Patient Assessment. Scene-Size-up – Initial Assessment – Focused history and physical exam- Detailed Physical Exam- On-Going Assessment-

Patient AssessmentPatient Assessment

Patient AssessmentPatient Assessment

Scene-Size-up –Scene-Size-up –

Initial Assessment –Initial Assessment –

Focused history and physical exam-Focused history and physical exam-

Detailed Physical Exam-Detailed Physical Exam-

On-Going Assessment-On-Going Assessment-

Patient AssessmentPatient Assessment

BSIBSI

BSIBSI BSIBSI

BSIBSI BSIBSI

BSIBSI BSIBSI

BSIBSI

Patient AssessmentPatient Assessment

Scene Size-up – Initial Assessment – Focused Hx. & PE Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment– Detailed Assessment – On-going assessment

Patient AssessmentPatient Assessment

Scene Size-upScene Size-up

Initial evaluation of the sceneInitial evaluation of the scene►Continues throughout the sceneContinues throughout the scene

Part I SCENE SIZE-UPDefined:

Begins with dispatchInitial evaluation of the scene

Goals:Ensure scene safety

To determine if patient is medical or traumaDetermine total number of patients

Patient AssessmentPatient Assessment

► Scene Size-upScene Size-upBegins with DispatchBegins with Dispatch

demographics: residence - Pull to curbside demographics: residence - Pull to curbside in front of housein front of house

Always remember, scene safety is a component of Scene Size-up

Nature of illness: Breathing problemsNumber of patients: 68 year old femaleConsiders stabilization of spineRequests additional help if necessary: ALS

Scene SafetyScene Safety

Personal protectionPersonal protection►Always perform your own size-upAlways perform your own size-up►Observe as you approach and before Observe as you approach and before

getting out of the truckgetting out of the truck

Nature of IllnessNature of Illness► Information can be obtained fromInformation can be obtained from

The patientThe patient

Family members or bystandersFamily members or bystanders

SceneScene

►Mechanism of injuryMechanism of injury

►Number of patientsNumber of patients►Call for additional help if neededCall for additional help if needed

ALSALS

Collision SceneCollision Scene►Look and listenLook and listen►Check for power outagesCheck for power outages►Observe traffic flowObserve traffic flow►Check for smokeCheck for smoke

As you approach:As you approach:► Look for clues to escape hazourdous materialsLook for clues to escape hazourdous materials► Look for patients on or near the roadLook for patients on or near the road► Look for smoke not seen at a distanceLook for smoke not seen at a distance► Look for broken utility poles and downed linesLook for broken utility poles and downed lines► Be on the look-out for bystandersBe on the look-out for bystanders► Watch for signals of police officers or other Watch for signals of police officers or other

agency personnelagency personnel

Danger ZoneDanger Zone► No apparent hazard-at least 50ft in all directonsNo apparent hazard-at least 50ft in all directons► Fuel spill-at least 100 ft. in all directionsFuel spill-at least 100 ft. in all directions

uphill and downwinduphill and downwindavoid gutter, gullies, ditchesavoid gutter, gullies, ditchesdo not use flaresdo not use flares

► Vehicle fire-at least 100 ft. in all directionsVehicle fire-at least 100 ft. in all directions► Downed wires-area in which contact can be madeDowned wires-area in which contact can be made► Hazardous MaterialsHazardous Materials

Emergency Response Guide BookEmergency Response Guide BookChemtrecChemtrec

Crimes Scenes and Acts of ViolenceCrimes Scenes and Acts of Violence

Signals of violence:Signals of violence:►Fighting or loud voicesFighting or loud voices►Visible weaponsVisible weapons►Signs of alcohol or other drug useSigns of alcohol or other drug use►Unusual silenceUnusual silence►Knowledge of prior violenceKnowledge of prior violence

Nature of callNature of call► IllnessIllness► InjuryInjury

► Part II INITIAL ASSESSMENTPart II INITIAL ASSESSMENT► Defined:Defined:► Discovering and treating life-threatening conditionsDiscovering and treating life-threatening conditions► Goals:Goals:► Determine if the patient is ill or injuredDetermine if the patient is ill or injured► TriageTriage► Components:Components:► General ImpressionGeneral Impression

Illness or injuryIllness or injury Mechanism of injury/Nature of illnessMechanism of injury/Nature of illness Age, sex, raceAge, sex, race Identify life-threatening problemsIdentify life-threatening problems

► Mental StatusMental Status► A lertA lert V erbal Response P ainful ResponseV erbal Response P ainful Response U U

nresponsivenresponsive► Assess BreathingAssess Breathing► Assess BreathingAssess Breathing► TriageTriage

Patient AssessmentPatient Assessment

Initial AssessmentInitial Assessment► General Impression:General Impression:68 year old white female68 year old white femaleSitting on the couch answering questions in brokenSitting on the couch answering questions in brokensentences and obeying commandssentences and obeying commandsObviously A & O x 4Obviously A & O x 4c/c of Shortness of breathc/c of Shortness of breathIndex of suspicion: PMHx. Of AsthmaIndex of suspicion: PMHx. Of AsthmaLife Threats:Life Threats:► A B C’sA B C’s

Patient AssessmentPatient Assessment

► Airway: Patent; answering questionsAirway: Patent; answering questions► Breathing: Complains of shortness of breathBreathing: Complains of shortness of breath

Rhythm Rhythm and and qualityqualityLabored Labored ShallowShallow

O2 @ 15lpm with NRBO2 @ 15lpm with NRB► Circulation: Major bleeding???Circulation: Major bleeding???

