Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Assessment Chapter 7

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Scene Size-Up Initial Assessment Physical Examination Patient History Ongoing Assessment Hand-Off Report Scene Size-Up Initial Assessment Physical Examination Patient History Ongoing Assessment Hand-Off Report

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Assessment The process of determining the problems a patient is experiencing Goal of FR is to identify and treat critical problems The process of determining the problems a patient is experiencing Goal of FR is to identify and treat critical problems

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Assessment Scene size-up Initial assessment Physical examination Ongoing assessment Hand-off report Scene size-up Initial assessment Physical examination Ongoing assessment Hand-off report

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Scene Size- Up

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Scene Size-Up First step of patient assessment Quick determination of scene –Personal safety –Safety of scene –Assessment of Mechanism of Injury (MOI) or Nature of Illness (NOI) First step of patient assessment Quick determination of scene –Personal safety –Safety of scene –Assessment of Mechanism of Injury (MOI) or Nature of Illness (NOI)

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Size up this scene Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Personal Safety First concern is PPE –BSI –Protective clothing First concern is PPE –BSI –Protective clothing

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Size up this scene

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Safety of the Scene Common hazards: Unstable vehicles Undeployed airbags Leaking fluids Traffic Agitated or violent patient or bystanders Common hazards: Unstable vehicles Undeployed airbags Leaking fluids Traffic Agitated or violent patient or bystanders

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Safety of the Scene Common hazards Hazardous materials –Tractor-trailer crashes, train derailments, industrial sites, farm incidents –Notify HAZMAT team –Do not approach scene until directed Common hazards Hazardous materials –Tractor-trailer crashes, train derailments, industrial sites, farm incidents –Notify HAZMAT team –Do not approach scene until directed

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Safety of the Scene Common hazards: Crime Scenes –Violent crime –Domestic violence Environment –Slopes, ice, water, etc. –Weather conditions Common hazards: Crime Scenes –Violent crime –Domestic violence Environment –Slopes, ice, water, etc. –Weather conditions

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bystanders Often not aware of hazards and may put themselves at risk May also put others at risk –Smoking in presence of oxygen or spilled fuel Often not aware of hazards and may put themselves at risk May also put others at risk –Smoking in presence of oxygen or spilled fuel

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. If the scene is not safe, and you cannot make it safe, do not enter. Wait for specially trained rescue personnel to make scene safe or bring patient to you. STOP!

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Scene Size-Up Also includes Mechanism of injury (MOI) Nature of illness (NOI) Number of patients Also includes Mechanism of injury (MOI) Nature of illness (NOI) Number of patients

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MOI An evaluation of forces that caused an injury May help anticipate injuries Systematically survey scene and question bystanders An evaluation of forces that caused an injury May help anticipate injuries Systematically survey scene and question bystanders

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What would you ask or look for? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Determine: Vehicle speeds Seat belt use Presence of airbags Patient ejected or thrown from vehicle Point of impact Damage to vehicle or equipment Vehicle speeds Seat belt use Presence of airbags Patient ejected or thrown from vehicle Point of impact Damage to vehicle or equipment

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Determine: If patient assaulted (shot, beaten, stabbed) Weapon used Height of fall Surface patient landed on Position patient landed If patient assaulted (shot, beaten, stabbed) Weapon used Height of fall Surface patient landed on Position patient landed Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nature of Illness What are some clues to illness? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2004 Elsevier (USA). All Rights Reserved Why did patient call for help? What is the patient’s complaint? Why did patient call for help? What is the patient’s complaint? Nature of Illness Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Clues to Illness Patient confined to bed Patient uses walker or cane Patient lacks adequate food/shelter Patient takes medications Other clues? Patient confined to bed Patient uses walker or cane Patient lacks adequate food/shelter Patient takes medications Other clues?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Number of Patients Incident may involve more than 1 patient Must be determined before patient care Call for additional resources if needed If more than 1 patient, perform triage Incident may involve more than 1 patient Must be determined before patient care Call for additional resources if needed If more than 1 patient, perform triage

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Initial Assessment

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The initial assessment is performed to identify any immediate threats to the patient’s life.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Initial Assessment General impression Level of responsiveness Checking A,B,C,D of patient General impression Level of responsiveness Checking A,B,C,D of patient

