1. Section 3: Patient Assessment

2. Chapter 7 Patient Assessment

3. Chapter 7: Patient Assessment 3 Scene Size-up Recognize actual and potential hazards. Describe common hazards found at the scene of a trauma and a medical patient. Determine if the scene is safe to enter. Discuss common mechanisms of injury/nature of illness. Discuss the reason for identifying the total number of patients at the scene. Objectives (1 of 15)

4. Chapter 7: Patient Assessment 4 Scene Size-up Explain the reason for identifying the need for additional help or assistance. Explain how you can determine that the patient is obviously responsive or possibly has altered responsiveness. Explain the rationale for rescuers to evaluate scene safety before approaching the scene. Objectives (2 of 15)

5. Chapter 7: Patient Assessment 5 Initial Assessment Summarize the reasons for forming a general impression of the patient. Discuss methods of assessing and managing the airway in the adult, child, and infant patient. Objectives (3 of 15)

6. Chapter 7: Patient Assessment 6 Initial Assessment State reasons for management of the cervical spine once the patient has been determined to be a trauma patient. Describe the methods used for determining whether a patient is breathing and whether breathing is adequate. Describe the methods used to assess circulation. Objectives (4 of 15)

7. Chapter 7: Patient Assessment 7 Initial Assessment Differentiate between assessing circulation in an adult, child, and infant patient. State what care should be provided to the adult, child, and infant patient with an abnormal or absent pulse. Discuss the need for assessing the patient for external bleeding. Objectives (5 of 15)

8. Chapter 7: Patient Assessment 8 Initial Assessment Explain the reasons for prioritizing a patient for care and transport. Explain the importance of forming a general impression of the patient. Explain the value of performing an initial assessment. Objectives (6 of 15)

9. Chapter 7: Patient Assessment 9 Initial Assessment Demonstrate the techniques for assessing responsiveness. Demonstrate the techniques for assessing and stabilizing the ABCs. Demonstrate the techniques for assessing the patient’s skin color, temperature, moisture, and capillary refill. Demonstrate the ability to prioritize patients. Objectives (7 of 15)

10. Chapter 7: Patient Assessment 10 Rapid History and Physical Exam: Unresponsive Patient Discuss the method of assessing altered responsiveness. Describe the unique needs for assessing an individual who is unresponsive. Describe the indications for doing a rapid body survey. Objectives (8 of 15)

11. Chapter 7: Patient Assessment 11 Rapid History and Physical Exam: Unresponsive Patient Discuss the various rapid transport protocols for your location or organization. Explain the indications and value of performing a rapid body survey on site. Demonstrate the performance of a rapid body survey. Demonstrate the patient care skills that should be used to assist an unresponsive patient. Objectives (9 of 15)

12. Chapter 7: Patient Assessment 12 Focused History and Physical Exam: Responsive Trauma Patient Discuss the significance of the mechanism of injury. Differentiate when the assessment may be altered in order to provide patient care. Discuss the reason for performing a focused trauma history and physical exam. Demonstrate the trauma assessment that should be used to assess a responsive patient based on mechanism of injury. Objectives (10 of 15)

13. Chapter 7: Patient Assessment 13 Focused History and Physical Exam: Responsive Medical Patient Describe the unique needs for assessing an individual with a specific chief complaint with no known prior history. Demonstrate the patient care skills that should be used to assist a responsive patient with a medical illness. Objectives (11 of 15)

14. Chapter 7: Patient Assessment 14 Detailed Physical Exam Discuss the components of the detailed physical exam. State the areas of the body that are evaluated during the detailed physical exam. Objectives (12 of 15)

15. Chapter 7: Patient Assessment 15 Detailed Physical Exam Explain what additional care should be provided while performing the detailed physical exam. Demonstrate the skills involved in performing the detailed physical exam. Objectives (13 of 15)

16. Chapter 7: Patient Assessment 16 Ongoing Assessment Discuss the reason for repeating the initial assessment as part of the ongoing assessment. Describe the components of the ongoing assessment. Describe monitoring of the assessment components. Objectives (14 of 15)