Pulse Pulse rhythmrhythm andand qualityqualityregularregular strongstrong

► Transport decision: Stay/play vs Load/goTransport decision: Stay/play vs Load/go emergent/non-emergentemergent/non-emergent

► Part III Focused History and Physical ExamPart III Focused History and Physical Exam► Defined:Defined:► To identify additional serious or potentially life-threatening injuries or conditionsTo identify additional serious or potentially life-threatening injuries or conditions► Components, TraumaComponents, Trauma► Reconsider Mechanism of injuryReconsider Mechanism of injury

Index of suspicionIndex of suspicion► Rapid Trauma AssessmentRapid Trauma Assessment

Head to toe physical exam quickly conductedHead to toe physical exam quickly conducted► Base-line Vital SignsBase-line Vital Signs► Assess S A M P L E historyAssess S A M P L E history► Components MedicalComponents Medical► History of present illnessHistory of present illness

O – P – Q – R – S – TO – P – Q – R – S – T S A M P L ES A M P L E Rapid AssessmentRapid Assessment Base-line Vital SignsBase-line Vital Signs TreatTreat

► IF UNRESPONSIVE:IF UNRESPONSIVE:► Rapid AssessmentRapid Assessment► Base-line Vital SignsBase-line Vital Signs► Assess S A M P L EAssess S A M P L E► CareCare

Patient AssessmentPatient Assessment

Focused History and Physical ExamFocused History and Physical Exam► Onset? 45 minutes ago► Provokes?Nothing makes pain better/worse► Quality? Dull► Radiates? Non-radiating► Severity? 4:10► Time? >1 hour ago► Interventions?

Patient AssessmentPatient Assessment

► Allergies: PCN ► Medications: NTG, asa, Toprol XL, lasix► Past pertinent history: “I go to a heart DR.”► Last oral intake: Breakfast-eggs, toast, coffee► Event leading to present illness: Cleaning out a

closet► Performs focused physical examination: lung

soundsshort of breath; warm/dry/pink;

► Vitals: 142/86 130 38► Interventions: O2► Transport decision: More informed decision► Detailed physical examination necessary? YES

S A M P L E historyS A M P L E history►Signs/SymptomsSigns/Symptoms►AllergiesAllergies►MedicationsMedications►PMHx.PMHx.►Last oral intakeLast oral intake►Events leading to the illness/injuryEvents leading to the illness/injury

Vital Signs and Vital Signs and Sample HistorySample History

General ImpressionGeneral Impression Illness or injuryIllness or injury Mechanism of injury/Nature of illnessMechanism of injury/Nature of illness Age, sex, raceAge, sex, race Identify life-threatening problemsIdentify life-threatening problems

Vital SignsVital Signs► PulsePulse

ApicalApical► RespirationsRespirations► Skin color, temp, conditionSkin color, temp, condition► PupilsPupils► Blood PressureBlood Pressure

AuscultationAuscultationPalpationPalpation

► Mental StatusMental Status

Communicating with your patientCommunicating with your patient►Position yourself close to the patientPosition yourself close to the patient► Identify and yourself and reassureIdentify and yourself and reassure►Speak in a normal voiceSpeak in a normal voice►Learn your patient’s nameLearn your patient’s name►Learn your patient’s ageLearn your patient’s age

Patient AssessmentPatient Assessment

Detailed Physical ExamDetailed Physical Exam

Head: Facial cyanosis; cyanosisHead: Facial cyanosis; cyanosis

Neck: - JVD; - Tracheal deviationNeck: - JVD; - Tracheal deviation

Chest: Symmetrical; LS clear, bilat, all fieldsChest: Symmetrical; LS clear, bilat, all fields

ABD: Soft/non-tender/- distensionABD: Soft/non-tender/- distension

LE: - LE or pedal edemaLE: - LE or pedal edema

UE- - peripheral edemaUE- - peripheral edema

VS: 154/90VS: 154/90 130130 2828

► Part IV Detailed Physical ExamPart IV Detailed Physical Exam► DefinedDefined► Head to toe physical exam that is performed Head to toe physical exam that is performed

slower and in a more thorough manner that slower and in a more thorough manner that the rapid assessmentthe rapid assessment

► ComponentsComponents► Head to Toe examHead to Toe exam► Reassess vital signsReassess vital signs► Continue careContinue care

► Part V On-Going AssessmentPart V On-Going Assessment► Defined:Defined:► To detect any changes in the patient’s conditionTo detect any changes in the patient’s condition► To detect any missed injuries or conditionsTo detect any missed injuries or conditions► To adjust care as neededTo adjust care as needed► Goal:Goal:► The initial assessment is repeatedThe initial assessment is repeated► Vital signs are repeated and recordedVital signs are repeated and recorded► Focused assessment repeated for additional complaintsFocused assessment repeated for additional complaints► Components:Components:► Repeat Initial AssessmentRepeat Initial Assessment► Repeat focused assessmentRepeat focused assessment► Check interventionsCheck interventions► Note trends in patient conditionNote trends in patient condition

Patient AssessmentPatient Assessment

On-going AssessmentOn-going Assessment►Repeats initial assessment: ABC, MS,

Monitor►Repeats vital signs: 132/68 84

24►Repeats focused assessment

regarding patient complaint or injuries: O2 helping; Pain?

Patient AssessmentPatient Assessment

Scene Size-up – Initial Assessment – Focused Hx. & PE Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment– Detailed Assessment – On-going assessment