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. General Impression Gather information about patient and patient’s environment –What is the patient’s position? –What is the patient’s appearance? –Any sights/sounds/smells? –Does it appear to be medical or trauma? Gather information about patient and patient’s environment –What is the patient’s position? –What is the patient’s appearance? –Any sights/sounds/smells? –Does it appear to be medical or trauma?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is your general impression?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. LOC Evaluation of patient alertness

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Caution! If patient condition caused by trauma with significant mechanism of injury begin by stabilizing patient’s cervical spine. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Unconscious Patient Speak to patient If no response –Shake patient’s shoulder –Pinch earlobe or shoulder Speak to patient If no response –Shake patient’s shoulder –Pinch earlobe or shoulder Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

AVPU Scale Alert Verbal Painful Unresponsive Alert Verbal Painful Unresponsive

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Alert Patient awake Eyes open Speaks spontaneously Patient awake Eyes open Speaks spontaneously

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Verbal Not alert Patient responds to voice by: –Opening eyes –Speaking –Moving Not alert Patient responds to voice by: –Opening eyes –Speaking –Moving

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Painful Not alert No response to voice Responds to painful stimulus –Pinch

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Unresponsive Not alert No response to voice No response to painful stimulus

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Infants & Children AVPU not a good scale To determine responsiveness note if interaction with parents and actions normal for age AVPU not a good scale To determine responsiveness note if interaction with parents and actions normal for age

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A - Airway Responsive Patient Can patient speak without difficulty? Unresponsive Patient Perform head-tilt chin-lift/jaw-thrust Inspect airway Clear airway as needed Responsive Patient Can patient speak without difficulty? Unresponsive Patient Perform head-tilt chin-lift/jaw-thrust Inspect airway Clear airway as needed

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat If patient’s airway is not open …. OPEN IT! Before moving on to B - Breathing If patient’s airway is not open …. OPEN IT! Before moving on to B - Breathing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

B - Breathing Responsive Patient Ability to speak without stopping to catch breath Noisy breathing Patient position Use of accessory muscles Rate and depth of ventilations Responsive Patient Ability to speak without stopping to catch breath Noisy breathing Patient position Use of accessory muscles Rate and depth of ventilations

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. B - Breathing Unresponsive patient Look Listen Feel Unresponsive patient Look Listen Feel Any signs of inadequate breathing? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assess & Treat If breathing is absent, too fast, too slow, too shallow, Immediately begin ventilations before moving to C - Circulation If breathing is absent, too fast, too slow, too shallow, Immediately begin ventilations before moving to C - Circulation

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. C - Circulation Evaluation of circulation of patient’s blood –Assess pulse –Look for major blood loss –Assess skin Evaluation of circulation of patient’s blood –Assess pulse –Look for major blood loss –Assess skin Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assess Pulse - Where? Responsive adult –Radial pulse Unresponsive adult –Carotid pulse Responsive adult –Radial pulse Unresponsive adult –Carotid pulse

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse - Where? Responsive child –Radial or brachial pulse Unresponsive child –Carotid or femoral pulse Responsive child –Radial or brachial pulse Unresponsive child –Carotid or femoral pulse

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse - Where? Responsive or unresponsive infant –Brachial pulse Responsive or unresponsive infant –Brachial pulse

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse Determine: Presence or absence Rate Strength Regularity Determine: Presence or absence Rate Strength Regularity Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assess & Treat If no pulse, Immediately begin chest compressions If no pulse, Immediately begin chest compressions

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Check for Blood Loss Major external bleeding –Actively bleeding? –Pool of blood anywhere? –Collection of blood in patient clothes/hair? Major external bleeding –Actively bleeding? –Pool of blood anywhere? –Collection of blood in patient clothes/hair?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat Control major bleeding

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Skin Color Temperature Moisture Inadequate circulation causes pale, cool, clammy skin Color Temperature Moisture Inadequate circulation causes pale, cool, clammy skin

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. D - Disability Assessment of brain function Use Glasgow Coma Scale (GCS) Assessment of brain function Use Glasgow Coma Scale (GCS)

