Patient Assessment, PCR & Handover

S igns & Symptoms A M llergies P L edications E ast medical history Patient Assessment S A M P L E igns & Symptoms = O P Q R S T nset - When did it start? llergies rovocation/palliation - What makes it worse or better. edications uality- for example pain is it dull or sharp etc. ast medical history egion/radiation/referral – where is the symptom located etc. Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode. ast food/drink everity – pain score vents ime – how long have they had it for, etc.

10+yrs = 2-10yrs = 3mths-2yrs = 0-3mths = Patient Assessment 60-100bpm Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Rates for breathes are: >12 =12-20bpm 5-12=20-24bpm 2-5=24-30bpm 1-2= 26-34bpm <1=30-40bpm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode.

Patient Assessment Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode.

>12yrs = 5-12yrs = 2-5yrs = 1-2yrs = <1yrs = Patient Assessment 12-20bpm 20-24bpm 24-30bpm Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Rates for breathes are: >12 =12-20bpm 5-12=20-24bpm 2-5=24-30bpm 1-2= 26-34bpm <1=30-40bpm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode. 26-34bpm 30-40bpm

Patient Assessment Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode.

GCS = 9 / 15 Patient Assessment Motor Response Obeys Commands Localises Pain Withdraws From Pain Abnormal Flexion Extensor Response No Response to Pain Verbal Response Orientated Confused Inappropriate Words Incomprehensible Words No Verbal Response Eyes Opening Spontaneously To Speech To Pain None = 6 = 5 = 4 = 3 = 2 = 1 = 5 = 4 = 3 = 2 = 1 = 4 = 3 = 2 = 1 Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode. GCS = 9 / 15

Verbal Response (CHILD) Appropriate Words or Smile Patient Assessment Motor Response Obeys Commands Localises Pain Withdraws From Pain Abnormal Flexion Extensor Response No Response to Pain Verbal Response (CHILD) Appropriate Words or Smile Cries but is Consolable Persistent Irritable Restless, Agitated Silent Eyes Opening Spontaneously To Speech To Pain None = 6 = 5 = 4 = 3 = 2 = 1 = 5 = 4 = 3 = 2 = 1 = 4 = 3 = 2 = 1 Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.   Pulse Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory) Describe the ‘average’ adult pulse rate, and then explain the differences in age. Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses. Breathing Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm. Pain Score 0 – 10. Try not to lead the response. Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how. Explain the Wong Baker Faces – good for children, dementia & learning difficulties. SAMPLE Signs and Symptoms – Ask what the difference between the two is. Allergies – Medication allergies unless it is a reaction. Medications – Ask for green slips or doset boxes, consider insulin in the fridge. Past medical history Last food or drink Events – Talk about this episode.

Differences in the body's ability to compensate for an illness. Working with Children Differences in the body's ability to compensate for an illness. 

Working with Children Can you think of some do and don'ts when dealing with children and there parents/carers? Approach slowly, you’re a stranger! Introduce yourself Observe the child from a distance Put any equipment down out of sight DO NOT wear your high vis Smile and use open body language Talk to the child as you would anyone else Explain everything to the parent/carer Use teddy and/or toys

Paediatric Assessment Triangle (PAT) Working with Children Paediatric Assessment Triangle (PAT) Appearance Work of Breathing Circulation to Skin Tone Interactiveness Consolability Look / Gaze Speech / Cry Abnormal airway sounds Abnormal positioning Recession Flaring Pallor Cyanosis Mottling

Let's put the PAT test to the test... Working with Children ! Warning: The following video clips are of actual sick children. Parents and carers will record these videos to raise awareness amongst others. Initially mocked, this is now a proven method amongst parents, relatives, carers, it has led to early recognition and diagnoses for potentially life threatening/changing conditions. *** Please warn the delegates that there is real videos coming up, these videos may be upseting and can leave the room if they feel it necessary, if so then please talk to them afterwards and make sure they are ok, equally do this if somone is getting visibly upset during the videos *** The purpose of these videos is to put the PAT test to practice, this can be done a number of ways. They question may arise on these videos as to what you would do, or how can that situation be managed, this can be referenced within the ACFR book. I have also included notes on each slide of the videos for your reference. Let's put the PAT test to the test... Video Clip 1 Video Clip 2 Video Clip 3

A T M I S - Age - Time of incident - Mechanism - Injuries Handover Technique A T M I S - Age - Time of incident - Mechanism - Injuries - Signs and Symptoms - Treatment Given The handover needs to be: Concise Effective Factual

Working with Children Any questions?