2Scene Size-up Objectives (1 of 2) Cognitive3-1.1 Recognize hazards/potential hazards.3-1.2 Describe common hazards found at the scene of a trauma and a medical patient.3-1.3 Determine if the scene is safe to enter.3-1.4 Discuss common mechanisms of injury/nature of illness.3-1.5 Discuss the reason for identifying the total number of patients at the scene.3-1.6 Explain the reason for identifying the need for additional help or assistance.
3Scene Size-up Objectives (2 of 2) Affective3-1.7 Explain the rationale for crew members to evaluate scene safety prior to entering.3-1.8 Serve as a model for others explaining how patient situations affect your evaluation of mechanism of injury or illness.Psychomotor3-1.9 Observe various scenarios and identify potential hazards.
4Initial Assessment Objectives (1 of 7) Cognitive3-2.1 Summarize the reasons for forming a general impression of the patient.3-2.2 Discuss methods of assessing altered mental status.3-2.3 Differentiate between assessing the altered mental status in the adult, child, and infant patient.3-2.4 Discuss methods of assessing the airway in the adult, child, and infant patient.3-2.5 State reasons for management of the cervical spine once the patient has been determined to be a trauma patient.
5Initial Assessment Objectives (2 of 7) 3-2.6 Describe methods used for assessing if a patient is breathing.3-2.7 State what care should be provided to the adult, child, and infant patient with adequate breathing.3-2.8 State what care should be provided to the adult, child, and infant patient without adequate breathing.3-2.9 Differentiate between a patient with adequate and inadequate breathing.Distinguish between methods of assessing breathing in the adult, child, and infant patient.
6Initial Assessment Objectives (3 of 7) Compare the methods of providing airway care to the adult, child, and infant patient.Describe the methods used to obtain a pulse.Differentiate between obtaining a pulse in an adult, child, and infant patient.Discuss the need for assessing the patient for external bleeding.Describe normal and abnormal findings when assessing skin color.Describe normal and abnormal findings when assessing skin temperature.
7Initial Assessment Objectives (4 of 7) Describe normal and abnormal findings when assessing skin condition.Describe normal and abnormal findings when assessing skin capillary refill in the infant and child patient.Explain the reason for prioritizing a patient for care and transport.
8Initial Assessment Objectives (5 of 7) AffectiveExplain the importance of forming a general impression of the patient.Explain the value of performing an initial assessment.
9Initial Assessment Objectives (6 of 7) PsychomotorDemonstrate the techniques for assessing mental status.Demonstrate the techniques for assessing the airway.Demonstrate the techniques for assessing if the patient is breathing.Demonstrate the techniques for assessing if the patient has a pulse.
10Initial Assessment Objectives (7 of 7) Demonstrate the techniques for assessing the patient for external bleeding.Demonstrate the techniques for assessing the patient's skin color, temperature, condition, and capillary refill (infants and children only).Demonstrate the ability to prioritize patients.
11Focused History and Physical Exam: Trauma Objectives (1 of 3) Cognitive3-3.1 Discuss the reasons for reconsideration concerning the mechanism of injury.3-3.2 State the reasons for performing a rapid trauma assessment.3-3.3 Recite examples and explain why patients should receive a rapid trauma assessment.3-3.4 Describe the areas included in the rapid trauma assessment and discuss what should be evaluated.
12Focused History and Physical Exam: Trauma Objectives (2 of 3) 3-3.5 Differentiate when the rapid assessment may be altered in order to provide patient care.3-3.6 Discuss the reason for performing a focused history and physical exam.Affective3-3.7 Recognize and respect the feelings that patients might experience during assessment.
13Focused History and Physical Exam: Trauma Objectives (3 of 3) Psychomotor3-3.8 Demonstrate the rapid trauma assessment that should be used to assess a patient based on mechanism of injury.
14Focused History and Physical Exam: Medical Patients Objectives (1 of 3) Cognitive3-4.1 Describe the unique needs for assessing an individual with a specific chief complaint with no known prior history.3-4.2 Differentiate between the history and physical exam that are performed for responsive patients with no known prior history and responsive patients with a known prior history.3-4.3 Describe the needs for assessing an individual who is unresponsive.
15Focused History and Physical Exam: Medical Patients Objectives (2 of 3) 3-4.4 Differentiate between the assessment that is performed for a patient who is unresponsive or has an altered mental status and other medical patients requiring assessment.Affective3-4.5 Attend to the feelings that these patients might be experiencing.
