Patient Assessment

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

Patient Assessment BSI BSI BSI BSI BSI BSI BSI

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

Patient Assessment Scene Size-up

Initial evaluation of the scene Continues throughout the scene

Initial evaluation of the scene Goals: Ensure scene safety 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

Patient Assessment 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

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

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

Mechanism of injury

Number of patients Call for additional help if needed ALS

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

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

Danger Zone No apparent hazard-at least 50ft in all directons 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 Downed wires-area in which contact can be made Hazardous Materials Emergency Response Guide Book Chemtrec

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

Nature of call Illness Injury

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

Patient Assessment Initial Assessment 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 C’s

Patient Assessment Airway: Patent; answering questions Breathing: Complains of shortness of breath Rhythm and quality Labored Shallow O2 @ 15lpm with NRB Circulation: Major bleeding??? Pulse rhythm and quality regular strong Transport decision: Stay/play vs Load/go emergent/non-emergent

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

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?

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: 142/86 130 38 Interventions: O2 Transport decision: More informed decision Detailed physical examination necessary? YES

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

Vital Signs and Sample History

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

Vital Signs Pulse Apical Respirations Skin color, temp, condition Pupils Blood Pressure Auscultation Palpation Mental Status

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

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: 154/90 130 28

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

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

Patient Assessment On-going Assessment Repeats initial assessment: ABC, MS, Monitor Repeats vital signs: 132/68 84 24 Repeats focused assessment regarding patient complaint or injuries: O2 helping; Pain?

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