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Patient Assessment. Scene-Size-up – Initial Assessment – Focused history and physical exam- Detailed Physical Exam- On-Going Assessment-

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Presentation on theme: "Patient Assessment. Scene-Size-up – Initial Assessment – Focused history and physical exam- Detailed Physical Exam- On-Going Assessment-"— Presentation transcript:

1 Patient Assessment

2 Scene-Size-up – Initial Assessment – Focused history and physical exam- Detailed Physical Exam- On-Going Assessment-

3 Patient Assessment BSI BSIBSI BSI

4 Patient Assessment Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment

5 Patient Assessment Scene Size-up

6 Initial evaluation of the scene Continues throughout the scene Continues throughout the scene

7 Part I SCENE SIZE-UP Defined: Begins with dispatch Initial evaluation of the scene Goals: Ensure scene safety To determine if patient is medical or trauma Determine total number of patients

8 Patient Assessment Scene Size-up Scene Size-up Begins with Dispatch demographics: residence - Pull to curbside in front of house Always remember, scene safety is a component of Scene Size-up Nature of illness: Breathing problems Number of patients: 68 year old female Considers stabilization of spine Requests additional help if necessary: ALS

9 Scene Safety Personal protection Always perform your own size-up Always perform your own size-up Observe as you approach and before getting out of the truck Observe as you approach and before getting out of the truck

10 Nature of Illness Information can be obtained from The patient Family members or bystanders Scene

11 Mechanism of injury Mechanism of injury

12 Number of patients Number of patients Call for additional help if needed Call for additional help if neededALS

13 Collision Scene Look and listen Look and listen Check for power outages Check for power outages Observe traffic flow Observe traffic flow Check for smoke Check for smoke

14 As you approach: Look for clues to escape hazourdous materials Look for clues to escape hazourdous materials Look for patients on or near the road Look for patients on or near the road Look for smoke not seen at a distance Look for smoke not seen at a distance Look for broken utility poles and downed lines Look for broken utility poles and downed lines Be on the look-out for bystanders Be on the look-out for bystanders Watch for signals of police officers or other agency personnel Watch for signals of police officers or other agency personnel

15 Danger Zone No apparent hazard-at least 50ft in all directons No apparent hazard-at least 50ft in all directons Fuel spill-at least 100 ft. in all directions Fuel spill-at least 100 ft. in all directions uphill and downwind avoid gutter, gullies, ditches do not use flares Vehicle fire-at least 100 ft. in all directions Vehicle fire-at least 100 ft. in all directions Downed wires-area in which contact can be made Downed wires-area in which contact can be made Hazardous Materials Hazardous Materials Emergency Response Guide Book Chemtrec

16 Crimes Scenes and Acts of Violence Signals of violence: Fighting or loud voices Visible weapons Signs of alcohol or other drug use Unusual silence Knowledge of prior violence

17 Nature of call Illness Illness Injury Injury

18 Part II INITIAL ASSESSMENT Part II INITIAL ASSESSMENT Defined: Defined: Discovering and treating life-threatening conditions Discovering and treating life-threatening conditions Goals: Goals: Determine if the patient is ill or injured Determine if the patient is ill or injured Triage Triage Components: Components: General Impression General Impression Illness or injury Illness or injury Mechanism of injury/Nature of illness Mechanism of injury/Nature of illness Age, sex, race Age, sex, race Identify life-threatening problems Identify life-threatening problems Mental Status Mental Status A lertV erbal Response P ainful Response U nresponsive A lertV erbal Response P ainful Response U nresponsive Assess Breathing Assess Breathing Triage Triage

19 Patient Assessment Initial Assessment General Impression: General Impression: 68 year old white female Sitting on the couch answering questions in broken sentences and obeying commands Obviously A & O x 4 c/c of Shortness of breath Index of suspicion: PMHx. Of Asthma Life Threats: A B Cs A B Cs

20 Patient Assessment Airway: Patent; answering questions Airway: Patent; answering questions Breathing: Complains of shortness of breath Breathing: Complains of shortness of breath Rhythm and quality Labored Shallow 15lpm with NRB Circulation: Major bleeding??? Circulation: Major bleeding??? Pulse rhythmandquality regularstrong Transport decision: Stay/play vs Load/go emergent/non-emergent Transport decision: Stay/play vs Load/go emergent/non-emergent

