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1 Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain.

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Presentation on theme: "1 Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain."— Presentation transcript:

1 1 Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain

2 2 Scene Size-Up 1. Scene Safety 2. BSI 3. MOI/NOI 4. # Patients 5. Additional Help? 6. C-Spine?

3 3 Initial Assessment

4 4 Initial /Primary Assessment 1. General Impression Age, Sex, Race, CC, Environment 2. Mental Status AVPU 3. Airway (C-Spine) 4. Breathing 5. Circulation Pulse – Skin - Bleeds 6. Determine Priority

5 5 Components of General Survey General Appearance/Impression Height and Weight

6 6 General Appearance - Description Apparent state of health  Acute or chronically ill, frail Level of consciousness  Awake, alert, responsive or lethargic, obtunded, comatose Signs of distress  Cardiac or respiratory; pain; anxiety/depression Skin color and obvious lesions Dress, grooming, and personal hygiene  Appropriate to weather and temperature  Clean, properly buttoned/zipped Facial expression  Eye contact, appropriate changes in facial expression Odors of body and breath Posture, gait, and motor activity

7 7 Mental Status and Behavior Terminology To appreciate the differences in mental status and behavior, you must learn the terminology  Level of consciousness: how aware the person is of his environment  Attention: the ability to focus or concentrate o Alert: the patient is awake and aware o Lethargic: you must speak to the patient in a loud forceful manner to get a response o Obtunded: you must shake a patient to get a response o Stuporous: the patient is unarousable except by painful stimuli (sternal rub) o Coma: the patient is completely unarousable

8 8 Height and Weight Height  Short or tall  Build: slender and lanky, muscular, or stocky  Body symmetry  Note general body proportions and any deformities Weight  Emaciated, slender, plump, obese  If obese, is fat distributed evenly or concentrated over trunk, upper torso, or around the hips? small – medium – large?

9 9 Initial Assessment?

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25 25 What next Health form  History  Secondary Assessment: Detailed exam Focused exam  Ongoing exam

26 26 Health History: subjective Changes in weight  Rapid or gradual o Rapid changes over a few days suggest changes in fluid, not tissue  Weight gain: nutrition vs. medical causes  Weight loss: medical vs. psychosocial causes Fatigue and weakness  Fatigue: a sense of weariness or loss of energy  Weakness: a demonstrable loss of muscle power  Medical vs. psychosocial causes Fever, chills, and night sweats  Ask about exposure to illness or any recent travel  Some medications may cause elevated temperature

27 27 Question A patient presents with a 6-day history of rapid weight gain, and increasing fatigue. The most likely explanation is: a. Dysphagia b. Excessive absorption of nutrients c. Diabetes mellitus d. Accumulation of body fluids

28 28 Answer d. Accumulation of body fluids Rapid changes over a few days suggest changes in fluid.

29 29 Vital Signs Blood pressure Heart rate and rhythm Respiratory rate and rhythm Temperature Pain SaO2

30 30 Question A patient’s vital signs are recorded as follows: T 98.4 F, HR 74, R 18, BP 180/98 What would be the MOST appropriate action related to this patient’s vital signs? a. The blood pressure should not be repeated b. Repeat the blood pressure and verify in contralateral arm c. Check the heart rate again to see if it is regular d. Listen to the patient’s lungs for adventitious sounds

31 31 Answer b. Repeat the blood pressure measurement and verify in the contralateral arm

32 32 Pain Assess  OPQRST

33 33 Pain Types of pain  Nociceptive or somatic – related to tissue damage  Neuropathic – resulting from direct trauma to the peripheral or central nervous system  Psychogenic – relates to factors that influence the patient’s report of pain o Psychiatric conditions o Personality and coping style o Cultural norms o Social support systems  Idiopathic – no identifiable etiology

34 34 Examination Techniques Inspection Palpation Percussion Auscultation System with cc: function / physiology System above and below

35 35 Thoracic Landmarks—Anterior Chest

36 36 Shoulders and Related Structures

37 37 Percussion and Auscultation of Chest

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39 39 Thoracic Landmarks—Posterior Chest

40 40 Spine Inspection  Cervical, thoracic, and lumbar curves Lordosis (swayback) Kyphosis (hunchback) Scoliosis (razorback)  Height differences of shoulders  Height differences of iliac crest

41 41 Breath Sounds Fig. 11-26

42 42 Pulse Auscultate for:  Frequency (pitch)  Intensity (loudness)  Duration  Timing in cardiac cycle

43 43 Abdomen four quadrants Inspect Auscultate Percuss Palpate

44 44 Abdomen—Inspection Skin Umbilicus Contour Abdominal movement

45 45 Pelvis Pelvic structural integrity  Hands on anterior iliac crests Press down and out  Heel of hand on symphysis pubis Press down

46 46 Ankles and Feet Range of motion  Dorsiflexion  Plantar flexion  Inversion  Eversion

47 47 Ongoing Assessment Components  Repeat initial assessment Stable patient: every 15 minutes Unstable patient: every 5 minutes (minimum)  Reassess mental status  Reassess airway  Monitor breathing for rate and quality  Reassess circulation  Reestablish patient priorities

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