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CONFIDENTIAL1 Patient assessment for the Basic EMT.

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Presentation on theme: "CONFIDENTIAL1 Patient assessment for the Basic EMT."— Presentation transcript:

1 CONFIDENTIAL1 Patient assessment for the Basic EMT

2 CONFIDENTIAL2 Lesson Goal Obtain and interpret vital signs & SAMPLE history Provide information necessary to evaluate scene during initial stages of response Perform initial patient assessment, form a general impression, and determine transport priority of medical or trauma patient Recognize MOI to predict injury in trauma patient

3 CONFIDENTIAL3 Lesson Goal Perform ongoing assessment Reassess & confirm patients status Review assessment Check interventions for adequacy & response Perform detailed physical examination, understand findings, and use findings to provide appropriate patient care Assess patients with medical complaint and obtain a focused history

4 CONFIDENTIAL4 Why is it important? We are the eyes and ears We cannot treat what we do not assess We cannot report what we do not assess or treat

5 CONFIDENTIAL5 Assessment tools

6 CONFIDENTIAL6 Most Important Assessment Tools

7 CONFIDENTIAL7 When does assessment begin?

8 CONFIDENTIAL8 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

9 CONFIDENTIAL9 Scene Size-Up

10 CONFIDENTIAL10 General Impression Includes: –NOI for medical patients –MOI for trauma patients Determine need for cervical spine stabilization –Both medical problem & injury possible –Age –Gender –Race (ethnicity)

11 CONFIDENTIAL11 Level of Consciousness (Mental Status) A Alert V responds to Verbal stimulus P responds only to Painful stimulus U Unresponsive

12 CONFIDENTIAL12 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

13 CONFIDENTIAL13 Initial Assessment Find and fix –Airway –Breathing –Circulation/Shock Assess disability/environment Expose as necessary Transport decision

14 CONFIDENTIAL14 Assess Airway Look –Patient position –Intact structure –No foreign bodies –Patient color Listen –Snoring –Gurgling –Crowing/stridor –Silence –Patient complaint Feel –Stable structure –Air exchange

15 CONFIDENTIAL15 Treat Airway Position Suction Adjuncts Consider early transport

16 CONFIDENTIAL16 Assess Breathing Look –Patient position –Patient color –Chest wall movement –Use of accessory muscles –Rate/Regularity –Pulse oxymetry Listen –Audible wheezing –Breath sounds –Patient complaint Feel –Chest wall –Subcutaneous emphysema

17 CONFIDENTIAL17 Treat breathing Position for comfort Consider early transport Apply oxygen –High-flow/NRB Assist breathing –Once every 5-6 seconds Seal chest wounds –Occlusive dressing Consider early transport

18 CONFIDENTIAL18 Assess Circulation/Shock Look –External bleeding –Patient color Listen –Mental status Feel –Pulse Location Quality Rate regularity

19 CONFIDENTIAL19 Treat Circulation/Shock Stop the bleeding High-flow oxygen Maintain body temperature

20 CONFIDENTIAL20 Consider C-Spine stabilization

21 CONFIDENTIAL21 Assess Disability (neuro status) Mental Status Pupil check Bilateral movement Glasgow Coma scale

22 CONFIDENTIAL22 Assess Environment/Expose Too hot/too cold Surface contact Move patient to a controlled environment ASAP Expose injuries

23 CONFIDENTIAL23 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

24 CONFIDENTIAL24 Focused History and Physical ExamTrauma Rapid Trauma Assessment VS Focused Trauma Assessment

25 CONFIDENTIAL25 Detailed Exam Check the nooks and crannies

26 CONFIDENTIAL26 Hands-on AssessmentHead to Toe D Deformities C Contusions A Abrasions P Penetrations B Burns T Tenderness L Lacerations S Swelling

27 CONFIDENTIAL27 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

28 CONFIDENTIAL28 Focused History and Physical Exam--Medical Getting a history is the key!! –S Signs and Symptoms--OPQRST –A Allergies –M Medications –P Pertinent Past history –L Last oral intake –E Events leading up to Focused physical assessment

29 CONFIDENTIAL29 Assessing Signs and Symptoms O Onset P Provoke Q Quality R Radiate S Severity T Time

30 CONFIDENTIAL30 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

31 CONFIDENTIAL31 Detailed Exam Check the nooks and crannies

32 CONFIDENTIAL32 Vital Signs/History PATIENT ASSESSMENT OVERVIEW Scene Size-up Initial Assessment Rapid Focused and Physical Exam: Trauma Detailed Exam Ongoing Assessment Rapid Focused And Physical Exam: Medical

33 CONFIDENTIAL33 On-Going Assessment Assess, re-assess and then assess again Vital signs every 15 minutes for the stable patient Vital signs every 5 minutes for the unstable patient

34 CONFIDENTIAL34 Vital Signs Pulse Respirations Breath Sounds Blood Pressure Oxygen saturation Pupils GCS Skin color, condition, and temperature Time

35 CONFIDENTIAL35 Skin color/condition –Normal, pale, jaundiced, flushed, cyanotic –Warm, hot, cool, cold, moist, dry Pupils –Equal/reactive

36 CONFIDENTIAL36 Pulse –Rate: adult normal –Location: carotid/radial –Quality: strong, weak, thready –Regularity: regular/irregular Respirations –Rate: adult normal –Quality: easy, labored, noisy –Regularity Breath sounds Present and equal

37 CONFIDENTIAL37 Blood pressure –Auscultation –Palpation –Oscillation –Automatic Oxygen saturation –> 90% for adults –> 95% for pediatrics

38 CONFIDENTIAL38 Glasgow Coma Scale CriteriaPatient ResponseScore Eye opening Spontaneously To speech To pain None Verbal response Oriented Confused Inappropriate words Incomprehensible words None Motor response Obeys commands Localizes pain Withdraws to pain Flexion to pain Extension to pain None

39 CONFIDENTIAL39 The Last Word… EVERYONE gets an assessment

40 CONFIDENTIAL40 Questions and answers


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