1. Patient Assessment, PCR & Handover

2. S igns & Symptoms A M llergies P L edications E ast medical history
Patient Assessment S A M P L E
igns & Symptoms
= O P Q R S T
nset - When did it start?
llergies
rovocation/palliation - What makes it worse or better.
edications
uality- for example pain is it dull or sharp etc.
ast medical history
egion/radiation/referral – where is the symptom located etc.
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.
ast food/drink
everity – pain score
vents
ime – how long have they had it for, etc.

3. 10+yrs = 2-10yrs = 3mths-2yrs = 0-3mths = Patient Assessment 60-100bpm
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Rates for breathes are:
>12 =12-20bpm
5-12=20-24bpm
2-5=24-30bpm
1-2= 26-34bpm
<1=30-40bpm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.

4. Patient Assessment
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.

5. >12yrs = 5-12yrs = 2-5yrs = 1-2yrs = <1yrs = Patient Assessment
12-20bpm
20-24bpm
24-30bpm
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Rates for breathes are:
>12 =12-20bpm
5-12=20-24bpm
2-5=24-30bpm
1-2= 26-34bpm
<1=30-40bpm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.
26-34bpm
30-40bpm

6. Patient Assessment
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.

7. GCS = 9 / 15 Patient Assessment Motor Response Obeys Commands
Localises Pain
Withdraws From Pain
Abnormal Flexion
Extensor Response
No Response to Pain
Verbal Response
Orientated
Confused
Inappropriate Words
Incomprehensible Words
No Verbal Response
Eyes Opening
Spontaneously
To Speech
To Pain
None
= 6
= 5
= 4
= 3
= 2
= 1
= 5
= 4
= 3
= 2
= 1
= 4
= 3
= 2
= 1
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.
GCS = 9 / 15

8. Verbal Response (CHILD) Appropriate Words or Smile
Patient Assessment
Motor Response
Obeys Commands
Localises Pain
Withdraws From Pain
Abnormal Flexion
Extensor Response
No Response to Pain
Verbal Response (CHILD)
Appropriate Words or Smile
Cries but is Consolable
Persistent Irritable
Restless, Agitated
Silent
Eyes Opening
Spontaneously
To Speech
To Pain
None
= 6
= 5
= 4
= 3
= 2
= 1
= 5
= 4
= 3
= 2
= 1
= 4
= 3
= 2
= 1
Explain the importance of the patient assessment including the need for early and repeat application. Explain how this forms into the handover.
Pulse
Describe the two pulse sites available and the preference of each, looking for RSR (Rate, Strength & regulatory)
Describe the ‘average’ adult pulse rate, and then explain the differences in age.
Split the group into pairs and get them to take the radial pulse for 1 minute, explaining the importance of sticking to the minute for the initial measurement. Allow the group to also have a go at finding each other’s carotid pulses.
Breathing
Again for 1 minute on the initial measurement, taking note of; depth, rate and rhythm.
Pain Score
0 – 10. Try not to lead the response.
Explain that a single measurement is only a snapshot, for it to be really useful there needs to be repeat measurements. This way they can see how the pain is changing and how.
Explain the Wong Baker Faces – good for children, dementia & learning difficulties.
SAMPLE
Signs and Symptoms – Ask what the difference between the two is.
Allergies – Medication allergies unless it is a reaction.
Medications – Ask for green slips or doset boxes, consider insulin in the fridge.
Past medical history
Last food or drink
Events – Talk about this episode.

9. Differences in the body's ability to compensate for an illness.
Working with Children
Differences in the body's ability to compensate for an illness. 

10. Working with Children
Can you think of some do and don'ts when dealing with children and there parents/carers?
Approach slowly, you’re a stranger!
Introduce yourself
Observe the child from a distance
Put any equipment down out of sight
DO NOT wear your high vis
Smile and use open body language
Talk to the child as you would anyone else
Explain everything to the parent/carer
Use teddy and/or toys

11. Paediatric Assessment Triangle (PAT)
Working with Children
Paediatric Assessment Triangle (PAT)
Appearance
Work of Breathing
Circulation to Skin
Tone
Interactiveness
Consolability
Look / Gaze
Speech / Cry
Abnormal airway sounds
Abnormal positioning
Recession
Flaring
Pallor
Cyanosis
Mottling

12. Let's put the PAT test to the test...
Working with Children !
Warning:
The following video clips are of actual sick children. Parents and carers will record these videos to raise awareness amongst others. Initially mocked, this is now a proven method amongst parents, relatives, carers, it has led to early recognition and diagnoses for potentially life threatening/changing conditions.
*** Please warn the delegates that there is real videos coming up, these videos may be upseting and can leave the room if they feel it necessary, if so then please talk to them afterwards and make sure they are ok, equally do this if somone is getting visibly upset during the videos ***
The purpose of these videos is to put the PAT test to practice, this can be done a number of ways. They question may arise on these videos as to what you would do, or how can that situation be managed, this can be referenced within the ACFR book. I have also included notes on each slide of the videos for your reference.
Let's put the PAT test to the test...
Video Clip 1
Video Clip 2
Video Clip 3

13. A T M I S - Age - Time of incident - Mechanism - Injuries
Handover Technique A T M I S
- Age
- Time of incident
- Mechanism
- Injuries
- Signs and Symptoms
- Treatment Given
The handover needs to be:
Concise
Effective
Factual

14. Working with Children
Any questions?