Patient assessment for the Basic EMT CONFIDENTIAL

Lesson Goal Obtain and interpret vital signs & SAMPLE history Provide information necessary to evaluate scene during initial stages of response Perform initial patient assessment, form a general impression, and determine transport priority of medical or trauma patient Recognize MOI to predict injury in trauma patient CONFIDENTIAL

Presentation Information Lesson Goal Perform detailed physical examination, understand findings, and use findings to provide appropriate patient care Perform ongoing assessment Reassess & confirm patient’s status Review assessment Check interventions for adequacy & response Assess patients with medical complaint and obtain a focused history CONFIDENTIAL CONFIDENTIAL

Why is it important? We are the eyes and ears We cannot treat what we do not assess We cannot report what we do not assess or treat CONFIDENTIAL

Assessment tools CONFIDENTIAL

Most Important Assessment Tools CONFIDENTIAL

When does assessment begin? CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Scene Size-Up CONFIDENTIAL

General Impression Includes: NOI for medical patients MOI for trauma patients Determine need for cervical spine stabilization Both medical problem & injury possible Age Gender Race (ethnicity) CONFIDENTIAL

Level of Consciousness (Mental Status) A Alert V responds to Verbal stimulus P responds only to Painful stimulus U Unresponsive CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Initial Assessment Find and fix Assess disability/environment Airway Breathing Circulation/Shock Assess disability/environment Expose as necessary Transport decision CONFIDENTIAL

Assess Airway Look Listen Feel Patient position Intact structure No foreign bodies Patient color Listen Snoring Gurgling Crowing/stridor Silence Patient complaint Feel Stable structure Air exchange CONFIDENTIAL

Treat Airway Position Suction Adjuncts Consider early transport CONFIDENTIAL

Assess Breathing Look Listen Feel Patient position Patient color Chest wall movement Use of accessory muscles Rate/Regularity Pulse oxymetry Listen Audible wheezing Breath sounds Patient complaint Feel Chest wall Subcutaneous emphysema CONFIDENTIAL

Treat breathing Position for comfort Consider early transport Apply oxygen High-flow/NRB Assist breathing Once every 5-6 seconds Seal chest wounds Occlusive dressing CONFIDENTIAL

Assess Circulation/Shock Look External bleeding Patient color Listen Mental status Feel Pulse Location Quality Rate regularity CONFIDENTIAL

Treat Circulation/Shock Stop the bleeding High-flow oxygen Maintain body temperature CONFIDENTIAL

Consider C-Spine stabilization CONFIDENTIAL

Assess Disability (neuro status) Mental Status Pupil check Bilateral movement Glasgow Coma scale CONFIDENTIAL

Assess Environment/Expose Too hot/too cold Surface contact Move patient to a controlled environment ASAP Expose injuries CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Focused History and Physical Exam—Trauma Presentation Information Focused History and Physical Exam—Trauma Rapid Trauma Assessment VS Focused Trauma Assessment CONFIDENTIAL CONFIDENTIAL

Check the nooks and crannies Detailed Exam Check the nooks and crannies CONFIDENTIAL

Hands-on Assessment—Head to Toe Presentation Information Hands-on Assessment—Head to Toe D Deformities C Contusions A Abrasions P Penetrations B Burns T Tenderness L Lacerations S Swelling The video will start when the mouse is clicked. CONFIDENTIAL CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Focused History and Physical Exam--Medical Getting a history is the key!! S Signs and Symptoms--OPQRST A Allergies M Medications P Pertinent Past history L Last oral intake E Events leading up to Focused physical assessment CONFIDENTIAL

Assessing Signs and Symptoms O Onset P Provoke Q Quality R Radiate S Severity T Time CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Check the nooks and crannies Detailed Exam Check the nooks and crannies CONFIDENTIAL

PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Rapid Focused And Physical Exam: Medical Vital Signs/History Detailed Exam Ongoing Assessment CONFIDENTIAL

Presentation Information On-Going Assessment Assess, re-assess and then assess again Vital signs every 15 minutes for the stable patient Vital signs every 5 minutes for the unstable patient CONFIDENTIAL CONFIDENTIAL

Vital Signs Pulse Respirations Breath Sounds Blood Pressure Oxygen saturation Pupils GCS Skin color, condition, and temperature Time CONFIDENTIAL

Skin color/condition Pupils Normal, pale, jaundiced, flushed, cyanotic Warm, hot, cool , cold, moist, dry Pupils Equal/reactive CONFIDENTIAL

Pulse Respirations Breath sounds Rate: adult normal 60-100 Location: carotid/radial Quality: strong, weak, thready Regularity: regular/irregular Respirations Rate: adult normal 12-20 Quality: easy, labored, noisy Regularity Breath sounds Present and equal CONFIDENTIAL

Blood pressure Oxygen saturation Auscultation Palpation Oscillation Automatic Oxygen saturation > 90% for adults > 95% for pediatrics CONFIDENTIAL

Presentation Information Glasgow Coma Scale Criteria Patient Response Score Eye opening Spontaneously To speech To pain None 4 3 2 1 Verbal response Oriented Confused Inappropriate words Incomprehensible words 5 Motor response Obeys commands Localizes pain Withdraws to pain Flexion to pain Extension to pain 6 CONFIDENTIAL CONFIDENTIAL

EVERYONE gets an assessment The Last Word… EVERYONE gets an assessment CONFIDENTIAL

Questions and answers CONFIDENTIAL