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Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 4 – The Initial Assessment. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. . Objectives.
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Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P
Chapter 4 – The Initial Assessment © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives • Describe the importance of obtaining the chief complaint in the patient’s own words and list examples of chief complaints. • Define AVPU and discuss how it is used to assess a patient’s mental status. • List the three key questions the EMS provider needs to ask when assessing the airway of any patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives (continued) • Describe how to assess a patient’s breathing. • List three key questions the EMS provider must keep in mind when assessing circulatory status. • Describe how to assess a patient’s skin and list several abnormal skin conditions. • Describe the last step of the initial assessment and how it is used to make a transportation decision. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction • Purpose is to rapidly identify and manage the life-threats. • Every patient should receive an initial assessment. • Treat any life-threats immediately. • Most patients do not have life-threatening problems. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Your General Impression • The environment (ie: bottom of stairs, out in the cold, tripod position, pool of blood) • Patient’s MOI/NOI • Patient’s age and sex • Patient’s degree of distress • Listen for the chief complaint • Keep the priority of care in focus © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Mental Status • Are they conscious or unconscious? (if unconscious do CPR quick-check) • Introduce yourself • What’s your name? (oriented to person) • Do you know where you are? (oriented to place) • What day of the week is it? (oriented to day) • How can I help you today? (chief complaint) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
A V P U • Alert – oriented to person, place, and day (“big three”) • Verbal – cannot answer the “big three” correctly • Painful – either appropriate, inappropriate, or posturing (decorticate/decerebrate) • Unresponsive © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Airway Status • The 3 key questions: • Is the airway open? • Will the airway stay open? • Does anything endanger the airway? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Airway Status • Factors to consider: • Unconsciousness • Suspected spinal injury • Obstruction © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Airway Status • Complex airway problems: • Impaled object(s) • Significant MOI (i.e.: gunshot) • Burns • Crushed or fractured larynx © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Breathing • The 6 key questions: • Is the patient breathing? • What’s the respiratory rate? • Is the rate adequate? • Does anything endanger breathing? • Can the patient take a deep breath? • Is the patient having trouble breathing? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Breathing • Adequacy • Dyspnea • Chest wall stability © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Circulatory Status • Ask the 3 key questions: • Does the patient have a pulse? • What is the quality of the pulse? • Is there any major bleeding that needs to be controlled? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Assess the Pulse • Distal vs. proximal • Infant and child pulses • External hemorrhage • Skin signs (CTC): • Color • Temperature • Condition • Capillary refill (in children) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Make a Priority Decision! • High or low priority • Transportation decision • Is ALS needed (consider an intercept) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Conclusion • Quickly assess for life-threats! • Remember the key steps of the initial assessment (MS-ABC). • Make a priority and transport decision! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