17. Chapter 7: Patient Assessment 17 Ongoing Assessment Explain the value of performing an ongoing assessment. Explain the value of trending assessment components to other health professionals who assume care of the patient. Demonstrate the skills involved in performing the ongoing assessment. Objectives (15 of 15)

18. Chapter 7: Patient Assessment 18 Patient Assessment Process Scene size-up Initial assessment Provide spinal immobilization Identify and treat life threats Focused history and physical exam Arrange for transport if needed Detailed physical exam Reassess vital signs Ongoing assessment

19. Chapter 7: Patient Assessment 19 The Patient Assessment Process

20. Chapter 7: Patient Assessment 20 The Golden Hour

21. Chapter 7: Patient Assessment 21 Components of the Scene Size-Up Protect the safety of all How many patients? Is triage needed? Is extrication needed? Are more resources needed? What is the patient’s status?

22. Chapter 7: Patient Assessment 22 Body Substance Isolation Assumes all body fluids present a possible risk for infection. Protective equipment –Latex or vinyl gloves should always be worn –Eye protection –Mask –Gown

23. Chapter 7: Patient Assessment 23 Scene Safety Adverse weather Avalanche Rock fall Steep terrain Swift water Traffic (people and machines) Fire or smoke Hazardous materials Structural collapses Live wires or lightning Dangerous animals

24. Chapter 7: Patient Assessment 24 Mechanism of Injury Helps determine the possible extent of injuries on trauma patients Evaluate –Amount of force applied to body –Length of time force was applied –Area of the body involved

25. Chapter 7: Patient Assessment 25 Falls Amount of force related to height of fall Note surface that patient landed on Attempt to determine how patient landed

26. Chapter 7: Patient Assessment 26 Nature of Illness Search for clues to determine the nature of illness. Often described by the patient’s chief complaint Gather information from the patient and people on scene. Observe the scene.

27. Chapter 7: Patient Assessment 27 Number of Patients Determine the number of patients and their condition. Assess what additional resources will be needed. Triage to identify severity of each patient’s condition.

28. Chapter 7: Patient Assessment 28 Patient Assessment Process

29. Chapter 7: Patient Assessment 29 Components of the Initial Assessment Develop a general impression. Assess responsiveness. Assess airway. Assess the adequacy of breathing. Assess circulation. Identify patient priority. Initiate transport decision.

30. Chapter 7: Patient Assessment 30 Develop a General Impression Occurs as you approach the scene and the patient –Assessment of the environment –Patient’s chief complaint –Presenting signs and symptoms of patient

31. Chapter 7: Patient Assessment 31 Assessing Responsiveness Checking responsiveness –Assess how well the patient responds to external stimuli. Check for orientation –Check the patient’s memory to person, place, time, and event. If he or she recalls all four, then he or she is fully alert and oriented times four.

32. Chapter 7: Patient Assessment 32 Level of Consciousness A Alert V Responsive to Verbal stimulus P Responsive to Pain U Unresponsive

33. Chapter 7: Patient Assessment 33 Assess and Stabilize the Airway 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

34. Chapter 7: Patient Assessment 34 Signs of Airway Obstruction in the Unconscious Patient Obvious trauma, blood, or other obstruction Noisy breathing such as bubbling, gurgling, crowing, or other abnormal sounds Extremely shallow or absent breathing

35. Chapter 7: Patient Assessment 35 Assess and Stabilize 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?

36. Chapter 7: Patient Assessment 36 Managing Breathing If patient is having difficulty breathing, reevaluate 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.

37. Chapter 7: Patient Assessment 37 Normal Respiratory Rates Adults 12 to 20 breaths/min Children 18 to 34 breaths/min Infants 30 to 60 breaths/min

38. Chapter 7: Patient Assessment 38 Unresponsive Patients Use the look, listen, and feel technique. Consider spinal cord injury. Provide high-flow oxygen. Assist ventilations if needed.