16Focused History and Physical Exam: Medical Patients Objectives (3 of 3) Psychomotor3-4.6 Demonstrate the patient care skills that should be used to assist a patient who is responsive with no known history.3-4.7 Demonstrate the patient care skills that should be used to assist a patient who is unresponsive or has an altered mental status.
17Detailed Physical Exam Objectives (1 of 2) Cognitive3-5.1 Discuss the components of the detailed physical exam.3-5.2 State the areas of the body that are evaluated during the detailed physical exam.3-5.3 Explain what additional care should be provided while performing the detailed physical exam.3-5.4 Distinguish between the detailed physical exam that is performed on a trauma patient and that of the medical patient.
18Detailed Physical Exam Objectives (2 of 2) Affective3-5.5 Explain the rationale for the feelings that these patients might be experiencing.Psychomotor3-5.6 Demonstrate the skills involved in performing the detailed physical exam.
19Ongoing Assessment Objectives (1 of 2) Cognitive3-6.1 Discuss the reason for repeating the initial assessment as part of the ongoing assessment.3-6.2 Describe the components of the ongoing assessment.3-6.3 Describe trending of assessment components.Affective3-6.4 Explain the value of performing an ongoing assessment.
20Ongoing Assessment Objectives (2 of 2) 3-6.5 Recognize and respect the feelings that patients might experience during assessment.3-6.6 Explain the value of trending assessment components to other health professionals who assume care of the patient.Psychomotor3-6.7 Demonstrate the skills involved in performing the ongoing assessment.
21Patient Assessment Scene size-up Initial assessment Focused history and physical examVital signsHistoryDetailed physical examOngoing assessment
23Nature of illness/chief complaint Number of patients Scene Size-upDispatch informationInspection of sceneScene hazardsSafety concernsMechanism of injuryNature of illness/chief complaintNumber of patientsAdditional resources needed
24Body Substance Isolation Assumes all body fluids present a possible risk for infectionProtective equipmentLatex or vinyl gloves should always be wornEye protectionMaskGownTurnout gear
25Scene Safety: Potential Hazards Oncoming trafficUnstable surfacesLeaking gasolineDowned electrical linesPotential for violenceFire or smokeHazardous materialsOther dangers at crash or rescue scenesCrime scenes
26Scene Safety Park in a safe area. Speak with law enforcement first if present.The safety of you and your partner comes first!Next concern is the safety of patient(s) and bystanders.Request additional resources if needed to make scene safe.
27Mechanism of InjuryHelps determine the possible extent of injuries on trauma patientsEvaluate:Amount of force applied to bodyLength of time force was appliedArea of the body involved
28Nature of Illness Search for clues to determine the nature of illness. Often described by the patient’s chief complaintGather information from the patient and people on scene.Observe the scene.
29The Importance of MOI/NOI Guides preparation for care to patientSuggests equipment that will be neededPrepares for further assessmentFundamentals of assessment are same whether emergency appears to be related to trauma or medical cause.
30Number of PatientsDetermine the number of patients and their condition.Assess what additional resources will be needed.Triage to identify severity of each patient’s condition.
31Additional Resources Medical resources Additional units Advanced life supportNonmedical resourcesFire suppressionRescueLaw enforcement
32C-Spine Immobilization Consider early during assessment.Do not move without immobilization.Err on the side of caution.
34Develop a general impression. Assess mental status. Assess airway. Initial AssessmentDevelop a general impression.Assess mental status.Assess airway.Assess the adequacy of breathing.Assess circulation.Identify patient priority.
35Develop a General Impression Occurs as you approach the scene and the patientAssessment of the environmentPatient’s chief complaintPresenting signs and symptoms of patient
41Caring for Abnormal Mental Status Complete initial assessment.Provide high-flow oxygen.Consider spinal immobilization.Initiate transport.Support ABCs.Reassess.
