CONFIDENTIAL1 Patient assessment for the Basic EMT.

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Patient assessment for the Basic EMT

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Lesson Goal

• Obtain and interpret vital signs & SAMPLE history

• Provide information necessary to evaluate scene during initial stages of response• Perform initial patient assessment, form a general impression, and determine transport priority of medical or trauma patient

• Recognize MOI to predict injury in trauma

patient

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Lesson Goal

• Perform ongoing assessment• Reassess & confirm patient’s status

•Review assessment•Check interventions for adequacy & response

•Perform detailed physical examination,

understand findings, and use findings to

provide appropriate patient care

•Assess patients with medical complaint and obtain a focused history

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Why is it important?

• We are the eyes and ears

• We cannot treat what we do not assess

• We cannot report what we do not assess or treat

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Assessment tools

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Most Important Assessment Tools

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When does assessment begin?

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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Scene Size-Up

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General Impression

• Includes:– NOI for medical patients– MOI for trauma patients

• Determine need for cervical spine stabilization

– Both medical problem & injury possible– Age– Gender– Race (ethnicity)

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Level of Consciousness (Mental Status)

• A Alert

• V responds to Verbal stimulus

• P responds only to Painful stimulus

• U Unresponsive

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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Initial Assessment

• Find and fix– Airway– Breathing– Circulation/Shock

• Assess disability/environment• Expose as necessary

• Transport decision

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Assess Airway

• Look– Patient position– Intact structure– No foreign bodies– Patient color

• Listen– Snoring– Gurgling– Crowing/stridor– Silence– Patient complaint

• Feel– Stable structure– Air exchange

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Treat Airway

• Position

• Suction

• Adjuncts

• Consider early transport

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Assess Breathing• Look

– Patient position– Patient color– Chest wall movement– Use of accessory muscles– Rate/Regularity– Pulse oxymetry

• Listen– Audible wheezing– Breath sounds– Patient complaint

• Feel– Chest wall– Subcutaneous emphysema

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Treat breathing

• Position for comfort• Consider early transport• Apply oxygen

– High-flow/NRB

• Assist breathing– Once every 5-6 seconds

• Seal chest wounds– Occlusive dressing

• Consider early transport

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Assess Circulation/Shock

• Look– External bleeding– Patient color

• Listen– Mental status

• Feel– Pulse

• Location• Quality• Rate• regularity

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Treat Circulation/Shock

• Stop the bleeding

• High-flow oxygen

• Maintain body temperature

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• Consider C-Spine stabilization

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Assess Disability (neuro status)

• Mental Status

• Pupil check

• Bilateral movement

• Glasgow Coma scale

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Assess Environment/Expose

• Too hot/too cold• Surface contact• Move patient to a controlled

environment ASAP• Expose injuries

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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Focused History and Physical Exam—Trauma

Rapid Trauma Assessment

VS

Focused Trauma Assessment

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Detailed Exam

Check the nooks and crannies

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Hands-on Assessment—Head to Toe

• D Deformities

• C Contusions• A Abrasions• P

Penetrations

• B Burns• T

Tenderness• L Lacerations• S Swelling

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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Focused History and Physical Exam--Medical

• Getting a history is the key!!– S Signs and Symptoms--OPQRST– A Allergies– M Medications – P Pertinent Past history– L Last oral intake– E Events leading up to

• Focused physical assessment

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Assessing Signs and Symptoms

• O Onset• P Provoke• Q Quality• R Radiate• S Severity• T Time

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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Detailed Exam

Check the nooks and crannies

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Vital Signs/History

PATIENT ASSESSMENT OVERVIEW

Scene Size-up

Initial Assessment

Rapid Focused and Physical Exam: Trauma

Detailed Exam

Ongoing Assessment

Rapid Focused And Physical Exam: Medical

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On-Going Assessment

Assess, re-assess and then assess again

Vital signs every 15 minutes for the stable

patient

Vital signs every 5 minutes for the unstable

patient

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Vital Signs

• Pulse• Respirations• Breath Sounds• Blood Pressure• Oxygen saturation• Pupils• GCS• Skin color, condition, and

temperature• Time

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• Skin color/condition– Normal, pale, jaundiced, flushed, cyanotic– Warm, hot, cool , cold, moist, dry

• Pupils– Equal/reactive

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• Pulse– Rate: adult normal 60-100– Location: carotid/radial– Quality: strong, weak, thready– Regularity: regular/irregular

• Respirations– Rate: adult normal 12-20– Quality: easy, labored, noisy– Regularity

• Breath soundsPresent and equal

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• Blood pressure– Auscultation– Palpation– Oscillation– Automatic

• Oxygen saturation– > 90% for adults– > 95% for pediatrics

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Glasgow Coma Scale

Criteria Patient Response

Score

Eye opening SpontaneouslyTo speechTo painNone

4321

Verbal response

OrientedConfusedInappropriate wordsIncomprehensible wordsNone

54321

Motor response

Obeys commandsLocalizes painWithdraws to painFlexion to painExtension to painNone

654321

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The Last Word…

EVERYONE gets an assessment

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Questions and answers