Patient Assessment

1. Patient Assessment

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

3. Patient Assessment BSI BSI BSI BSI BSI BSI BSI BSI

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

5. Patient Assessment Scene Size-up

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

7. 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

8. 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: Breathing problems Number of patients: 68 year old female Considers stabilization of spine Requests additional help if necessary: ALS

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

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

11. Mechanism of injury

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

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

14. 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

15. 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

16. 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

17. Nature of call • Illness • Injury

18. 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

19. Patient Assessment Initial Assessment • General Impression: 68 year old white female Sitting on the couch answering questions in broken sentences and obeying commands Obviously A & O x 4 c/c of Shortness of breath Index of suspicion: PMHx. Of Asthma Life Threats: • A B C’s

20. Patient Assessment • Airway: Patent; answering questions • Breathing: Complains of shortness of breath Rhythm and quality Labored Shallow O2 @ 15lpm with NRB • Circulation: Major bleeding??? Pulse rhythm and quality regular strong • Transport decision: Stay/play vs Load/go emergent/non-emergent

21. 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

22. Patient Assessment Focused History and Physical Exam • Onset? 45 minutes ago • Provokes? Nothing makes pain better/worse • Quality? Dull • Radiates? Non-radiating • Severity? 4:10 • Time? >1 hour ago • Interventions?

23. Patient Assessment • Allergies: PCN • Medications: NTG, asa, Toprol XL, lasix • Past pertinent history: “I go to a heart DR.” • Last oral intake: Breakfast-eggs, toast, coffee • Event leading to present illness: Cleaning out a closet • Performs focused physical examination: lung sounds short of breath; warm/dry/pink; • Vitals: 142/86 130 38 • Interventions: O2 • Transport decision: More informed decision • Detailed physical examination necessary? YES

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

25. Vital Signs and Sample History

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

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

28. 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

29. Patient Assessment Detailed Physical Exam Head: Facial cyanosis; cyanosis Neck: - JVD; - Tracheal deviation Chest: Symmetrical; LS clear, bilat, all fields ABD: Soft/non-tender/- distension LE: - LE or pedal edema UE- - peripheral edema VS: 154/90 130 28

30. 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

31. 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

32. Patient Assessment On-going Assessment • Repeats initial assessment: ABC, MS, Monitor • Repeats vital signs: 132/68 84 24 • Repeats focused assessment regarding patient complaint or injuries: O2 helping; Pain?

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