(VERY IMPORTANT) Patient Assessment

Learning Goals Scene size up  2 part patient assessment (  Intervention) Confidence with patient assessment! Realize there are unknowns and the point of this is to cover the things that are most important Understand why we do the patient assessment how we do it (if it makes sense to you you’ll do it right) Get super comfortable taking vitals

Acronyms  ABCD (E)s  MOI  NOI  LOR  DCAP-BTLS  PERRL  SAMPLE  OPQRST  AVPU

Scene Size Up Easy to be like OMG A PATIENT and ignore the surroundings Is it safe to enter the scene?  Examples of why it wouldn’t be? How will you treat and transport this patient? MOI vs. NOI Always introduce yourself and gain permission to help first. What is the chief complaint? Even if a patient looks fine, never rule anything out until you have asked what happened.

Patient Assessment “Fortunately, the process need not be daunting” Primary Assessment  Life threatening situation??  Unresponsive patient vs. responsive  ABCDs Secondary Assessment  SAMPLE history  Head-to-toe  Vitals

Evaluating an Unresponsive Patient Check for response by tapping the victims shoulder and shouting Open airway, check for breathing and check carotid pulse If breathing normally continue primary assessment If there is no pulse, start chest compressions (CPR) If there is a pulse but no breathing, start rescue breathing

ABCDs Airway: having an open and patent airway which will remain open Breathing: being able to breathe, so oxygen gets to the body’s tissues effectively and carbon dioxide is removed Circulation: having blood moving through the vessels to perfuse the tissues Disability: having a normal mental status and central and peripheral neurologic function, includes having no spinal injury

How to Open an Airway Head-tilt, chin-lift maneuver Jaw-thrust maneuver

Normal Vital Signs AdultChild (1-8 years)Infant (Birth-1 year) Pulse60 – 100 beats per minute 80 – – 120 Respirations12 – 20 respirations per minute 15 – 3075 – 95 Blood Pressure Systolic Diastolic 90 – 140 mmHg 60 – 90 mmHg 80 – – 95 Temperature97.0 – 100.4

How to Check Level of Responsiveness Normal conditions: awake and oriented AAO x 4:  Awake, alerted and oriented to person, place, time and situation If they miss the answer to even just one question it could signify a brain injury Important to measure over time Pediatric patients

Glasgow Coma Scale vs. AVPU Glascow Coma ScaleAVPU Eyes 4 opens eyes spontaneously 3 opens eyes to verbal stimuli 2 opens eyes to pain 1 does not open eyes Verbal 5 speaks coherently 4 speaks confusedly 3 mutters words in response to pain 2 moans in response to pain 1 no verbal response to pain Motor 6 follows commands 5 localizes pain 4 withdrawals from pain 3 has a flexor response to pain 2 has an extensor response to pain 1 has no motor response to pain A – Alert V – Unresponsive, but responds to verbal stimuli P – unresponsive, but responds to painful stimuli U – unresponsive to pain

SAMPLE History S – Signs and Symptoms  What’s the difference between a sign and a symptom? A – Allergies M – Medications P – Past medical history L – Last oral intake (Last ins and outs) E – Events leading to incident

OPQRST O – onset  When did the pain start? Was it sudden or gradual? P – provocation and palliation  Do they know what caused the pain? Does anything make it worse or better? Q – quality  Describe the pain. Is it dull, sharp, throbbing? R – radiation  Point to where the symptoms are most intense. Does the pain stay in one spot? S – severity  Ask to rate the pain from 1 – 10. What is their worst pain? T – time  How long as the patient had this problem and has it changed over time?

Physical Exam (DCAP – BTLS) D – deformity C – contusions A – abrasions/avulsions P – punctures/penetrations B – burns/bleeding/bruises T – tenderness L – lacerations S – swelling

Physical Exam Do a head to toe physical exam Check eyes  Pupils are Equal, Round and Reactive to Light – PERRL, then check eye movement Examine: head, neck, chest, abdomen, back, pelvis, extremities

Check for Vital Signs:  Level of responsiveness, pulse rate, respiration rate, blood pressure and body temperature  Pulse: radial pulse (side of wrist), carotid pulse (neck), brachial pulse (biceps), femoral pulse (leg and lower abdomen) AdultChild (1- 8yrs) Infant (0- 1) Pulse Respirations Systolic BP Diastolic BP60-90 Temperature

Who’s heart rate has gone up?

Special Assessment Considerations Unresponsive patients:  CPR  Check for breathing and pulse in less than 10 seconds  Ask relatives, friends or bystanders for information  ABCD  MAINTAIN OPEN AIRWAY  Everything else same as for a responsive patient minus assessment of sensation and movement in extremities Cultural Diversity Communication Barriers Environmental Conditions