection • Protective equipment • Latex or vinyl gloves should always be worn • Eye protection • Mask • Gown Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  15. Oncoming traffic Unstable surfaces Leaking gasoline Downed electrical lines Potential for violence Fire or smoke Hazardous materials Other dangers at crash or rescue scenes Crime scenes Scene Safety Potential Hazards Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  16. Scene Safety • Park in a safe area • Speak with law enforcement first if present. • The safety of you and your partner comes first! • Next concern is the safety of patient(s) and bystanders. • Request additional resources if needed to make scene safe. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  17. Mechanism of Injury • Helps determine the possible extent of injuries on trauma patients • Evaluate: • Amount of force applied to body • Length of time force was applied • Area of the body involved Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  18. Motor Vehicle Crashes • Amount of force related to speed • Injuries can be predicted by: • Position in the car • Use of seat belts • How the body shifts during the crash Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  19. Falls • Amount of force related to height of fall • Note surface that patient landed on • Attempt to determine how patient landed Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  20. Gunshot and Stab Wounds • Gunshot wounds • Force is related to caliber of weapon and distance from gun to the patient • Stab wounds • Injury can be estimated by looking at the entrance and length of the weapon Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  21. Nature of Illness • Search for clues to determine the nature of illness. • Often described by the patient’s chief complaint • Gather information from the patient and people on scene. • Observe the scene. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  22. Number of Patients • Determine the number of patients and their condition. • Assess what additional resources will be needed. • Triage to identify severity of each patient’s condition. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  23. Patient Assessment Process Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  24. Components of the Initial Assessment • Develop a general impression • Assess mental status • Assess airway • Assess the adequacy of breathing • Assess circulation • Identify patient priority Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  25. Develop a General Impression • Occurs as you approach the scene and the patient • Assessment of the environment • Patient’s chief complaint • Presenting signs and symptoms of patient Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  26. 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. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  27. Assessing Mental Status • Checking responsiveness • Assess how well the patient responds to external stimuli. • Check for orientation • Check the patient’s memory to person, place, time, and event. If he or she recalls all four, then he or she is fully alert and oriented times four. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  28. Level of Consciousness • A Alert • V Responsive to Verbal stimulus • P Responsive to Pain • U Unresponsive Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  29. Assessing the Airway • 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 Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  30. Signs of Airway Obstruction in the Unconscious Patient • Obvious trauma, blood, or other obstruction • Noisy breathing such as bubbling, gurgling, crowing, or other abnormal sounds • Extremely shallow or absent breathing Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  31. 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? Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  32. Managing Breathing • If patient is having difficulty breathing reevaluate 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. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  33. Unresponsive Patients • Look, listen and feel technique • Consider spinal cord injury. • Provide high-flow oxygen. • Assist ventilations if needed. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  34. 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 Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  35. 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 Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  36. Restoring Circulation • Control bleeding and improve oxygen delivery. • If unresponsive and pulseless begin CPR. • Apply and operate the AED as quickly as possible. • Do not use AED on patients with a catastrophic traumatic injury. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  37. Poor general impression Unresponsive with no gag or cough reflexes Difficulty breathing Signs of poor perfusion Complicated childbirth Uncontrolled bleeding Severe pain Severe chest pain Inability to move any part of the body Identifying Priority Patients Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  38. Patient Assessment Process Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  39. Goals of Exam • Identify the patient’s chief complaint. • Understand the specific circumstances surrounding the chief complaint. • Direct further physical examination. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  40. The Golden Hour Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  41. Ejection from vehicle Death in passenger compartment Fall greater than 15´-20´ Vehicle rollover High-speed collision Vehicle-pedestrian collision Motorcycle crash Unresponsiveness or altered mental status Penetrating trauma to head, chest, or abdomen Significant Mechanism of Injury Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  42. Includes the list from the previous slide as well as: Fall greater than 2 to 3 times their height Bicycle crash Significant Mechanism of Injury for Children Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  43. Hidden Injuries • Seat belts • May cause injuries if worn improperly • Airbags • Look beneath airbag for bent steering wheel. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  44. D Deformities C Contusions A Abrasions P Punctures/ Penetrations B Burns T Tenderness L Lacerations S Swelling Trauma Assessment Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  45. Rapid Trauma Assessment (1 of 3) • Maintain spinal immobilization while checking patient’s ABCs. • Assess the head. • Assess the neck. • Apply a cervical spine immobilization collar. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  46. Rapid Trauma Assessment (2 of 3) • Assess the chest. • Assess the abdomen. • Assess the pelvis. • Assess all four extremities. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  47. Rapid Trauma Assessment (3 of 3) • Roll the patient with spinal precautions. • Assess baseline vital signs and SAMPLE history. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  48. Head, Neck, and Cervical Spine • Feel head and neck for deformity, tenderness, or crepitation. • Check for bleeding. • Ask about pain or tenderness. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  49. Chest • Watch chest rise and fall with breathing. • Feel for grating bones as patient breathes. • Listen to breath sounds. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  50. Abdomen • Look for obvious injury, bruises, or bleeding. • Evaluate for tenderness and any bleeding. • Do not palpate too hard. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

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