Patient Assessment VS Communication Documentation The older folks The younger folks Block III written and practical

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

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

Scene Size-up

Initial evaluation of the scene Continues throughout the scene

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

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: Number of patients: Considers stabilization of spine Requests additional help if necessary: ALS

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

Nature of Illness I nformation 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: F ighting or loud voices V isible weapons S igns of alcohol or other drug use U nusual silence K nowledge 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 lertV erbal Response P ainful Response U nresponsive Assess Breathing Triage

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 Base-line Vital Signs Treat IF UNRESPONSIVE: Rapid Assessment Base-line Vital Signs Assess S A M P L E Care

Focused History and Physical Exam O nset? P rovokes? Q uality? R adiates? S everity? T ime? I nterventions?

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

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 patients name Learn your patients age

P art IV Detailed Physical Exam D efined H ead to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment C omponents H ead to Toe exam R eassess vital signs C ontinue care

Part V On-Going Assessment Defined: To detect any changes in the patients 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

On-going Assessment R epeats initial assessment R epeats vital signs: R epeats focused assessment regarding patient complaint or injuries:

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

Responsive Four parts History of present illness Focused physical exam OPQRST SAMPLE Baseline VS Prior history DCAPBTLS

Unresponsive Patient history from family, bystanders etc. Rapid assessment Abd: distension, firmness, rigidity Pelvis: Incontinence of urine, feces ID bracelets Baseline VS Consider need for ALS History of present illness and SAMPLE

Patients name What happened what did family/bystander see Did patient complain of anything prior Know illness Medications