BLOCK III

2. BLOCK III • Patient Assessment • VS • Communication • Documentation • The older folks • The younger folks • Block III written and practical

3. Patient Assessment

4. Patient Assessment Scene-Size-up – Initial Assessment – Focused history and physical exam- Detailed Physical Exam- On-Going Assessment-

5. Patient Assessment BSI BSI BSI BSI BSI BSI BSI BSI

6. Patient Assessment Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment

7. Patient Assessment Scene Size-up

8. Initial evaluation of the scene • Continues throughout the scene

9. Part I SCENE SIZE-UP Defined: Begins with dispatch Initial evaluation of the scene Goals: Ensure scene safety To determine if patient is medical or trauma Determine total number of patients

10. Patient Assessment • Scene Size-up Begins with Dispatch demographics: residence - Pull to curbside in front of house Always remember, scene safety is a component of Scene Size-up Nature of illness: Number of patients: Considers stabilization of spine Requests additional help if necessary: ALS

11. Scene Safety Personal protection • Always perform your own size-up • Observe as you approach and before getting out of the truck

12. Nature of Illness • Information can be obtained from The patient Family members or bystanders Scene

13. Mechanism of injury

14. Number of patients • Call for additional help if needed ALS

15. Collision Scene • Look and listen • Check for power outages • Observe traffic flow • Check for smoke

16. As you approach: • Look for clues to escape hazourdous materials • Look for patients on or near the road • Look for smoke not seen at a distance • Look for broken utility poles and downed lines • Be on the look-out for bystanders • Watch for signals of police officers or other agency personnel

17. Danger Zone • No apparent hazard-at least 50ft in all directons • Fuel spill-at least 100 ft. in all directions uphill and downwind avoid gutter, gullies, ditches do not use flares • Vehicle fire-at least 100 ft. in all directions • Downed wires-area in which contact can be made • Hazardous Materials Emergency Response Guide Book Chemtrec

18. Crimes Scenes and Acts of Violence Signals of violence: • Fighting or loud voices • Visible weapons • Signs of alcohol or other drug use • Unusual silence • Knowledge of prior violence

19. Nature of call • Illness • Injury

20. Part II INITIAL ASSESSMENT • Defined: • Discovering and treating life-threatening conditions • Goals: • Determine if the patient is ill or injured • Triage • Components: • General Impression • Illness or injury • Mechanism of injury/Nature of illness • Age, sex, race • Identify life-threatening problems • Mental Status • A lert V erbal Response P ainful Response U nresponsive • Assess Breathing • Assess Breathing • Triage

21. Patient Assessment

22. Patient Assessment

23. Part III Focused History and Physical Exam • Defined: • To identify additional serious or potentially life-threatening injuries or conditions • Components, Trauma • Reconsider Mechanism of injury • Index of suspicion • Rapid Trauma Assessment • Head to toe physical exam quickly conducted • Base-line Vital Signs • Assess S A M P L E history • Components Medical • History of present illness • O – P – Q – R – S – T • S A M P L E • Rapid Assessment • Base-line Vital Signs • Treat • IF UNRESPONSIVE: • Rapid Assessment • Base-line Vital Signs • Assess S A M P L E • Care

24. Patient Assessment Focused History and Physical Exam • Onset? • Provokes? • Quality? • Radiates? • Severity? • Time? • Interventions?

25. Patient Assessment

26. S A M P L E history • Signs/Symptoms • Allergies • Medications • PMHx. • Last oral intake • Events leading to the illness/injury

27. Vital Signs and Sample History

28. General Impression • Illness or injury • Mechanism of injury/Nature of illness • Age, sex, race • Identify life-threatening problems

29. Vital Signs • Pulse Apical • Respirations • Skin color, temp, condition • Pupils • Blood Pressure Auscultation Palpation • Mental Status

30. Communicating with your patient • Position yourself close to the patient • Identify and yourself and reassure • Speak in a normal voice • Learn your patient’s name • Learn your patient’s age

31. Patient Assessment

32. Part IV Detailed Physical Exam • Defined • Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment • Components • Head to Toe exam • Reassess vital signs • Continue care

33. Part V On-Going Assessment • Defined: • To detect any changes in the patient’s condition • To detect any missed injuries or conditions • To adjust care as needed • Goal: • The initial assessment is repeated • Vital signs are repeated and recorded • Focused assessment repeated for additional complaints • Components: • Repeat Initial Assessment • Repeat focused assessment • Check interventions • Note trends in patient condition

34. Patient Assessment On-going Assessment • Repeats initial assessment • Repeats vital signs: • Repeats focused assessment regarding patient complaint or injuries:

35. Patient Assessment Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment

37. Assessment of the Medical Patient Responsive • Four parts History of present illness Focused physical exam OPQRST SAMPLE Baseline VS • Prior history • DCAPBTLS

38. Unresponsive • Patient history from family, bystanders etc. • Rapid assessment Abd: distension, firmness, rigidity Pelvis: Incontinence of urine, feces • ID bracelets • Baseline VS • Consider need for ALS • History of present illness and SAMPLE

39. History of present illness and SAMPLE • Patient’s name • What happened what did family/bystander see • Did patient complain of anything prior • Know illness • Medications