1. InitialAssessment CHAPTER 9

2. Decisions about assessment and care are typically made within the first few seconds of observing the patient.

3. Initial Assessment Includes:  Form a general impression  Identify life-threatening injuries; provide immediate interventions as necessary  Assess mental status  Assess the airway  Assess breathing  Assess circulation  Make an initial transport decision

4. General Impression of the Patient Sick or Not Sick

5. General impression: The EMS provider’s immediate assessment of the environment and the patient’s chief complaint.

6. The process of forming a general impression takes a few seconds.

7. Determine if the patient has a medical condition......or an injury.

8. Nature of illness: The patient’s description of the chief complaint; or why EMS was called.

9. Mechanism of injury: The event or forces that caused the patient’s injury.

10. If a life-threatening condition is identified… …it must be corrected immediately!

11. Assessing the Patient’s Mental Status

12. A lert V erbal P ainful U nresponsive

13. Check response to painful stimuli.

14. Assessing the Patient’s Airway Status Responsive Patient Unresponsive Patient Responsive Patient Unresponsive Patient

15. Airway - Responsive Patients  Talking/crying  Assess breathing  Responsive to pain  Assess airway

16. Airway - Unresponsive Patients  Trauma  Jaw thrust  Chin lift  Medical  Head-tilt/chin-lift

17. Airway Management  Assess airway  Foreign body  Teeth  Blood  Vomitus  Clear airway

18. The modified jaw thrust can minimize C-spine movement.

19. Head-tilt, Chin-lift Maneuver Done in the absence of spinal injury.

20. Assessing the Patient’s Breathing

21. Look for chest rise, listen for air movement, and feel for exhaled air.

22. Assessing the Patient’s Circulation Pulse

23. Assess the brachial pulse in infants.

24. Compare radial and carotid pulses simultaneously.

25. Major Bleeding

26. Major bleeding is one of the life-threats, and is an essential part of assessing the patient’s circulation.

27. PerfusionPerfusion

28. Check capillary refill in children less than 6 years of age.

29. Identifying Priority Patients

30. TRANSPORTEDIMMEDIATELY! If available, request ALS Priority patients should be

31. Transport Rapidly  Poor general impression  Unresponsive with no gag reflex or cough  Responsive but unable to follow commands  Difficulty breathing  Signs and symptoms of hypoperfusion

32. Transport Rapidly continued  Complicated childbirth  Chest pain with a BP less than 100 systolic  Uncontrolled bleeding  Severe pain

33. SUMMARY General Impression General Impression Assessing the Patient’s Mental Status Assessing the Patient’s Mental Status Assessing the Patient’s Airway Status Assessing the Patient’s Airway Status Assessing the Patient’s Breathing Assessing the Patient’s Breathing Assessing the Patient’s Circulation Assessing the Patient’s Circulation Identifying Priority Patients Identifying Priority Patients