39. Chapter 7: Patient Assessment 39 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

40. Chapter 7: Patient Assessment 40 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

41. Chapter 7: Patient Assessment 41 Restoring Circulation Control bleeding and improve oxygen delivery. If unresponsive and pulseless, begin CPR. Apply and operate the AED as quickly as possible. Do not use AED on patients with a catastrophic traumatic injury.

42. Chapter 7: Patient Assessment 42 Normal Pulse Rates Adults60 to 100 beats/min Children 70 to 140 beats/min Toddlers 90 to 150 beats/min Infants100 to 160 beats/min

43. Chapter 7: Patient Assessment 43 Identifying Priority Patients Poor general impression Unresponsive with no gag or cough reflexes Difficulty breathing Signs of poor perfusion Complicated childbirth Uncontrolled bleeding Severe pain Severe chest pain Inability to move any part of the body

44. Chapter 7: Patient Assessment 44 Initiate Transport Decisions Contact outside agencies early. Preplanning is the key to success. Use resources efficiently.

45. Chapter 7: Patient Assessment 45 Patient Assessment Process

46. Chapter 7: Patient Assessment 46 Assessment of Unresponsive Patients Rapid body survey Baseline vital signs SAMPLE history (from friends, family of bystanders) Rapid transport

47. Chapter 7: Patient Assessment 47 Rapid Body Survey (1 of 4) Maintain body temperature Protect the cervical spine Rapid head-to-toe Treat injuries

48. Chapter 7: Patient Assessment 48 Rapid Body Survey (2 of 4) Maintain spinal immobilization while checking patient’s ABCs. Assess the head. Assess the neck. Apply a cervical spine immobilization collar.

49. Chapter 7: Patient Assessment 49 Rapid Body Survey (3 of 4) Assess the chest. Assess the abdomen. Assess the pelvis. Assess all four extremities.

50. Chapter 7: Patient Assessment 50 Rapid Body Survey (4 of 4) Roll the patient with spinal precautions. Assess baseline vital signs and SAMPLE history.

51. Chapter 7: Patient Assessment 51 DCAP-BTLS D Deformities C Contusions A Abrasions P Punctures/ Penetrations B Burns T Tenderness L Lacerations S Swelling

52. Chapter 7: Patient Assessment 52 Vital Signs After rapid assessment, obtain baseline vital signs and a SAMPLE history. Vital signs of stable patients should be reassessed every 15 minutes. Vital signs of unstable patients should be reassessed every 5 minutes.

53. Chapter 7: Patient Assessment 53 Baseline Vital Signs Respirations Pulse Blood pressure (where and when appropriate) Level of responsiveness

54. Chapter 7: Patient Assessment 54 SAMPLE SAMPLE History S Signs and symptoms A Allergies M Medications P Past medical history L Last oral intake E Events leading to the episode

55. Chapter 7: Patient Assessment 55 Patient Assessment Process

56. Chapter 7: Patient Assessment 56 Assessment of Responsive Trauma Patient Significant MOI Rapid Body Survey Baseline Vital Signs SAMPLE History (from friends, family, and bystanders) Rapid Transport Nonsignificant MOI Focused Physical Exam Baseline Vital Signs SAMPLE History Reevaluate Transport

57. Chapter 7: Patient Assessment 57 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.

58. Chapter 7: Patient Assessment 58 Significant MOI Reconsider MOI. Treat immediate or potential life threats. Maintain spinal immobilization. Perform rapid body survey and treatment. Obtain baseline vital signs and SAMPLE history. Arrange for rapid transport.

59. Chapter 7: Patient Assessment 59 Nonsignificant MOI Identify the patient’s chief complaint. Consider spinal immobilization. Assess the specific injury site(s). Obtain baseline vital signs and SAMPLE history. Provide care and stabilization. Reevaluate transport.

