Patient Assessment/Management- Medical

  1. BSI Scene Safety
    Takes appropriate BSI precautions
  2. Scene Size-Up
    Determines the scene/situation is safe
  3. Scene Size-Up
    Determines the nature of illness
  4. Scene Size-Up
    Determines the number of patients
  5. Scene Size-Up
    Requests additional resources as needed
  6. Scene Size-Up
    Considers stabilization of the spine (implied it will be performed if stated by candidate)
  7. Primary Assessment/Resuscitation
    Verbalizes general impression of the patient
  8. Primary Assessment/Resuscitation
    Determines level of responsiveness (AVPU)/level of consciousness (orientation questions)
  9. Primary Assessment/Resuscitation
    Determines chief complaint/apparent life threats
  10. Primary Assessment/Resuscitation
    Airway- Opens and assesses airway

    Inserts adjunct as indicated (verbalize)
  11. Primary Assessment/Resuscitation

    • Assures adequate ventilation
    • Initiates appropriate oxygen therapy
  12. Primary Assessment/Resuscitation

    • Checks pulse (radial, brachial then carotid as needed, not exact rate)
    • Assesses skin (color, temperature, moisture)
    • Assesses/controls major bleeding at appropriate time (if present)
  13. Primary Assessment/Resuscitation
    Identifies patient priority and makes treatment/transport decision
  14. Secondary Assessment
    History of the Chief Complaint

    • Signs and Symptoms
    • Onset (Activity?, gradual/sudden?)
    • Provocation (Better/Worse)
    • Quality
    • Region/Radiation/Recurrence
    • Severity
    • Time
    • Special questions specific to chief complaint (minimum 2)
  15. Secondary Assessment
    Medical History

    • Allergies
    • Medications
    • Past pertinent history
    • Last oral intake
    • Events leading to present illness
  16. Secondary Assessment
    Vital Signs- Obtains baseline vital signs using PROBELLS

    A full set of vital signs will be taken on the patient by the candidate
  17. Secondary Assessment
    Physical Exam- Rapid or Focused (whichever is appropriate based on C/C, LOC)

    Visualize, Palpate, Auscultate (if indicated)
  18. Secondary Assessment
    Additional Interventions- Obtains medical direction or verbalizes standing orders for medications or other interventions (rules out contraindications, administer or assists in administration of medications using FIVE RIGHTS)
  19. Reassessment
    Reassess the patient- C/C, ABCs, Vital Signs, Interventions, Turnover Report
Card Set
Patient Assessment/Management- Medical