Chapter 5 Patient Assessment EMR 5-1 1-

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 1-

Medical Patient and Trauma Patient 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

Medical Patient and Trauma Patient 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

Medical Patient and Trauma Patient 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 5-5

Medical Patient and Trauma Patient 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 5-6

Unresponsive and Responsive Patients 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 5-7

Unresponsive and Responsive Patients Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT CAB for unresponsive patient Circulation Airway Breathing Cont. EMR 5-8

Unresponsive and Responsive Patients Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT Hands-only CPR or compression-only CPR Defibrillation Rapid survey Transport EMR 5-9

Unresponsive and Responsive Patients 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 5-10

Unresponsive and Responsive Patients Learning Objective 2 Unresponsive and Responsive Patients RESPONSIVE MEDICAL OR TRAUMA PATIENT Primary survey Orientation Airway Breathing Circulation Cont. EMR 5-11

Unresponsive and Responsive Patients 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 5-12

Unresponsive and Responsive Patients 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 5-13

Medical Acronyms Used to Assess Patients 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 5-14

Medical Acronyms Used to Assess Patients Learning Objective 3 Medical Acronyms Used to Assess Patients ASSESSMENT TOOLS PERRL—eyes DRGERM—abdomen OPQRST—pain assessment EMR 5-15

Medical Acronyms Used to Assess Patients 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 5-16

Medical Acronyms Used to Assess Patients 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 5-17

Medical Acronyms Used to Assess Patients 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 5-18

Medical Acronyms Used to Assess Patients 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 5-19

Critical Thinking and EMRs 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 5-20

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 5-21 1-