1. Patient Assessment INITIAL ASSESSMENT

2. Patient Assessment 2 Components of the Initial Assessment Develop a general impression Assess mental status Assess airway “A” Assess the adequacy of breathing “B” Assess circulation “C” Identify patient priority

3. Patient Assessment 3 Develop a General Impression Looks for life-threatening conditions Occurs as you approach the scene and the patient Assessment of the environment Patient’s chief complaint Presenting signs and symptoms of patient

4. Patient Assessment 4 Distinguishing Between Medical and Trauma Determination should come after assessment is finished. Patients may have traumatic injuries caused by a medical reason. Initially assume all patients have both medical and traumatic aspects to their condition.

5. Patient Assessment 5 Level of Consciousness A Alert V Responsive to Verbal stimulus P Responsive to Pain U Unresponsive

6. Patient Assessment 6 Assessing the Airway (Unconscious) Open the airway Head tilt, chin lift technique. Look, Listen, Feel for breathing for 5 seconds. If not breathing, give two initial breaths.

7. Patient Assessment 7 Assessing the Airway (Conscious) Look for signs of airway compromise: Two- to three-word dyspnea Use of accessory muscles Nasal flaring and use of accessory muscles in children Labored breathing

8. Patient Assessment 8 Assessing Breathing Are the patient’s respirations shallow or deep? Does the patient appear to be choking? Is the patient cyanotic (blue)? Is the patient moving air into and out of the lungs as the chest rises and falls?

9. Patient Assessment 9 Managing Breathing If patient is having difficulty breathing re-evaluate airway. Consider assisting ventilations with a BVM or applying a nonrebreathing mask if patient’s respirations are greater than 24/min or less than 8/min.

10. Patient Assessment 10 Unresponsive Patients Look, listen and feel for breathing about 5 seconds Consider spinal cord injury. Provide high-flow oxygen. Assist ventilations if needed.

11. Patient Assessment 11 Assessing Circulation (1 of 2) Assess the pulse. Rate, rhythm and strength Assess and control external bleeding. Direct pressure Evaluate skin color. Cyanotic, flushed, pale or jaundiced

12. Patient Assessment 12 Assessing Circulation (2 of 2) Evaluate skin temperature. Skin is an organ. Evaluate skin condition. Dry or moist Evaluate capillary refill. Should be less than 2 seconds

13. Patient Assessment 13 Identifying Priority Patients Poor general impression Unresponsive Difficulty breathing Signs of poor perfusion (capillary refill) Uncontrolled bleeding Severe pain Severe chest pain Inability to move any part of the body

14. Patient Assessment 14 Goals of Exam Identify life threatening conditions. Identify the patient’s chief complaint.

15. Patient Assessment 15 The Golden Hour

16. Patient Assessment 16 Trauma Assessment D Deformities O Open Wounds T Tenderness S Swelling

17. Patient Assessment 17 Trauma Assessment D Deformities C Contusions A Abrasions P Punctures/ Penetrations B Burns T Tenderness L Lacerations S Swelling

18. Patient Assessment 18 Assessing the Responsive Patient Ask general questions to find out the chief complaint. If they answer, they are conscious, breathing, and have a pulse. Listen to the patient.

19. Patient Assessment 19 Review

20. Patient Assessment 20 The Communication Process Do what you can to make the patient comfortable. Listen to the patient. Make eye contact. Base questions on the patient's complaint. Mentally summarize before starting treatment.