21 Part III Focused History and Physical Exam Part III Focused History and Physical Exam Defined: Defined: To identify additional serious or potentially life-threatening injuries or conditions To identify additional serious or potentially life-threatening injuries or conditions Components, Trauma Components, Trauma Reconsider Mechanism of injury Reconsider Mechanism of injury Index of suspicion Index of suspicion Rapid Trauma Assessment Rapid Trauma Assessment Head to toe physical exam quickly conducted Head to toe physical exam quickly conducted Base-line Vital Signs Base-line Vital Signs Assess S A M P L E history Assess S A M P L E history Components Medical Components Medical History of present illness History of present illness O – P – Q – R – S – T O – P – Q – R – S – T S A M P L E S A M P L E Rapid Assessment Rapid Assessment Base-line Vital Signs Base-line Vital Signs Treat Treat IF UNRESPONSIVE: IF UNRESPONSIVE: Rapid Assessment Rapid Assessment Base-line Vital Signs Base-line Vital Signs Assess S A M P L E Assess S A M P L E Care Care

22 Patient Assessment Focused History and Physical Exam Onset?45 minutes ago Provokes?Nothing makes pain better/worse Quality?Dull Radiates?Non-radiating Severity?4:10 Time?>1 hour ago Interventions?

23 Patient Assessment Allergies: PCN Medications: NTG, asa, Toprol XL, lasix Past pertinent history: I go to a heart DR. Last oral intake: Breakfast-eggs, toast, coffee Event leading to present illness: Cleaning out a closet Performs focused physical examination: lung sounds short of breath; warm/dry/pink; Vitals: 142/ Interventions: O2 Transport decision: More informed decision Detailed physical examination necessary? YES

24 S A M P L E history Signs/Symptoms Signs/Symptoms Allergies Allergies Medications Medications PMHx. PMHx. Last oral intake Last oral intake Events leading to the illness/injury Events leading to the illness/injury

25 Vital Signs and Sample History

26 General Impression Illness or injury Illness or injury Mechanism of injury/Nature of illness Mechanism of injury/Nature of illness Age, sex, race Age, sex, race Identify life-threatening problems Identify life-threatening problems

27 Vital Signs Pulse PulseApical Respirations Respirations Skin color, temp, condition Skin color, temp, condition Pupils Pupils Blood Pressure Blood PressureAuscultationPalpation Mental Status Mental Status

28 Communicating with your patient Position yourself close to the patient Position yourself close to the patient Identify and yourself and reassure Identify and yourself and reassure Speak in a normal voice Speak in a normal voice Learn your patients name Learn your patients name Learn your patients age Learn your patients age

29 Patient Assessment Detailed Physical Exam Head: Facial cyanosis; cyanosis Neck: - JVD; - Tracheal deviation Chest: Symmetrical; LS clear, bilat, all fields ABD: Soft/non-tender/- distension LE: - LE or pedal edema UE- - peripheral edema VS: 154/

30 Part IV Detailed Physical Exam Defined Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment Components Head to Toe exam Reassess vital signs Continue care

31 Part V On-Going Assessment Part V On-Going Assessment Defined: Defined: To detect any changes in the patients condition To detect any changes in the patients condition To detect any missed injuries or conditions To detect any missed injuries or conditions To adjust care as needed To adjust care as needed Goal: Goal: The initial assessment is repeated The initial assessment is repeated Vital signs are repeated and recorded Vital signs are repeated and recorded Focused assessment repeated for additional complaints Focused assessment repeated for additional complaints Components: Components: Repeat Initial Assessment Repeat Initial Assessment Repeat focused assessment Repeat focused assessment Check interventions Check interventions Note trends in patient condition Note trends in patient condition

32 Patient Assessment On-going Assessment Repeats initial assessment: ABC, MS, Monitor Repeats vital signs: 132/ Repeats focused assessment regarding patient complaint or injuries: O2 helping; Pain?

33 Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment


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