11)Initial Assessment

Initial Assessment

Initial Assessment

• Rapid means of assessing:• Pt condition• Life threats• Priority of care

• “Stay & Play”• “Load a& Go”

• Quickly evaluate the 3 major organ systems

• Respiratory• Circulatory• Nervous

• Identify and treat most life threatening conditions and transport.

• AVPU• ABC

General Impression

• Helps form a general sense of severity of pt• Based on immediate assessment of scene and C/C

• Cardiac arrest• Medical or Trauma• MOI/NOI• Age, Sex, Race

• If life threatening condition is found treat immediately• Unresponsive• Inadequate breathing• Inadequate perfusion• Severe bleeding

Life Saving Treatments

• Airway management• + pressure ventilation• Supplemental O2• Bleeding control• CPR• Defibrillation• Medical direction• ALS intercept• Rapid transport

Assessment of Mental Status

• Mental status is most sensitive indicator of CNS activity• Level of consciousness (LOC) = CNS function

• AVPU• A-Alert

• Pt alert to Person/Place/Time • Alert and Oriented X 3---- AOX3

• Pt alert to Person/Place/Time/Event• Alert and Oriented X 4---- AOX4

• V-Verbal• Pt responds to verbal stimuli

• P-Painful• Pt unresponsive to verbal but responds to pain• Sternal run, pinch nail beds, etc

• U-Unresponsive • Pt unresponsive to both verbal and painful stimuli

• C-Spine control if trauma suspected/unresponsive• Log Roll to supine if not

Sternal Rub

Log Rolling

• Log rolls• Movement of a supine/prone pt

• EMT 1: Maintain C-spine• EMT 2 & 3: Position kneeling at pt

side• EMT 2: Raise pt nearest arm over

pt head• EMT 2: Place 1 hand on pt shoulder

the other on pt hip• EMT 3: Place 1 hand on pt waist

and the other at knees• EMT 2 & 3: On count of 3 from EMT

1, roll pt onto side• Place pt on backboard, transport

Measuring C-Collars

• All pts who have sustained significant trauma • Est early manual stabilization of C-Spine and maintain it until

pt immobilized to LBB.• How to measure a c-collar

• Bring pt head gently into neutral position• Measure distance between bottom of the pt chin and the top

of the pt shoulders with a hand• Compare measurement with indicator lines on c-collar• Side c-collar behind pt neck moving it as little as possible• Hold the front of the collar while bringing the back around the neck

and velcro in place• Make sure pt can still swallow and breathe

Manual Stabilization by 1 rescuer

Measuring C-Spine

Sizing C-Collar

Securing C-Collar

Maintaining C-Spine Control

Airway

• Responsive Patient• Is the pt talking/crying

• Yes = Assess adequacy• No = Open airway

• Unresponsive Patient• Is the airway open?

• Open it • Assess if clear• If not clear it

• Medical Pt• Head tilt chin lift

• Trauma Pt • Jaw thrust

Breathing

• Look – Listen – Feel• If pt breathing and responsive

• Oxygen may be dictated by MOI/NOI• Breathing more than 24 bpm or less than 8 bpm

• Receive high flow oxygen/BVM• If unresponsive and breathing:

• Maintain airway and provide high flow oxygen• If breathing is inadequate:

• Open and maintain airway, assist in ventilation, use adjuncts. • If pt is not breathing:

• Open and maintain airway with adjuncts, assume ventilatory support

Circulation

• Assess the pt pulse• Unresponsive

• Carotid• Responsive

• Radial• 1 y/o or younger

• Brachial• Absent pulseless

• CPR & AED• Assess for major bleeding

• If found, Treat it:• Direct Pressure• Elevation• Pressure Points• Tourniquet

Skin

• Clues to perfusion and oxygenation• Components

• Color• Temp• Moisture• Capillary Refill

Skin Color

• Locations of assessment• Nail beds, oral mucosa, conjunctiva• Pediatric

• Palms of hand/Sole of feet• Normal = Pink• Abnormal

• Pale• Poor Perfusion

• Cyanotic• Blue/grey= Poor oxygenation/perfusion

• Flushed• Heat or CO exposure

• Jaundiced • Liver/Gallbladder problems

Temperature

• Place back of gloved hand on pt skin• Normal = Warm• Abnormal

• Hot• Fever/Heat exposure

• Cool• Poor perfusion/Cold exposure

• Cold• Extreme cold exposure• Excessively dead…

• Also check for moisture• Diaphoresis or extremely dry

Capillary Refill

• Evaluation• Press on pt nail bed until it

is blanched/white• Release and count time

until pink returns

• Normal• 2 seconds or less

• Abnormal• More than 2 seconds

Identify Priority Patients

• Consider transport decision• Load and Go• Stay and Play

• Priority Patients• Poor General Impression• Unresponsive (No gag)• AMS• SOB• Shock• Complicated childbirth• Chest pain with systolic pressure less than 100mmHg• Uncontrollable bleeding• Severe pain

• Provide lifesaving treatment throughout initial assessment as needed• Transport unstable pt and pt with conditions needing immediate

hospital treatment

Remember…

It all starts with your ABC’S!!!