Transcript Document

Scene Size Up
Pt Assessment
Scene Size-up
Body substance isolation
Scene Assessment
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Scene safety
Location of all patients
Mechanism of injury
Nature of the illness
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Always stop to size up the scene
before going in.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Scene Assessment
Routes of extrication for crew and
patient
Number of patients
Need for additional resources
– Extrication equipment
– Additional transport units
– Additional manpower
Use of all of your senses.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Scene Safety
Natural hazards
Fire
Risk of violence
Traffic
Chemical/industrial agents
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Location of All Patients
Scene size-up also includes a search
of the area to locate all of the patients.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury
External vehicle damage
– Forces involved in the collision
Interior vehicle damage
– Structures damaged inside the vehicle
Patient impact
– Anatomic regions of the body struck
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Nature of Illness
To determine the nature of illness:
– Use bystanders, family members, or the
patient.
– Use the scene to give clues to the
patient’s condition.
Oxygen equipment in the home
Medicine containers
General appearance of environment
– Remember that the patient’s illness may
be very different from the chief complaint.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Initial Assessment Steps
Form a general impression.
Stabilize the cervical spine.
Assess the baseline mental status.
Assess the airway.
Assess breathing.
Assess circulation.
Determine priority.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The General Impression
The general impression is the initial,
intuitive evaluation of the patient to
determine the general clinical status
and priority for transport.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mental Status
Alert
Verbal
Painful stimuli
Unresponsive
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Airway Assessment
If the patient is responsive and can
speak clearly, assume the airway is
patent.
If the patient is unconscious, the
airway may be obstructed.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Breathing Assessment
Altered mental
status
Shortness of
breath
Retractions
Asymmetric
chest wall
movement
Accessory
muscle use
Cyanosis
Audible sounds
Abnormal rate or
pattern
Nasal flaring
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Breathing (2 of 2)
Rate
Depth
Presence of bilateral breath sounds
Symmetry of chest movement
– Observe for accessory muscle use.
– Expose the chest wall and palpate for:
Structural integrity
Tenderness
Crepitus
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Circulation Assessment
The circulation assessment consists of
evaluating the pulse and skin and
controlling hemorrhage.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Top Priority Patients
Poor general
impression
Unresponsive
Conscious but
cannot follow
commands
Difficulty
breathing
Hypoperfusion
Complicated
childbirth
Chest pain and BP
below 100 systolic
Uncontrolled
bleeding
Severe pain
Multiple injuries
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The Focused History and
Physical Exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Types of Patients
Trauma patient with significant
mechanism of injury
Trauma patient with isolated injury
Responsive medical patient
Unresponsive medical patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Trauma
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Predictors of Serious
Internal Injury
Ejection from
vehicle
Death in same
passenger
compartment
Fall from higher
than 20 feet
Rollover of vehicle
High-speed motor
vehicle collision
Vehicle-passenger
collision
Motorcycle crash
Penetration of the
head, chest, or
abdomen
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury Considerations
for Infants and Children
Fall from higher than ten feet
Bicycle collision
Medium-speed vehicle collision
with resulting severe vehicle
deformity
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
DCAP-BTLS
Deformity
Contusion
Abrasion
Penetration
Burns
Tenderness
Lacerations
Swelling
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The Isolated-Injury
Trauma Patient
No significant mechanism of injury
Shows no signs of systemic
involvement
Does not require an extensive history
Does not require a comprehensive
physical exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Examination of the
Musculoskeletal System
Observe, inspect, and palpate the joints,
structure, and movement.
Note:
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Pain
Swelling
Deformity
Symmetry
Tissue changes
– Compare strength
– Range of motion
– Crepitus
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Range of Motion (Active)
Have patient position the joints.
Watch for decreased or increased
movement of the joint compared to the
other side as well as the norm.
Watch for pain with movement.
Listen for crepitus or “popping.”
Watch for abnormal movements.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Range of Motion (Passive)
Next position the joints passively,
comparing the end points to the active.
Note any decrease or increase in
movement.
Note pain with the movement.
Listen for crepitus or “popping.”
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The Responsive Medical
Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The History
Chief complaint
History of the present illness
Past history
Current health status
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a Patient
History
Establishing rapport
Chief complaint
History of the present illness
Past medical history
Current health status
– Family history
– Psychosocial history
Review of systems
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Rapport – Active
Listening
Facilitation
Reflection
Clarification
Empathy
Confrontation
Interpretation
Asking about feelings
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges (1 of 2)
Silence
Overly talkative
patients
Multiple symptoms
Anxiety
Depression
Sexually attractive
or seductive
patients
Confusing
behaviors or
symptoms
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges (2 of 2)
Patients needing
reassurance
Anger and hostility
Intoxication
Crying
Limited intelligence
Language barriers
Hearing problems
Blindness
Talking with
families or friends
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appearance (1 of 2)
Level of consciousness
Signs of distress
Apparent state of health
Vital statistics
Sexual development
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appearance (2 of 2)
Skin color and obvious lesions
Posture, gait, and motor activity
Dress, grooming, and personal
hygiene
Odors of breath or body
Facial expression
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The History of the Present
Illness (OPQRST-ASPN)
Onset
Provocation
or
Palliation
Quality
Region/Radiation
Severity
Time
Associated
Symptoms
Pertinent Negatives
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Past Medical History
General state of health
Childhood and adult diseases
Psychiatric illnesses
Accidents and injuries
Surgeries and hospitalizations
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Psychosocial History
Chronic health conditions
Job
– Work schedule
– Stress
Family dynamics
Support
Safety issues
– Car seat usage
– Smoke and CO alarms
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The physical exam of the medical
patient is aimed at identifying
medical complications rather than
signs of injury.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Examination Techniques
Inspection
Palpation
Auscultation
Percussion
These 4 techniques are the
foundation of the physical exam.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Review of Systems
A system-by-system series of questions
designed to identify problems your patient
has not already identified:
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Skin
Head
Eyes
Ears
Nose
Mouth/Throat
Respiratory
Cardiovascular
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Gastrointestinal
Genitourinary
Musculoskeletal
Neurologic
Psychologic
Endocrine
Hematologic
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Areas of Nervous System
Exam
Mental status and speech
Cranial nerves
Motor system
Reflexes
Sensory system
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
One-Minute Cranial Nerve Exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Measure vital signs early
in the physical examination and,
in the emergency situation, repeat
them often and look for trends.
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Assessing the Unresponsive
Medical Patient
Initial assessment
Rapid medical assessment
Brief history
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ongoing Assessment
Mental status
Airway patency
Breathing rate
and quality
Pulse rate and
quality
Skin condition
Transport
priorities
Vital signs
Focused
assessment
Effects of
interventions
Management
plans
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
THE END
Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