1. Patient Assessment

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

3. Patient Assessment
BSI
BSI BSI
BSI BSI
BSI BSI

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

5. Patient Assessment
Scene Size-up

6. Initial evaluation of the scene
Continues throughout the scene

7. 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

8. 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

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

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

11. Mechanism of injury

12. Number of patients
Call for additional help if needed
ALS

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

14. 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

15. 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

16. 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

17. Nature of call
Illness
Injury

18. 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

19. 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

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

21. 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

22. 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?

23. 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/
Interventions: O2
Transport decision: More informed decision
Detailed physical examination necessary? YES

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

25. Vital Signs and Sample History

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

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

28. 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

29. 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/

30. 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

31. 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

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

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