National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 7 Patient Assessment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 7.1 Describe the two parts of the overall assessment process. 7.2 Describe the importance of scene safety. 7.3 List the two parts of a patient assessment. 7.4 Describe and demonstrate how to perform a primary assessment and manage the ABCDs. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 7.5 Describe and demonstrate how to perform a secondary assessment. 7.6 Define the following terms: a.assessment b.chief complaint c.DCAP-BTLS d.sign e.symptom continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 7.7 List and describe the key components of a patient history. 7.8 Describe how environmental conditions can affect patient assessment. 7.9 Describe and demonstrate how to obtain a SAMPLE history Describe and demonstrate how to assess pain using the OPQRST mnemonic. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 7.11 Describe and demonstrate how to assess the eyes (pupils and movement) Describe and demonstrate how to assess a patient’s level of responsiveness using the following: a.AVPU b.Glasgow Coma Score continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 7.13 Describe and demonstrate the procedure for obtaining the following vital signs: a.Respiratory rate b.Blood pressure c.Heart rate 7.14 Describe and demonstrate how to reassess a patient. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Scene Size-up Patient Assessment Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are called to help a male in his mid-50s who fell approximately 6 feet to the ground while rock climbing. He is wearing a helmet and did not lose consciousness. He is having difficulty breathing and is complaining of upper left chest pain that he describes as being “hit with a baseball bat.”

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Scene Size Up Use all senses to evaluate scene for potential hazards Control the risk – Scene safety ◦ What should you do to ensure that the rescuers are safe? continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Scene Size Up Copyright J. Selkowitz

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY General Impression Chief complaint ◦ What is the most important symptom? ◦ Traumatic? Medical? ◦ Specific location? ◦ Life threatening? MOI or NOI ◦ What likely caused the injury? ◦ What is the source of the medical concern? continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY General Impression Initial patient appearance ◦ What do you see when you look at the patient? Expressions of pain? Blood? Deformities? Skin color? May allow establishment of priorities for care and transport

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment The formal process in which injuries and illnesses are identified The most important skill in patient care Allows for assessment to be performed in a systematic, organized manner each time Includes the primary and secondary assessments

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Primary Assessment Identify/Assess all life threats ◦ Airway ◦ Breathing ◦ Circulation ◦ Disability C-Spine CSM of extremities ◦ Level of consciousness AVPU / Glasgow Coma Scale

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You ask permission to assess and treat the patient. The patient says, “Yes.” The patient is awake and speaks to you in two- or three-word sentences. His airway is open, he is having trouble breathing. His pulse is 100/rpm. The patient complains of a persistent pain on the left side of his chest.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Medical History SAMPLE Signs/Symptoms Allergies Medications Past med history Last oral intake Events leading up to the incident OPQRST Onset Provocation/Palliation Quality Radiation Severity Time

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Physical Exam Systematic head-to-toe, hands-on assessment Initiate BSI Look, then touch ◦ Head (scalp, face, ears, eyes) ◦ Neck (C-Spine) ◦ Trunk (chest, abdomen, back, pelvis) ◦ Extremities Expose as appropriate continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Physical Exam DCAP – BTLS ◦ Deformity ◦ Contusions ◦ Abrasions/Avulsions ◦ Punctures/Penetrations ◦ Burns / Bleeding / Bruises ◦ Tenderness ◦ Lacerations ◦ Swelling

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Vital Signs Vital Signs ◦ Level of Consciousness AVPU scale ◦ Pulse Rate and quality ◦ Respirations Rate and quality ◦ Blood Pressure Regular and Orthostatic ◦ Temperature

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Special Assessment Considerations Unresponsive patient ◦ Assume C-Spine injury Communication barriers Cultural diversity Aggressive behavior Pediatric patients Geriatric patients

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Environmental Considerations Assess just enough to provide urgent care and ensure safe transport ◦ Temperature ◦ Slope/incline ◦ Bright sun ◦ Wind, dust, rain, dark

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Reassessment Patient condition is dynamic, so assessment must be ongoing Frequency determined by patient condition ◦ More severe = more frequent checks ABCDs and vitals should be tracked

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You call for backup and perform a physical exam on the patient. You notice some discoloration on the left upper portion of the patient’s chest. He has some tenderness in his lower back, near his spine. Pulses in both the upper and lower extremities are equal and strong. The vital signs are normal.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Your first priority is scene safety. Assess the ABCDs first. The chief complaint is the patient’s primary concern. Stabilize all potential threats to life before performing a secondary assessment. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary A significant MOI for a patient who has no signs of physical injury should raise your suspicions. A minor MOI does not mean that the patient has no serious injury. Use SAMPLE, OPQRST, and DCAP- BTLS when performing a secondary assessment. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Know the normal values of vital signs. Any abnormalities should raise your level of concern. Reassess the patient frequently.