42Assessing the Airway Look for signs of airway compromise: Two- to three-word dyspneaUse of accessory musclesNasal flaring and use of accessory muscles in childrenLabored breathing
43Signs of Airway Obstruction in the Unconscious Patient Obvious trauma, blood, or other obstructionNoisy breathing such as bubbling, gurgling, crowing, or other abnormal soundsExtremely shallow or absent breathing
44Assessing Breathing Choking Rate Depth Cyanosis Lung sounds Air movement
49Normal Pulse Rates in Infants and Children AgeRange (beats/min)Infant: 1 month to 1 year100 to 160Toddler: 1 to 3 years90 to 150Preschool-age: 3 to 6 years80 to 140School-age: 6 to 12 years70 to 120Adolescent: 12 to 18 years60 to 100
50Assessing and Controlling External Bleeding Assess after clearing the airway and stabilizing breathing.Look for blood flow or blood on floor/clothes.Controlling bleedingDirect pressureElevationPressure points
52Priority Patients Difficulty breathing Poor general impression Unresponsive with no gag reflexSevere chest painSigns of poor perfusionComplicated childbirthUncontrolled bleedingResponsive but unable to follow commandsSevere painInability to move any part of the body
53Transport Decision Patient condition Availability of advanced care Distance to transportLocal protocols
55Goals of the Focused History and Physical Exam Understand the circumstances surrounding the chief complaint.Obtain objective measurements.Perform physical exam.
56Components of Focused History and Physical Exam Medical historyBaseline vital signsPhysical exam
57Rapid Physical Exam 60-90 second head-to-toe exam Performed on: Significant trauma patientsUnresponsive medical patientsIdentifies undiscovered conditions
58DCAP-BTLS D Deformities C Contusions A Abrasions P Punctures/ PenetrationsB BurnsT TendernessL LacerationsS Swelling
59Components of a Rapid Physical Exam (1 of 3) Maintain spinal immobilization while checking patient’s ABCs.Assess the head.Assess the neck.Apply a cervical spine immobilization collar.
60Components of a Rapid Physical Exam (2 of 3) Assess the chest.Assess the abdomen.Assess the pelvis.
61Components of a Rapid Physical Exam (3 of 3) Assess all four extremities.Roll the patient with spinal precautions.
62Focused Physical Exam Used to evaluate patient’s chief complaint Performed on:Trauma patients without significant MOIResponsive medical patients
63Head, Neck, and Cervical Spine Feel head and neck for deformity, tenderness, or crepitation.Check for bleeding.Ask about pain or tenderness.
64Chest Watch chest rise and fall with breathing. Feel for grating bones as patient breathes.Listen to breath sounds.
65Abdomen Look for obvious injury, bruises, or bleeding. Evaluate for tenderness and any bleeding.Do not palpate too hard.
66Pelvis Look for any signs of obvious injury, bleeding, or deformity. Press gently inward and downward on pelvic bones.
67Extremities Look for obvious injuries. Feel for deformities. Assess PulseMotor functionSensory function
68Posterior Body Feel for tenderness, deformity, and open wounds. Carefully palpate from neck to pelvis.Look for obvious injuries.
69Specific Chief Complaints Chest painShortness of breathAbdominal painPain associated with bones or jointsDizziness
70Significant Mechanism of Injury Ejection from vehicleDeath in passenger compartmentFall greater than 15'-20'Vehicle rolloverHigh-speed collisionVehicle-pedestrian collisionMotorcycle crashUnresponsiveness or altered mental statusPenetrating trauma to the head, chest, or abdomen
71Assessment Steps for Significant MOI Rapid trauma assessmentBaseline vital signsSAMPLE historyReevaluate transport decision
72Assessment Steps for Trauma Patients Without Significant MOI Focused assessmentBaseline vital signsSAMPLE historyReevaluate transport decision
73Responsive Medical Patients History of illnessSAMPLE historyFocused assessmentVital signsReevaluate transport decision
74Unresponsive Medical Patients Rapid medical assessmentBaseline vital signsSAMPLE historyReevaluate transport decision
88Is treatment improving the patient’s condition? Ongoing AssessmentIs treatment improving the patient’s condition?Has an already identified problem gotten better? Worse?What is the nature of any newly identified problems?
89Steps of the Ongoing Assessment Repeat the initial assessment.Reassess and record vital signs.Repeat focused assessment.Check interventions.
90Review Assessment of an unconscious patient's breathing begins by: A. inserting an oral airway.B. manually positioning the head.C. assessing respiratory rate and depth.D. clearing the mouth with suction as needed.
91ReviewAnswer: BRationale: You cannot assess or treat an unconscious patient’s breathing until the airway is patent—that is, open and free of obstructions. Manually open the patient’s airway (eg, head tilt-chin lift, jaw-thrust), use suction as needed to clear the airway of blood or other liquids, insert an airway adjunct to assist in maintaining airway patency, and then assess the patient’s respiratory effort.
