1. Scene Size Up Pt Assessment

2. Scene Size-up Body substance isolation Scene Assessment Scene safety
Location of all patients
Mechanism of injury
Nature of the illness
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

3. Always stop to size up the scene before going in.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

4. Scene Assessment Routes of extrication for crew and patient
Number of patients
Need for additional resources
Extrication equipment
Additional transport units
Additional manpower
Use of all of your senses.
Identify any noises or sounds, smells, or visually confusing events/findings.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

5. Scene Safety Natural hazards Fire Risk of violence Traffic
Chemical/industrial agents
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

6. Location of All Patients
Scene size-up also includes a search of the area to locate all of the patients.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

7. Mechanism of Injury External vehicle damage Interior vehicle damage
Forces involved in the collision
Interior vehicle damage
Structures damaged inside the vehicle
Patient impact
Anatomic regions of the body struck
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

8. Nature of Illness To determine the nature of illness:
Use bystanders, family members, or the patient.
Use the scene to give clues to the patient’s condition.
Oxygen equipment in the home
Medicine containers
General appearance of environment
Remember that the patient’s illness may be very different from the chief complaint.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

9. Initial Assessment Steps
Form a general impression.
Stabilize the cervical spine.
Assess the baseline mental status.
Assess the airway.
Assess breathing.
Assess circulation.
Determine priority.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

10. The General Impression
The general impression is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

11. Mental Status Alert Verbal Painful stimuli Unresponsive
Discuss the utilization of various painful response techniques. Many paramedics use only the sternal rub reflex, which may not be effective in a patient with a spinal injury. The sternal rub reflex is a spinal reflex.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

12. Airway Assessment
If the patient is responsive and can speak clearly, assume the airway is patent.
If the patient is unconscious, the airway may be obstructed.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

13. Breathing Assessment Altered mental status Shortness of breath
Retractions
Asymmetric chest wall movement
Accessory muscle use
Cyanosis
Audible sounds
Abnormal rate or pattern
Nasal flaring
Neck
Neck is part of breathing
Access JVD
Access tracheal deviation
Subcutaneous emphysema
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

14. Breathing (2 of 2) Rate Depth Presence of bilateral breath sounds
Symmetry of chest movement
Observe for accessory muscle use.
Expose the chest wall and palpate for:
Structural integrity
Tenderness
Crepitus
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

15. Circulation Assessment
The circulation assessment consists of evaluating the pulse and skin and controlling hemorrhage.
When we say evaluate pulse what are we eval for rate rhythm and quality/ skin color temp and moisture/
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

16. Top Priority Patients Poor general impression Unresponsive
Conscious but cannot follow commands
Difficulty breathing
Hypoperfusion
Complicated childbirth
Chest pain and BP below 100 systolic
Uncontrolled bleeding
Severe pain
Multiple injuries
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

17. The Focused History and Physical Exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

18. Types of Patients Trauma patient with significant mechanism of injury
Trauma patient with isolated injury
Responsive medical patient
Unresponsive medical patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

19. Trauma
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

20. Predictors of Serious Internal Injury
Ejection from vehicle
Death in same passenger compartment
Fall from higher than 20 feet
Rollover of vehicle
High-speed motor vehicle collision
Vehicle-passenger collision
Motorcycle crash
Penetration of the head, chest, or abdomen
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

21. Mechanism of Injury Considerations for Infants and Children
Fall from higher than ten feet
Bicycle collision
Medium-speed vehicle collision with resulting severe vehicle deformity
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

22. DCAP-BTLS Deformity Contusion Abrasion Penetration Burns Tenderness
Lacerations
Swelling
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

23. The Isolated-Injury Trauma Patient
No significant mechanism of injury
Shows no signs of systemic involvement
Does not require an extensive history
Does not require a comprehensive physical exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

24. Examination of the Musculoskeletal System
Observe, inspect, and palpate the joints, structure, and movement.
Note:
Compare strength
Range of motion
Crepitus
Pain
Swelling
Deformity
Symmetry
Tissue changes
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

25. Range of Motion (Active)
Have patient position the joints.
Watch for decreased or increased movement of the joint compared to the other side as well as the norm.
Watch for pain with movement.
Listen for crepitus or “popping.”
Watch for abnormal movements.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

26. Range of Motion (Passive)
Next position the joints passively, comparing the end points to the active.
Note any decrease or increase in movement.
Note pain with the movement.
Listen for crepitus or “popping.”
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

27. The Responsive Medical Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

28. The History Chief complaint History of the present illness
Past history
Current health status
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

29. Components of a Patient History
Establishing rapport
Chief complaint
History of the present illness
Past medical history
Current health status
Family history
Psychosocial history
Review of systems
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

30. Patient Rapport – Active Listening
Facilitation
Reflection
Clarification
Empathy
Confrontation
Interpretation
Asking about feelings
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

31. Special Challenges (1 of 2)
Silence
Overly talkative patients
Multiple symptoms
Anxiety
Depression
Sexually attractive or seductive patients
Confusing behaviors or symptoms
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

32. Special Challenges (2 of 2)
Patients needing reassurance
Anger and hostility
Intoxication
Crying
Limited intelligence
Language barriers
Hearing problems
Blindness
Talking with families or friends
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

33. Appearance (1 of 2) Level of consciousness Signs of distress
Apparent state of health
Vital statistics
Sexual development
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

34. Appearance (2 of 2) Skin color and obvious lesions
Posture, gait, and motor activity
Dress, grooming, and personal hygiene
Odors of breath or body
Facial expression
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

35. The History of the Present Illness (OPQRST-ASPN)
Onset
Provocation or Palliation
Quality
Region/Radiation
Severity
Time
Associated Symptoms
Pertinent Negatives
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

36. Past Medical History General state of health
Childhood and adult diseases
Psychiatric illnesses
Accidents and injuries
Surgeries and hospitalizations
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

37. Psychosocial History Chronic health conditions Job Family dynamics
Work schedule
Stress
Family dynamics
Support
Safety issues
Car seat usage
Smoke and CO alarms
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

38. The physical exam of the medical patient is aimed at identifying medical complications rather than signs of injury.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

39. Examination Techniques
Inspection
Palpation
Auscultation
Percussion
These 4 techniques are the foundation of the physical exam.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

40. Review of Systems
A system-by-system series of questions designed to identify problems your patient has not already identified:
Skin
Head
Eyes
Ears
Nose
Mouth/Throat
Respiratory
Cardiovascular
Gastrointestinal
Genitourinary
Musculoskeletal
Neurologic
Psychologic
Endocrine
Hematologic
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

41. Areas of Nervous System Exam
Mental status and speech
Cranial nerves
Motor system
Reflexes
Sensory system
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

42. One-Minute Cranial Nerve Exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

43. Measure vital signs early in the physical examination and, in the emergency situation, repeat them often and look for trends.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

44. Assessing the Unresponsive Medical Patient
Initial assessment
Rapid medical assessment
Brief history
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

45. Ongoing Assessment Mental status Airway patency
Breathing rate and quality
Pulse rate and quality
Skin condition
Transport priorities
Vital signs
Focused assessment
Effects of interventions
Management plans
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

46. THE END
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