Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 5 Special Considerations / Operations

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 7 Assessment-Based Management

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Effective Assessment The Right Equipment General Approach to the Patient Presenting the Patient Review of Common Complaints

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Sequence of assessment Inverted pyramid reasoning –Critical thinking, problem solving, or clinical decision making Differential diagnosis

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Effective Assessment

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Effective Assessment Assessment forms the foundation for patient care You must gather, evaluate, and synthesize information The ability to reason and to reach a field diagnosis is critical to paramedic practice

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Importance of Accurate Information The History –A patient’s history is a crucial part of the medical record –It is important for you to question the patient, family members, and bystanders

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Importance of Accurate Information The Physical Exam –Never forget, or minimize, the importance of a thorough physical exam You may have to move the patient into the ambulance or some other controlled environment –Significant mechanism of injury Head-to-toe –Medical patient or minor isolated trauma Focused exam

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Importance of Accurate Information Pattern Recognition –Remain alert to patterns –Compare information to what is in your knowledge base about various diseases –The ability to recognize patterns increases with experience

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Importance of Accurate Information Assessment/Field Diagnosis –Based on a combination of pattern recognition and intuition A product of experience –Formulate a plan of action, based on the patient’s condition and the environment BLS/ALS Protocols –Use of protocols –Know when to apply appropriately

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Assessment and Decision Making Personal attitudes –Be as nonjudgmental as possible –Seek to identify any preconceived notions that you may have about a group © Craig Jackson/In the Dark Photography

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Assessment and Decision Making Uncooperative patients –Patients are perceived as being “high,” either on alcohol or drugs –Consider medical causes

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Assessment and Decision Making Patient compliance –Cultural and ethnic barriers and prior negative experiences Distracting injuries –You must resist the temptation to form a field diagnosis too early May lead to snap judgments

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Assessment and Decision Making Environmental and personal considerations –Include scene chaos, violent or dangerous situations, high noise levels, or crowds of bystanders

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Assessment/Management Choreography Role of the team leader –Usually the person who will accompany the patient through to definitive care –During multiple-casualty situations, the team leader acts as the initial EMS commander –Must maintain overall patient perspective and provide leadership to the team

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Assessment/Management Choreography Role of the Patient Care Provider –The patient care provider should ensure “scene cover” –Performs any skills or interventions requested by the team leader –Acts as the triage group leader during mass casualty

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Right Equipment

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Right Equipment Having the right equipment at the patient’s side is essential Assessment and management must usually be done simultaneously –You must be prepared to manage many conditions and injuries or changes in the patient’s condition Essential equipment

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Approach to the Patient

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Approach to the Patient Scene size-up Initial assessment –Resuscitative approach –Contemplative approach –Immediate evacuation Focused history and physical exam Ongoing assessment and detailed physical exam © Glen Jackson

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Identify Life-Threatening Problems Rapidly determine the chief complaint –Assess the distress in a systematic manner Keep in mind the mechanism of injury and the nature of the illness Your role as paramedic is to rapidly and accurately assess the patient and then to treat for the worst case scenario

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Presenting the Patient

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Presenting the Patient The ability to communicate effectively is the key to transferring patient information A skill that will be used on every single patient is that of effective presentation –Radio, telephone, face-to-face, and writing

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Trust and Credibility Effective presentation and communication skills help establish a paramedic’s credibility © Ken Kerr

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Developing Effective Presentation Skills Last less than one minute Are very concise and clear Avoid extensive use of medical jargon Follow a basic format, usually the SOAP format or some variation Include both pertinent findings and pertinent negatives Conclude with specific actions, requests, or questions related to the plan

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Elements of an Effective Presentation Patient identification, age, sex, and degree of distress Chief complaint Present illness/injury –Pertinent details about the present problem –Pertinent negatives Past medical history –Allergies –Medications –Pertinent medical history

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Elements of an Effective Presentation Physical signs –Vital signs –Pertinent positive findings –Pertinent negative findings Assessment –Paramedic impression Plan –What has been done –Orders requested

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Review of Common Complaints

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Review of Common Complaints Practice Sessions –Goal is to choreograph the roles and actions of the EMS response team Laboratory-based Simulations –Requires you to assess a preprogrammed patient or mannequin Self-motivation –Take advantage of every opportunity to practice your new skills

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Effective Assessment The Right Equipment General Approach to the Patient Presenting the Patient Review of Common Complaints