92Review Assessment of an unconscious patient's breathing begins by: inserting an oral airway.Rationale: You insert an airway adjunct to assist in maintaining airway patency after the head-tilt-chin-lift.B. manually positioning the head.Rationale: Correct answerC. assessing respiratory rate and depth.Rationale: After the airway is opened and suctioned, then determine the patient’s respiratory effort by assessing the respiratory rate and depth.D. clearing the mouth with suction as needed.Rationale: This is done after attempting to open the airway with proper positioning.
93Review2. You arrive at the scene of an “injured person.” As you exit the ambulance, you see a man lying on the front porch of his house. He appears to have been shot in the head and is lying in a pool of blood. You should:A. immediately assess the patient.B. proceed to the patient with caution.C. quickly assess the scene for a gun.D. Retreat to a safe place and wait for law enforcement to arrive.
94ReviewAnswer: DRationale: Your primary responsibility as an EMT-B is to protect yourself. Prior to entering any scene, you must assess for potential dangers. In cases where violence has occurred, you must retreat to a safe place and wait for law enforcement personnel to arrive.
95Review2. You arrive at the scene of an “injured person.” As you exit the ambulance, you see a man lying on the front porch of his house. He appears to have been shot in the head and is lying in a pool of blood. You should:immediately assess the patient.Rationale: You must wait until the scene is safe.B. proceed to the patient with caution.C. quickly assess the scene for a gun.Rationale: This is the responsibility of law enforcement.D. Retreat to a safe place and wait for law enforcement to arrive.Rationale: Correct answer
96Review3. During the scene size-up, you should routinely determine all of the following, EXCEPT:A. the mechanism of injury or nature of illness.B. the ratio of pediatric patients to adult patients.C. whether or not additional resources are needed.D. if there are any hazards that will jeopardize safety.
97ReviewAnswer: BRationale: Components of the scene size-up—after taking BSI precautions—include determining if the scene is safe for entry, determining the mechanism of injury or nature of illness, determining the number of patients, and determining if additional resources are needed at the scene.
98Review3. During the scene size-up, you should routinely determine all of the following, EXCEPT:the mechanism of injury or nature of illness.Rationale: This is part of the scene size-up.B. the ratio of pediatric patients to adult patients.Rationale: Correct answerC. whether or not additional resources are needed.D. if there are any hazards that will jeopardize safety.
99Review4. Findings such as inadequate breathing or an altered level of consciousness should be identified in the:A. initial assessment.B. focused physical exam.C. ongoing assessment.D. detailed physical exam.
100ReviewAnswer: ARationale: The purpose of the initial assessment is to identify and manage any life threats to the patient, such as inadequate breathing, an altered level of consciousness, or severe hemorrhage.
101Review4. Findings such as inadequate breathing or an altered level of consciousness should be identified in the:initial assessment.Rationale: Correct answerB. focused physical exam.Rationale: The focused physical exam will help EMS to identify specific problems, based upon the patient’s chief complaint.C. ongoing assessment.Rationale: This is performed during transport and will provide information on other clues on how the current care plan is working.D. detailed physical exam.Rationale: This will provide EMS with more information about the nature of the patient’s problem.
102Review5. A semiconscious patient pushes your hand away when you pinch his earlobe. You should describe his level of consciousness as:A. alert.B. unresponsive.C. responsive to painful stimuli.D. responsive to verbal stimuli.
103ReviewAnswer: CRationale: Semiconscious patients are not alert, nor or they unresponsive. The fact that the patient pushes your hand away when you pinch his earlobe indicates that he is responsive to painful stimuli. If he opens his eyes or responds when you speak to him, he would be described as being responsive to verbal stimuli.
104Review5. A semiconscious patient pushes your hand away when you pinch his earlobe. You should describe his level of consciousness as:alert.Rationale: This is when the patient’s eyes open spontaneously as you approach.B. unresponsive.Rationale: This is when the patient does not respond to any stimulus.C. responsive to painful stimuli.Rationale: Correct answerD. responsive to verbal stimuli.Rationale: This is when the patient’s eyes open with verbal stimuli and tries to respond.
105Review6. Which of the following is considered a significant mechanism of injury for a child?A. Bicycle collisionB. Fall from higher than 5'C. Slow-speed vehicle collisionD. Abrasion injury of the abdomen
106ReviewAnswer: ARationale: Significant mechanisms of injury for a child include falls from greater than 10’, bicycle collisions, and medium-speed vehicle collisions, among others.