60. Chapter 7: Patient Assessment 60 Focused Assessment (1 of 4) General Weakness Lightheaded Fatigue Bleeding Head Injury Headache Dizziness Loss of responsiveness Double vision

61. Chapter 7: Patient Assessment 61 Focused Assessment (2 of 4) Neck or Back Injury Numbness Tingling Weakness Inability to move Difficulty breathing Chest Injury Difficulty breathing Cough Bloody sputum Variable pain

62. Chapter 7: Patient Assessment 62 Focused Assessment (3 of 4) Abdominal Injury Nausea, vomiting Cramps Blood in urine or feces Swelling Last bowel movement Pregnancy Pelvic Injury Trouble urinating Blood in urine Blood from urethra, vagina, or rectum Pregnancy

63. Chapter 7: Patient Assessment 63 Focused Assessment (4 of 4) Extremity Injuries Pain on motion Numbness, tingling, weakness, or loss of motion in the extremity Inability to bear weight on lower extremity DCAP-BTLS

64. Chapter 7: Patient Assessment 64 Patient Assessment Process

65. Chapter 7: Patient Assessment 65 Assessment of Responsive Medical Patient History of illness SAMPLE history Focused physical exam Baseline vital signs Reevaluate transport

66. Chapter 7: Patient Assessment 66 History of Illness Important Signs and Symptoms: –Regional pain –Fever –Variation from normal function

67. Chapter 7: Patient Assessment 67 OPQRST (1 of 2) O Onset When did the problem first start? P Provoking factors What creates or makes the problem worse? Q Quality of pain Description of the pain

68. Chapter 7: Patient Assessment 68 OPQRST (2 of 2) R Radiation of pain or discomfort Does the pain radiate anywhere? S Severity Intensity of pain on 1-to-10 scale T Time How long has the patient had this problem?

69. Chapter 7: Patient Assessment 69 SAMPLE History Questions to ask: –Have you ever been told you have a heart condition? –Have you ever been told you have problems with your lungs? –Have you ever been told you have seizures?

70. Chapter 7: Patient Assessment 70 Focused Physical Exam Investigate problems associated with chief complaint. Examine abnormalities. Reassess vital signs. Provide emergency care. Reevaluate transport.

71. Chapter 7: Patient Assessment 71 Patient Assessment Process

72. Chapter 7: Patient Assessment 72 Detailed Physical Exam (1 of 2) More in-depth exam based on focused physical exam Should only be performed if time and patient’s condition allow Usually performed by EMS en route to the hospital

73. Chapter 7: Patient Assessment 73 Detailed Physical Exam (2 of 2) Head-to-toe steps DCAP-BTLS Vital signs

74. Chapter 7: Patient Assessment 74 Performing the Detailed Physical Exam (1 of 5) Visualize and palpate using DCAP-BTLS. Look at the face. Inspect the area around the eyes and eyelids. Examine the eyes. Pull the patient’s ear forward to assess for bruising.

75. Chapter 7: Patient Assessment 75 Performing the Detailed Physical Exam (2 of 5) Use the penlight to look for drainage or blood in the ears. Look for bruising and lacerations about the head. Palpate the zygomas. Palpate the maxillae. Palpate the mandible.

76. Chapter 7: Patient Assessment 76 Performing the Detailed Physical Exam (3 of 5) Assess the mouth for obstructions and cyanosis. Check for unusual odors. Look at the neck. Palpate the front and the back of the neck. Look for distended jugular veins.

77. Chapter 7: Patient Assessment 77 Performing the Detailed Physical Exam (4 of 5) Look at the chest. Gently palpate over the ribs. Listen for breath sounds. Listen also at the bases and apices of the lungs. Look at the abdomen and pelvis.

78. Chapter 7: Patient Assessment 78 Performing the Detailed Physical Exam (5 of 5) Gently palpate the abdomen. Gently compress the pelvis. Gently press the iliac crests. Inspect all four extremities. Assess the back for tenderness or deformities.

79. Chapter 7: Patient Assessment 79 Patient Assessment Process

80. Chapter 7: Patient Assessment 80 Ongoing Assessment (1 of 2) Repeat the initial assessment. Reassess and record vital signs. Repeat focused assessment. Check interventions.

81. Chapter 7: Patient Assessment 81 Ongoing Assessment (2 of 2) Is treatment improving the patient’s condition? Has an already identified problem gotten better? Worse? What is the nature of any newly identified problems?