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Glasgow Coma Scale Eye OpeningSpontaneous4 To Voice3 To Pain2 None1 Verbal ResponseOriented5 Confused4 Inappropriate Words3 Incomprehensible Words2 None1 Motor ResponseObeys Command6 Localizes Pain5 Withdraw (pain)4 Flexion (pain)3 Extension (pain)2 None1 Eye OpeningSpontaneous4 To Voice3 To Pain2 None1 Verbal ResponseOriented5 Confused4 Inappropriate Words3 Incomprehensible Words2 None1 Motor ResponseObeys Command6 Localizes Pain5 Withdraw (pain)4 Flexion (pain)3 Extension (pain)2 None1

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Make a decision! Is the patient critical? Is the patient non-critical? What is critical? Is the patient critical? Is the patient non-critical? What is critical?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Indicators Unresponsive Noisy airway Compromised airway Inadequate breathing Absence of breathing Uncontrolled bleeding Weak, absent or irregular pulse Unresponsive Noisy airway Compromised airway Inadequate breathing Absence of breathing Uncontrolled bleeding Weak, absent or irregular pulse Cyanosis Cool, clammy skin GCS ≤ 13 Confused/disoriented Pediatric – flaccid; glassy stare

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Communicate Patient’s age and sex Chief complaint Level of responsiveness Status of airway and breathing Status of circulation and disability Patient’s age and sex Chief complaint Level of responsiveness Status of airway and breathing Status of circulation and disability

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Any questions on initial assessment?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination Begins once life-threatening problems addressed Purpose is locating and beginning management for signs and symptoms of injury and illness Begins once life-threatening problems addressed Purpose is locating and beginning management for signs and symptoms of injury and illness

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Take Note! May not perform PE if life-saving care still required Not all patients will require all steps of PE May not perform PE if life-saving care still required Not all patients will require all steps of PE Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Inspection – Look for signs of illness or injury Inspection – Look for signs of illness or injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Palpation –Feel for signs of illness or injury Palpation –Feel for signs of illness or injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

DOTS D- Deformities O – Open injuries T – Tenderness S - Swelling D- Deformities O – Open injuries T – Tenderness S - Swelling

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Systematic and Orderly Often done “head to toe” Assess all body areas for DOTS Often done “head to toe” Assess all body areas for DOTS

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination Assess head Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the face Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the eyes, nose, and mouth Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the neck Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the chest Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Listen to lung sounds Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the abdomen Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the back Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the pelvis Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess the extremities Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Check C irculation (Post Tibial Pulse) Check C irculation (Post Tibial Pulse) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Check Circulation (Dorsalis Pedis Pulse) Check Circulation (Dorsalis Pedis Pulse) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Check for –Motion –Sensation Check for –Motion –Sensation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Repeat for upper extremities Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess circulation (Radial Pulse) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess circulation (Sensation) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Assess sensation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physical Examination Look for medical insignia tags Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Any questions on physical examination?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patient History

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. When? Take patient history either before, after, or during physical examination –Depends on situation Take patient history either before, after, or during physical examination –Depends on situation

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Who? Begin with patient If patient can’t answer –Ask family members –Ask bystanders Begin with patient If patient can’t answer –Ask family members –Ask bystanders Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

SAMPLE History S – Signs and symptoms A – Allergies M – Medications P – Pertinent past history L – Last oral intake E – Events leading to injury or illness S – Signs and symptoms A – Allergies M – Medications P – Pertinent past history L – Last oral intake E – Events leading to injury or illness

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is? A sign? A symptom? A sign? A symptom?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. S – Signs and Symptoms A sign is a finding you can hear, see, feel or measure. A symptom is something a patient describes. A sign is a finding you can hear, see, feel or measure. A symptom is something a patient describes.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ask Questions … Can you describe the problem? What kind of symptoms? What makes the symptoms better/worse? When did the symptoms start? How long have you had problem? Anything like this happen before? Can you describe the problem? What kind of symptoms? What makes the symptoms better/worse? When did the symptoms start? How long have you had problem? Anything like this happen before?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A - Allergies Medications Foods Substances in environment Any medical insignia tags? Medications Foods Substances in environment Any medical insignia tags?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. M - Medications Prescription medications Over-the-counter medications Another person’s medications Has patient recently stopped taking any medications Prescription medications Over-the-counter medications Another person’s medications Has patient recently stopped taking any medications

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. P – Pertinent Past History Are you seeing physician for anything? Ever been hospitalized? Any medical problems? Any pertinent surgeries? Any significant injuries? Are you seeing physician for anything? Ever been hospitalized? Any medical problems? Any pertinent surgeries? Any significant injuries?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. L – Last Oral Intake When did you last eat or drink? What was it? How much? When did you last eat or drink? What was it? How much?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. E – Events Leading up to injury or illness What were you doing when the problem started? Were there any other symptoms at that time? What were you doing when the problem started? Were there any other symptoms at that time?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Any questions on patient history?