107Review6. Which of the following is considered a significant mechanism of injury for a child?Bicycle collisionRationale: Correct answerB. Fall from higher than 5‘Rationale: A significant mechanism of injury is a fall greater than 10 feet or 2 to 3 times the child’s height.C. Slow-speed vehicle collisionRationale: A significant mechanism of injury occurs with speeds greater than 20 miles per hour.D. Abrasion injury of the abdomenRationale: An abrasion is the result of an injury.
108Review7. An unresponsive patient with a possible spinal injury and inadequate breathing should be placed:A. on a backboard and given assisted ventilations.B. in a PASG and given oxygen via nonrebreathing mask.C. in a semisitting position and given assisted ventilations.D. in the recovery position and given oxygen via nonrebreathing mask.
109ReviewAnswer: ARationale: Use spinal motion restriction precautions (eg, backboard, cervical collar, lateral immobilization of the head) on any patient with a possible spinal injury. If the patient is breathing inadequately (eg, shallow [reduced tidal volume] breathing, fast or slow rate), assist ventilations with a bag-mask device and 100% oxygen.
110Review7. An unresponsive patient with a possible spinal injury and inadequate breathing should be placed:on a backboard and given assisted ventilations.Rationale: Correct answerB. in a PASG and given oxygen via nonrebreathing mask.Rationale: Inadequate breathing is always managed with assisted ventilations via a bag-mask device.C. in a semisitting position and given assisted ventilations.Rationale: Spinal injuries are secured to a long backboard.D. in the recovery position and given oxygen via nonrebreathing mask.Rationale: Spinal injuries are not placed on the side but supine on a long backboard and breathing is assisted in this scenario.
111Review8. Which of the following would you NOT detect during your general assessment of a patient?A. CyanosisB. Gurgling respirationsC. Severe bleedingD. Rapid heart rate
112ReviewAnswer: DRationale: The general impression is what you first notice as you approach the patient, but before physical contact with the patient is made. It is what you see, hear, or smell. A rapid heart rate (tachycardia) would not be detected until you actually perform the initial assessment; you cannot see, hear, or smell tachycardia.
113Review8. Which of the following would you NOT detect during your general assessment of a patient?CyanosisRationale: You can see cyanosis during the general assessment.B. Gurgling respirationsRationale: You can hear gurgling during the general assessment.C. Severe bleedingRationale: You can see bleeding during your general assessment.D. Rapid heart rateRationale: Correct answer
114Review9. You should call for additional help before you begin to care for patients at a multiple-casualty incident because:A. a hazardous material may exist.B. the incident may be the result of terrorism.C. the patients will die if more help does not arrive quickly.D. you might get preoccupied with patient care and forget to call.
115ReviewAnswer: DRationale: If the call for additional resources is delayed, it is very easy to become involved with patient care. The tendency then is to complete the assessment and treatment before turning to other matters, such as re-evaluating the situation and calling for help. This just delays the needed resources that much longer.
116Review9. You should call for additional help before you begin to care for patients at a multiple-casualty incident because:a hazardous material may exist.Rationale: This is also part of the scene size-up and scene safety.B. the incident may be the result of terrorism.Rationale: This is part of scene size-up and calling for help before providing medical treatment.C. the patients will die if more help does not arrive quickly.Rationale: Patients may die during a multiple-casualty incident, but help must be called in before treatment begins.D. you might get preoccupied with patient care and forget to call.Rationale: Correct answer
117Review10. Your initial assessment of an elderly woman who fell reveals an altered level of consciousness and a large hematoma to her forehead. After protecting her spine and administering oxygen, you should:A. obtain baseline vital signs.B. perform a rapid trauma assessment.C. transport the patient immediately.D. perform a focused exam of her head.
118ReviewAnswer: BRationale: If any life-threatening problems are discovered in the initial assessment, they should be addressed immediately. The EMT-B should then perform a rapid trauma assessment (or rapid medical assessment in unresponsive medical patients) to look for other potentially life-threatening injuries or conditions.
119Review10. Your initial assessment of an elderly woman who fell reveals an altered level of consciousness and a large hematoma to her forehead. After protecting her spine and administering oxygen, you should:obtain baseline vital signs.Rationale: This is part of the initial assessment.B. perform a rapid trauma assessment.Rationale: Correct answerC. transport the patient immediately.Rationale: This is determined after the completion of a rapid trauma assessment.D. perform a focused exam of her head.Rationale: This is completed not only on the head but on the entire body.