Principles of Patient Assessment in EMS

The Initial Assessment

Introduction Purpose is to rapidly identify and manage the life-threats. Purpose is to rapidly identify and manage the life-threats. Every patient should receive an initial assessment. Every patient should receive an initial assessment. Treat any life-threats immediately. Treat any life-threats immediately. Most patients do not have life-threatening problems. Most patients do not have life-threatening problems.

Your General Impression The environment (ie: bottom of stairs, out in the cold, tripod position, pool of blood) The environment (ie: bottom of stairs, out in the cold, tripod position, pool of blood) Patient’s MOI/NOI Patient’s MOI/NOI Patient’s age and sex Patient’s age and sex Patient’s degree of distress Patient’s degree of distress Listen for the chief complaint Listen for the chief complaint Keep the priority of care in focus Keep the priority of care in focus © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Mental Status Are they conscious or unconscious? (if unconscious do CPR quick-check) Are they conscious or unconscious? (if unconscious do CPR quick-check) Introduce yourself Introduce yourself What’s your name? (oriented to person) What’s your name? (oriented to person) Do you know where you are? (oriented to place) Do you know where you are? (oriented to place) What day of the week is it? (oriented to day) What day of the week is it? (oriented to day) How can I help you today? (chief complaint) How can I help you today? (chief complaint) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

A V P U A lert – oriented to person, place, and day (“big three”) A lert – oriented to person, place, and day (“big three”) V erbal – cannot answer the “big three” correctly V erbal – cannot answer the “big three” correctly P ainful – either appropriate, inappropriate, or posturing (decorticate/decerebrate) P ainful – either appropriate, inappropriate, or posturing (decorticate/decerebrate) U nresponsive U nresponsive © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway Status The 3 key questions: The 3 key questions: Is the airway open? Is the airway open? Will the airway stay open? Will the airway stay open? Does anything endanger the airway? Does anything endanger the airway? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway Status Factors to consider: Factors to consider: Unconsciousness Unconsciousness Suspected spinal injury Suspected spinal injury Obstruction Obstruction © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway Status Complex airway problems: Complex airway problems: Impaled object(s) Impaled object(s) Significant MOI (i.e.: gunshot) Significant MOI (i.e.: gunshot) Burns Burns Crushed or fractured larynx Crushed or fractured larynx © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Breathing The 6 key questions: The 6 key questions: Is the patient breathing? Is the patient breathing? What’s the respiratory rate? What’s the respiratory rate? Is the rate adequate? Is the rate adequate? Does anything endanger breathing? Does anything endanger breathing? Can the patient take a deep breath? Can the patient take a deep breath? Is the patient having trouble breathing? Is the patient having trouble breathing? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Breathing Adequacy Adequacy Dyspnea Dyspnea Chest wall stability Chest wall stability © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Circulatory Status Ask the 3 key questions: Ask the 3 key questions: Does the patient have a pulse? Does the patient have a pulse? What is the quality of the pulse? What is the quality of the pulse? Is there any major bleeding that needs to be controlled? Is there any major bleeding that needs to be controlled? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Assess the Pulse Distal vs. proximal Distal vs. proximal Infant and child pulses Infant and child pulses External hemorrhage External hemorrhage Skin signs (CTC): Skin signs (CTC): Color Color Temperature Temperature Condition Condition Capillary refill (in children) Capillary refill (in children) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Make a Priority Decision! High or low priority High or low priority Transportation decision Transportation decision Is ALS needed (consider an intercept) Is ALS needed (consider an intercept) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion Quickly assess for life-threats! Quickly assess for life-threats! Remember the key steps of the initial assessment (MS-ABC). Remember the key steps of the initial assessment (MS-ABC). Make a priority and transport decision! Make a priority and transport decision!