Chapter 17 The Ongoing Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Ongoing Assessment  Components of the Ongoing Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Ongoing Assessment  Once the patient has been thoroughly assessed, vital signs measured, and transport decision made, the next step is to begin ongoing assessment  The purpose is to identify any significant changes in the patient’s condition that need immediate attention

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4  Watch this video clip about ongoing assessment Ongoing Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Components of the Ongoing Assessment  The initial assessment repeated  The patient’s condition dictates whether this step will take more than a moment  Carefully reassess the seriously injured patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Components of the Ongoing Assessment  The initial assessment repeated –Mental status Use AVPU Mental status changes may occur very gradually but may have devastating consequences if not recognized and quickly acted on –Airway Maintain constant vigil over the airway, making sure that it remains open and clear

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7  The initial assessment repeated –Breathing: Evaluate effectiveness of oxygen delivery Did the oxygen relieve the patient’s pain or make her feel better? If not, why not? Check for equipment malfunctions and kinked oxygen tubing Check to make sure you did not run out of oxygen! Changes in patient condition may necessitate switching from non-rebreather mask to assisted bag valve mask ventilations Pulse oximetry may be helpful in confirming the EMT’s findings; never should the pulse oximeter replace the EMT’s assessment of respiratory effort Components of the Ongoing Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8

9 Components of the Ongoing Assessment  The initial assessment repeated –Circulation Ensure that all bleeding has been addressed and remains controlled Reassess any external bleeding that was discovered and initially managed on scene Internal bleeding requires evaluation of the mechanism of injury and indicators of perfusion such as skin temperature, color, and distal pulse

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Components of the Ongoing Assessment  The initial assessment repeated –Reevaluate patient priority A low-priority patient’s condition may change, prompting notification of the hospital and arranging an ALS intercept if the patient’s condition deteriorates Destination facility may need to change based on the patient’s condition –Follow local protocols for this

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Components of the Ongoing Assessment  Reassess vital signs –First set of vitals is the baseline –Subsequent vitals are compared to the baseline –Ensure at a minimum two sets of vital signs are obtained and recorded

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Components of the Ongoing Assessment  Repeat history –Patients may have been confused or distracted on scene; history taking may be more accurate in the back of the ambulance –Reaffirming a patient’s history improves its reliability –Treatments may need to be adjusted due to historical findings

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Components of the Ongoing Assessment  Repeat physical examination—focused or detailed –Some findings may take time to develop –Reassess using DCAP-BTLS –Compare findings with on scene findings

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Components of the Ongoing Assessment  Check ABCs and interventions –Check all treatments in progress –Ask, Is it working? –Check splints –Check dressings and bandages used for wound control –If EMT assisted with meds, are they working?

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Components of the Ongoing Assessment  Note changes –All changes in the patient’s condition from on the scene and while en route must be noted –Changes may represent a pattern –Patterns reflect the patient’s trending—either positive or negative; this should be reported and recorded

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Components of the Ongoing Assessment  How often? –Determined by the priority of the patient –Reassess every 5 minutes if a high-priority patient –Reassess every 10–15 minutes if a low-priority patient –Remember these are just guidelines; a patient’s priority level may change rapidly, and reassessment intervals are not arbitrary

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Stop and Review  Why do we do an ongoing assessment?  Is the ongoing assessment done only one time?  At a minimum, how often should a high- priority patient be reassessed?  At a minimum, how often should a low-priority patient be reassessed?