Patient Assessment

Scene Size - Up Scene safety / BSI Mechanism of injury / Nature of the illness Number of patients Consider need for additional manpower or specialized resources

Primary Survey Goal of primary assessment To identify, and initiate treatment of immediate or potentially life threatening problems Whether the patients C/C is trauma or medical related we begin with the primary assessment.

Primary Assessment Steps Form a general impression Introduce yourself and ask for patients chief complaint Determine patients Level of Consciousness Conscious unaltered LOC Conscious with altered LOC Unconscious AVPU Glascow Coma Scale

Airway Responsive Patient Unresponsive Patient Are they talking to you or crying? Does patient exhibit any signs of dyspnea? Is breathing noisy? Unresponsive Patient Assume Trauma unless confirmed not to be trauma related Open airway with either modified jaw thrust or head tilt chin lift Address foreign body obstruction Apply airway adjuncts if indicated Suction if indicated Assist ventilations if needed If airway clear move to next step

Breathing Is spontaneous breathing present? Is breathing adequate or inadequate? How do we tell the difference?

Circulation Does patient have a pulse Carotid Radial Any bleeding that needs to be controlled Skin condition

Decision Time After primary assessment we decide Does this patient have a medical problem? Does this patient have trauma injuries? Does this patient have both? Is this patient a load and go? Do we need ALS support

Load and Go Patients Rapid trauma assessment Head to toe exam while maintaining C spine stabilization Note any obvious findings Assess any areas that will be inaccessible after immobilization Neck / Back Support and treat any life threats

Assessment Acronyms DCAP BLS TIC OPQRST SAMPLE FAST GEMS Diamond

Assessment Tools BP Cuff Stethoscope Pulse Oximeter Pen light Glucometer AED Senses Look listen and feel

Trauma Patient Once loaded and enroute start secondary assessment Head to toe using DCAP BLS TIC Assess any previous treatments performed Bandaging and splinting Note any abnormal findings Notify med comm of assessment and ETA

Remember Trauma patients may have an underlying medical problem that is exaserbated by the injury OR A Medical problem may have resulted in a traumatic injury

Medical Patient’s Focus assessment on chief complaint Cardiac Respiratory Abdominal complaints Neurological complaints Perform interventions as indicated Notify med comm of findings tx and ETA

Reassessment Every 5 minute for unstable patients Every 15 minute for stable patients

Changes in Condition Check previous interventions Start over with primary assessment

Assessment Challenges Geriatrics Pediatrics Special needs patients Patients who don’t speak English Multiple patients

Skills Practice Review hands on assessments both medical and trauma using National Registry skills sheets as a guide