Chapter 5 Patient Assessment

1. Chapter 5Patient Assessment EMR 5-1

2. Introduction • An Emergency Medical Responder (EMR) is often the first trained responder on the scene and is vital in the initiation of patient assessment • Assessment protocols may differ depending on the condition of the patient and his level of consciousness • An EMR must assess the overall patient presentation to see the complete medical picture • Being familiar with systematic assessment guidelines and having critical thinking skills help EMRs obtain pertinent information to make appropriate treatment decisions EMR 5-2

3. Learning Objective 1 Medical Patient and Trauma Patient • ASSESSING MEDICAL AND TRAUMA PATIENTS • Medical patient is one who verbalizes • Trauma patient is one who has an injury that may or may not be visible • EMR must assess the overall patient presentation • Systematic assessment guidelines and critical thinking skills EMR 5-3

4. Learning Objective 1 Medical Patient and Trauma Patient • PENMAN ASSESSMENT • Personal and personnel safety • Environmental hazards • Number of victims • Mechanism of injury or nature of illness • Additional resources needed from your agency • Need for resources outside your agency EMR 5-4

5. Questions related to PENMAN P – Is the scene safe? E – Will it stay safe? N – How many injured? M – What happened? A – What do I have (to help)? N – What do I need (to help)?

6. Learning Objective 1 Medical Patient and Trauma Patient • SPINAL STABILIZATION • Upon approaching the patient, state your name, agency, and credentials • Position yourself at the • head of the patient • Avoid “yes” and “no” questions EMR 5-6

7. Learning Objective 1 Medical Patient and Trauma Patient • PRIMARY SURVEY • Begins with assessing LOC • Responsiveness initially assessed with AVPU • Alert • Verbally responsive • Painful stimuli response • Unresponsive EMR 5-7

8. Learning Objective 2 Unresponsive and Responsive Patients • UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • No signs of life-sustaining perfusion • Critical interventions • Rapid survey • Immediate transportation • Cont. EMR 5-8

9. Learning Objective 2 Unresponsive and Responsive Patients • UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • CAB for unresponsive patient • Circulation • Airway • Breathing • Cont. EMR 5-9

10. Learning Objective 2 Unresponsive and Responsive Patients • UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • Hands-only CPR or compression-only CPR • Defibrillation • Rapid survey • Transport EMR 5-10

11. Learning Objective 2 Unresponsive and Responsive Patients • RESPONSIVE MEDICAL OR TRAUMA PATIENT • Varying degrees of responsiveness • Breathing and pulse are evident • May be inadequate perfusion • Continually monitor the patient’s status Cont. EMR 5-11

12. Learning Objective 2 Unresponsive and Responsive Patients • RESPONSIVE MEDICAL OR TRAUMA PATIENT • Primary survey • Orientation • Airway • Breathing • Circulation • Cont. EMR 5-12

13. Unresponsive and Responsive Patients A B C D E F A – airway assessment B – rate/depth/quality of breathing C – quality of circulation D – check for disabilities E – expose any area of concern F – assess body temperature (Fahrenheit)

14. Learning Objective 2 Unresponsive and Responsive Patients • BASELINE VITAL SIGNS • Blood pressure by auscultation • Systolic reading and the diastolic reading • Blood pressure cuff in addition to stethoscope • Blood pressure by palpation • Only the systolic pressure can be obtained EMR 5-14

15. Learning Objective 2 Unresponsive and Responsive Patients • SECONDARY OR RAPID SURVEY • Used on both trauma victims and medical patients • If unstable or complications suspected • Detailed secondary survey performed on stable patient • Start assessment at the feet of a responsive child EMR 5-15

16. Learning Objective 3 Medical Acronyms Used to Assess Patients • ASSESSMENT TOOLS • SAMPLE—basic information • DOTS—medical and trauma • TIC—muscular or joint trauma • CMS —extremities • Cont. EMR 5-16

17. Learning Objective 3 SAMPLE History Evaluation • S – Signs & Symptoms • A – Allergies • M – Medications • P – Previous pertinent medical History • L – Last oral intake • E – Events that lead to this current illness or injury EMR 5-17

18. Learning Objective 3 DOTS and TIC – Bone and Joint Screening • D – Deformities • O – Open wounds • T – Tenderness • S – Swelling • T – Tenderness • I – Instability • C – Crepitus • Cont. EMR 5-18

19. Learning Objective 3 CMS — secondary assessment for extremities • C – Circulation • M – Motor (movement) • S – Sensory (feel) • Cont. EMR 5-19

20. Learning Objective 3 • ASSESSMENT TOOLS • PERRL—eyes • DRGERM—abdomen • OPQRSTI—pain assessment EMR 5-20

21. Learning Objective 3 ASSESSING THE EYES PERRL a. P—Pupils, the dark part in the center of the eye b. E—Equal—Observe if both pupils are equal in size c. R—Round—Observe if both pupils are round d. RL—Reactive to light—Observe reaction to light of both pupils EMR 5-21

22. DRGERM – abdominal assessment EMR 5-22

24. Learning Objective 3 PAIN ASSESSMENT - OPQRST EMR 5-24

25. Learning Objective 3 PAIN ASSESSMENT - OPQRST • S—Severity: • Ask the patient to rate his pain using a pain scale of zero to ten, with zero being no pain at all and ten being his worst pain ever • When reassessing, ask how the pain compares with the last time it was reported • If the patient cannot understand the numbers on the chart, a face scale can be used to obtain a rating • When either the number or face scale is not possible due to age or special needs, document behaviors such as: tensing muscles, drawing up legs, arching, or difficulty to console • T—Time: • Ask the patient when the pain started and if she has had this type pain before, when, and how long it lasted EMR 5-25

26. Learning Objective 3 Medical Acronyms Used to Assess Patients • APPLYING ASSESSMENT TOOLS • Areas to be assessed with tools • Head • Eyes • Face • Ears and nose • Mouth • Neck • Cont. EMR 5-26

27. Learning Objective 3 Medical Acronyms Used to Assess Patients • APPLYING ASSESSMENT TOOLS • Areas to be assessed with tools • Chest • Abdomen • Pelvis • Legs • Arms • Back EMR 5-27

28. Learning Objective 3 Medical Acronyms Used to Assess Patients • REASSESSMENT • EMR has the responsibility to reassess patients • Unstable patients every five minutes or less • Stable patient every 15 minutes unless a change in the patient’s status • Dialogue is essential in reassessment EMR 5-28

29. Learning Objective 3 Medical Acronyms Used to Assess Patients • TRANSPORTATION DECISIONS • An EMR must make the decision to rapidly package • Method of packaging depends on the MOI • Condition of patient • Resources available • Environmental issues • Medications and legal documents also transported EMR 5-29

30. Learning Objective 4 Critical Thinking and EMRs • CRITICAL THINKING • Assess, treat, communicate, and make transportation decisions • Identification and evaluation of evidence to guide decision making • Knowledge base, experience, skills, and protocols EMR 5-30

31. Summary • Care provided by an EMR is based on a complete and accurate assessment of the patient’s condition • An EMR uses assessments such as PENMAN, spinal stabilization, patient assessment, proper interventions, reassessment, and transportation decisions to provide care • Systematic assessment tools and using critical thinking skills help the EMR • Obtaining pertinent patient data is vital to give appropriate, life-saving medical treatment EMR 5-31