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Patient Assessment
Problem-oriented evaluation of patient and establishment of priorities based on existing and potential threats to human life.
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Components of Patient Assessment
- Scene size-up
- Initial assessment
- Focused history and physical exam
- Ongoing assessment
- Detailed physical exam
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Advanced Life Support (ALS)
Life-support activities that go beyond basic procedures to include adjunctive equipment and invasive procedures
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Compnents of Scene Size-Up
- Standard precautions
- Scene safety
- Location of all patients
- Mechanism of injury/Nature of illness
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Standard Precautions
Strict form of infection control that is based on the assumption that all body fluids are infectious
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Personal Protective Equipment (PPE)
Equipment designed to protect against infection.
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Scene Safety
Doing everything possible to ensure a safe environment
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Order of Priorities for Scene Safety
- 1. Self
- 2. Crew
- 3. Other responders
- 4. Patient
- 5. Bystanders
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Minimum Rescue Operation Equipment
- Four point suspension helmets
- Eye goggles/safety glasses
- Hearing protection
- Leather work gloves
- Steel toed boots
- Insulated coveralls
- Turnout gear
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Minimum Patient Safety Equipment
- Hard hats
- Eye goggles
- Hearing/respiratory protection
- Protective blankets
- Protective shielding
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Mechanism of Injury
Combined stregnth, direction and nature of forces that injured the patient
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Index of Suspicion
Your anticipation of possible injuries based on analysis of the event
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Initial Assessment
Prehospital process designed to identify and correct life-threatening airway, breathing, and circulation problems
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Steps of the Initial Assessment
- General impression
- C-spine considerations
- AVPU response level
- Airway
- Breathing
- Circulation
- Priority
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General Impression
Your initial, intuitive evaluation of your patient
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AVPU
- Alert
- Verbal stimuli
- Painful stimuli
- Unresponsive
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Decorticate Posturing
Arms flexed, legs extended
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Decerebrate Posturing
Arms and legs extende
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Signs of Inadequate Breathing
- Altered mental status
- Shortness of breath
- Retractions
- Asymmetric chest wall movement
- Accessory muscle use
- Cyanosis
- Audible sounds
- Abnormal rate or pattern
- Nasal flaring
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Circulation Assessment
Evaluating the pulse and skin and controlling major hemorrhage
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Top Priority Patients
- Poor general impression
- Unresponsive
- Responsive but cannot follow commands
- Airway compromise
- Difficult breathing
- Signs and symptoms of hypoperfusion
- Multiple injuries
- Complicated childbirth
- Chest pain and BP below 100 systolic
- Uncontrolled bleeding
- Severe pain
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Focuses History and Physical Exam
Problem-oriented assessment process based on initial assessment and chief complaint
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Types of Patients
- Trauma patients, significant mechanism or AMS
- Trauma patients, isolated injury
- Medical patients, responsive
- Medical patients, unresponsive
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Major Trauma Patient
Person who has suffered significant mechanism of injury
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Order of Focused History and Physical Exam for Major Trauma Patients
- Initial assessment
- Rapid trauma assessment
- Packaging
- Rapid transport and ongoing assessment
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Predictors of Serious Internal Injury
- Ejection from vehicle
- Death in same passenger compartment
- Fall from higher than 20 ft
- Rollover of vehicle
- High-speed vehicle collision
- Vehicle vs pedestrian
- Motorcycle crash
- Penetration of head, chest or abdomen
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Predictors of Serious Internal Injuries for Infants and Children
- All adult predictiors plus:
- Fall from higher than 10 ft
- Bicycle collision
- Medium-speed vehicle collision
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Rapid Trauma Assessment
Check for signs of serious injury
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DCAP-BTLS
- Deformities
- Contusions
- Abrasions
- Penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
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Semi-Fowler's Positions
45 degrees up
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Subcutaneous Emphysema
Crackling sensation caused by air just underneath the skin
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Cullen's Sign
Bruising over the umbilicus
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Grey Turner's Sign
Bruising over the flanks
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Baseline Vitals
- Pulse rate/quality
- BP
- RR and quality
- Skin temp and condition
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SAMPLE History
- Signs/Symptoms
- Allergies
- Medications
- Pertinent past medical history
- Last oral intake
- Events leading to the incident
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Chief Complaint
The pain, discomfort or dysfunction that caused the patient to call the ambulance
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History for the Responsive Medical Patient
- CC
- History of present illness (OPQRST-ASPN)
- Past history
- Current health status
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OPQRST-ASPN
- Onset
- Provocation/Palliation
- Quality
- Region, radiation
- Severity
- Time
- Associated symptoms
- Pertinent negatives
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Past Medical History
- General state of health
- Childhood or adult diseases
- Psychiatric illness
- Accidents or injuries
- Surgeries/hospitalizations
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Current Health Status
- Current medications
- Allergies
- Tobacco/alcohol/substance abuse
- Diet
- Screening exams
- Immunizations
- Sleep patterns
- Excercise/leisure activity
- Environmental hazards
- Use of safety measures
- Family history
- Social history
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One-Minute Cranial Nerve Test
- I: Not done
- II, III: Direct response to light
- III, IV, VI: "H" test for extraocular movement
- V: Clench teeth, palpate jawline
- VII: Show teeth
- IX, X: Say "ah", watch uvula movement, test gag reflex
- XII: Stick out tongue
- VIII: Test balance (romberg test) and hearing
- XI: Shrug shoulders, turn head
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Additional Assessment Techniques
- Pulse oximetry
- Capnography
- Cardiac monitoring
- Blood glucose determination
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Assessing Unresponsive Medical Patient
- Initial assessment
- Rapid medical assessment
- Brief history
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Detailed Physical Exam
Careful, thorough process of eliciting the history and conducting a physical exam
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Periorbital Ecchymosis
Black and blue discoloration surrounding eye sockets. Can indicate skull fracture
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Battle's Sign
Black and blue discoloration over the mastoid process, just behind the ears. Can indicate skull fracture
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Areas of Nervous System Exam
- Mental status and speech
- Cranial nerves
- Motor system
- Reflexes
- Sensory system
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Reflex Tests
- Biceps
- Triceps
- Brachioradialis
- Quadriceps
- Achilles
- Abdominal
- Plantar
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Sensory System Tests
- Pain
- Light touch
- Temperature
- Position
- Vibration
- Discriminative
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Ongoing Assessment
- Detects trends
- Determines changes
- Assesses interventions
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