2 Chapter 38 Assessment-Based Management

3 Objectives There are no 1985 objectives for this chapter.

4 Assessment-Based Management You may have to provide care for patients who can’t answer questions for themselves. You must be able to assess the patient and the scene. Draw clues from the environment.

5 Effective Patient Assessment (1 of 3) Gathering Information –Critical to decision making The importance of history –80% of patient’s diagnosis is attributed to the history The EMT-I’s knowledge will help guide in asking appropriate questions

6 Effective Patient Assessment (2 of 3) Physical Assessment –Effectiveness may be compromised by some field situations. Patterns and Field Impression –Compare information gathered with what you know about similar conditions. –Look for patterns. –Patterns allow the EMT-I to formulate a plan of action.

7 Effective Patient Assessment (3 of 3) BLS/ALS Treatment –Standing orders/protocols –Correct impression essential to choosing appropriate protocol –Adapt treatment plan to problem

8 Choreographing Assessment and Management EMS teams need a plan for roles Team leader –Manages patient care Patient Care Person(s) –Gather scene information –Talk to relatives/bystanders

9 The Right Stuff Getting the right equipment to a patient’s side is an important component of care. –Hope for the best, prepare for the worst. –Incorrect equipment compromises patient care. Optional “Take In” equipment –Medications, IV equipment

10 Airway Oral airways Nasal airways Suction (electric or manual) Rigid Yankauer and flexible suction catheters Breathing Mouth-powered ventilation devices (pocket mask) Manual ventilation bag-valve-mask Spare masks Oxygen tank and regulator Oxygen masks, cannulas, and extension tubing Occlusive dressings Large-bore IV catheter for thoracic decompression EMT-I Management (1 of 2)

11 Circulation Dressings Bandages and tape Infection control supplies: gloves, eye shields Sphygmomanometer, stethoscope Disability and dysrhythmia Rigid collars Flashlight AED Exposure Scissors Space blanket or something to cover the patient EMT-I Management (2 of 2)

12 Aspects of Assessment/ Decision Making (1 of 2) Ensure nonjudgmental attitude. Consider causes of uncooperative, restless, and belligerent behavior. –Hypoxia –Hypovolemia –Hypoglycemia –Head injury

13 Aspects of Assessment/ Decision Making (2 of 2) Distracting Injuries –Obvious injuries that look bad can divert your attention from more serious injuries. Environment may be distracting. Move patient to controlled area (ie, ambulance). Be organized to avoid confusion.

14 General Approach (1 of 3) Calm, orderly demeanor –Have “preplan” before entering scene Initial assessment –Sets tone for patient encounter –Critical patients ABCs Perform necessary interventions

15 General Approach (2 of 3) Life-threatening problems –Cardiac/respiratory arrest –Respiratory distress/failure –Unstable dysrhythmias –Seizures –Coma/altered mental status –Shock/hypotension –Major trauma –Possible cervical spine injury

16 General Approach (3 of 3) Noncritical patients –More contemplative approach –Immediate interventions not needed –Time for history and exam The role of experience: the more knowledge the EMT-I has, the more productive he or she will be in knowing what to look for and what questions to ask.

17 Transferring the Patient (1 of 2) Effective communication and transfer of patient information is a vital component of care. –The way a patient is transferred is often the weak link in care. –Methods Face to face Telephone Radio In writing

18 Transferring the Patient (2 of 2) Good presentation suggests effective assessment and care. Popular formats –SOAP Subjective information, Objective information, Assessment, Plan –CHART Chief complaint, History, Assessment, Rx/ treatment, Transport Preprinted sheets help to organize.

19 Drills for Common Prehospital Complaints Help develop skill level and knowledge base. Common complaints –Chest pain –Cardiac arrest –Abdominal pain or GI bleeding –Altered mental status –Dyspnea –Syncope –Trauma –Allergic reactions/bites/envenomation –Pediatric