1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 7 Patient Assessment

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Scene Size Up Use all senses to evaluate scene for potential hazards Control the risk – Scene safety ◦ What should you do to ensure that the rescuers are safe? continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY General Impression Chief complaint ◦ What is the most important symptom? ◦ Traumatic? Medical? ◦ Specific location? ◦ Life threatening? MOI or NOI ◦ What likely caused the injury? ◦ What is the source of the medical concern? continued

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY General Impression Initial patient appearance ◦ What do you see when you look at the patient? Expressions of pain? Blood? Deformities? Skin color? May allow establishment of priorities for care and transport

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment The formal process in which injuries and illnesses are identified The most important skill in patient care Allows for assessment to be performed in a systematic, organized manner each time Includes the primary and secondary assessments

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Primary Assessment Identify/Assess all life threats ◦ Airway ◦ Breathing ◦ Circulation ◦ Disability C-Spine CSM of extremities ◦ Level of consciousness AVPU / Glasgow Coma Scale

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Normal Vital Signs Checking for circulation Radial, carotid, brachial Table 7-2 on pg. 221 Adult: ◦ 60-100 bpm; 12-20 rpm Child: ◦ 80-100 bpm; 15-30 rpm

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Medical History SAMPLE Signs/Symptoms Allergies Medications Past med history Last oral intake Events leading up to the incident OPQRST Onset Provocation/Palliation Quality Radiation Severity Time

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Physical Exam Systematic head-to-toe, hands-on assessment Initiate BSI Look, then touch ◦ Head (scalp, face, ears, eyes) ◦ Neck (C-Spine) ◦ Trunk (chest, abdomen, back, pelvis) ◦ Extremities Expose as appropriate continued

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Physical Exam DCAP – BTLS ◦ Deformity ◦ Contusions ◦ Abrasions/Avulsions ◦ Punctures/Penetrations ◦ Burns / Bleeding / Bruises ◦ Tenderness ◦ Lacerations ◦ Swelling

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Secondary Assessment Vital Signs Vital Signs ◦ Level of Consciousness AVPU scale ◦ Pulse Rate and quality ◦ Respirations Rate and quality ◦ Blood Pressure ◦ Temperature

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Special Assessment Considerations Unresponsive patient ◦ Assume C-Spine injury Communication barriers Cultural diversity Aggressive behavior Pediatric patients Geriatric patients

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Environmental Considerations Assess just enough to provide urgent care and ensure safe transport ◦ Temperature ◦ Slope/incline ◦ Bright sun ◦ Wind, dust, rain, dark

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Reassessment Patient condition is dynamic, so assessment must be ongoing Frequency determined by patient condition ◦ More severe = more frequent checks ABCDs and vitals should be tracked Stable patients (10-15 mins) vs. unstable patients (3-5 mins)

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 7 Skills Patient Assessment

16. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-1 Patient Assessment

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-1 Patient Assessment (a) Perform scene size-up. Initiate Standard Precautions.

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-1 Patient Assessment (b) Perform a primary assessment and manage ABCDs.

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-1 Patient Assessment (c) Perform a secondary assessment and provide intervention per your local protocols. Reassess the patient based on the patient's condition.

20. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-2 Patient Assessment – Trauma Patient

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-2 Patient Assessment—Trauma Patient (a) Perform scene size- up. Initiate Standard Precautions.

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-2 Patient Assessment—Trauma Patient (b) Perform a primary assessment and provide stabilization to the patient.

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-2 Patient Assessment—Trauma Patient (c) Perform a secondary assessment to detect any serious injuries. Take baseline vital signs. Then reassess as necessary.

24. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-3 Patient Assessment – Medical Patient

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-3 Patient Assessment—Medical Patient (a) Patroller is conducting a scene size-up in this incident involving skier in the lodge. Copyright Mike Halloran

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-3 Patient Assessment—Medical Patient (b) Patroller performs a primary assessment. Copyright Mike Halloran

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-3 Patient Assessment—Medical Patient (c) Listening to patient and examining him based on his chief complaint. Copyright Mike Halloran

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-3 Patient Assessment—Medical Patient (d) Performing a secondary assessment with a detailed examination. Copyright Mike Halloran

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-3 Patient Assessment—Medical Patient (e) Obtaining a complete SAMPLE history. Copyright Mike Halloran

30. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-4 Assessing Pupils

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-4 Assessing Pupils (a) Instruct the patient to stare at your nose or the center of your forehead. Check that the pupils are equally sized and are round. Copyright Mike Halloran

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-4 Assessing Pupils (b) Moving laterally to medially, briefly shine the penlight into the patient's left eye and then do so a second time. Copyright Mike Halloran

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-4 Assessing Pupils (c) Next shine the light in the patient's right eye, and then do so a second time.

34. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-5 Assessing Pulse

35. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-5 Assessing Pulse (a) Locate the radial pulse on an adult. Copyright Edward McNamara

36. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-5 Assessing Pulse (b) Locate the carotid pulse on an unresponsive adult. In each case, note the quality of the pulse. Copyright Edward McNamara

37. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-5 Assessing Pulse (c) Assess pulse rate and quality.

38. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-6 Assessing Respiration Rate

39. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-6 Assessing Respiration Rate (a) Look and feel for the patient's chest to rise and fall. Copyright Mike Halloran

40. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY OEC Skill 7-6 Assessing Respiration Rate (b) Assess the patient's respirations for rhythm, depth, effort, and noise to determine if the patient is breathing within normal limits.

41. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Skill 7-7 Blood Pressure