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ongoing Assessment

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ongoing Assessment Assessment doesn’t end after physical examination and patient history Continue to reassess patient until additional help arrives Frequency depends on patient’s condition Assessment doesn’t end after physical examination and patient history Continue to reassess patient until additional help arrives Frequency depends on patient’s condition

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ongoing Assessment Critical patient –Reassess at least every 5 minutes Non-critical patient –Reassess at least every 15 minutes Critical patient –Reassess at least every 5 minutes Non-critical patient –Reassess at least every 15 minutes

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What do I Reassess? Airway Breathing Circulation Disability (mental status) –AVPU –GCS Airway Breathing Circulation Disability (mental status) –AVPU –GCS

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Don’t forget … Reassure the patient while waiting for help

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hand-Off Report

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. When EMS Unit Arrives Provide: Patient age and sex Chief complaint Level of responsiveness Airway and breathing status Provide: Patient age and sex Chief complaint Level of responsiveness Airway and breathing status Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

When EMS Unit Arrives Provide: Circulation and mental status Physical examination findings SAMPLE history Interventions provided Provide: Circulation and mental status Physical examination findings SAMPLE history Interventions provided Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Summary Before treatment of a patient can be started, the First Responder must make it to the patient’s side safely, protect others at the scene, and make sure that needed additional resources are on their way. Patient assessment begins with scene size- up. This step gives clues about the mechanism of injury or nature of illness. Before treatment of a patient can be started, the First Responder must make it to the patient’s side safely, protect others at the scene, and make sure that needed additional resources are on their way. Patient assessment begins with scene size- up. This step gives clues about the mechanism of injury or nature of illness.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary The initial assessment gives the First Responder a general impression of the patient’s condition. All immediately life-threatening problems are to be detected and treated during the initial assessment. The initial assessment gives the First Responder a general impression of the patient’s condition. All immediately life-threatening problems are to be detected and treated during the initial assessment.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary Following the initial assessment, the First Responder will perform a physical exam and obtain a brief medical history. Assessment is ongoing to detect changes in the patient’s condition. The First Responder completes the patient assessment process by communicating findings to EMS personnel assuming care of the patient. Following the initial assessment, the First Responder will perform a physical exam and obtain a brief medical history. Assessment is ongoing to detect changes in the patient’s condition. The First Responder completes the patient assessment process by communicating findings to EMS personnel assuming care of the patient.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Vital Signs Team Work

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Respiratory Rate Count the number of breaths for 30 seconds and double it Note the depths, regularity and symmetry of breathing Count the number of breaths for 30 seconds and double it Note the depths, regularity and symmetry of breathing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Pulse Count the number of beats for 30 seconds and multiply by two Note the regularity and strength of the pulse Count the number of beats for 30 seconds and multiply by two Note the regularity and strength of the pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Skin Assess the color, temperature and moisture of the patient’s skin Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Wrap cuff around arm Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Palpate the brachial pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Place the stethoscope over the location where you found the pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Close the valve Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Use the balloon to pump up the cuff Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Loosen the valve and let air escape slowly while listening for a beat Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Note the gauge reading when you hear the first sound This is the systolic blood pressure Note the gauge reading when you hear the first sound This is the systolic blood pressure Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Note the gauge reading when you stop hearing sounds This is the diastolic blood pressure Note the gauge reading when you stop hearing sounds This is the diastolic blood pressure Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Blood Pressure Although less desirable, a blood pressure can be palpated by feeling for a radial pulse The systolic reading is felt instead of heard Although less desirable, a blood pressure can be palpated by feeling for a radial pulse The systolic reading is felt instead of heard Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.