Transcript Trauma Sick Not Sick Final JW

Sick/Not Sick
Rapid Assessment
of a Patient with Traumatic Injury
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The Concept of Sick/Not Sick
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This concept has been around for years and is
based off similar principles used during Mass
Casualty Incidents
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It’s a method of rapid patient assessment that
allows you to make good treatment decisions
based on proven clinical indicators
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Facilitates good coordination and communication
in the field and results in better patient care
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Purpose of Sick/Not Sick
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To help you quickly and accurately decide
who is critically injured and who is not
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Assure a rapid initial assessment and
transport to appropriate facility
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Prevent delays in patient care
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Objectives
Understanding Terms
 The clinical picture
 Who is “Sick”
 Who is “Not Sick”
 Making a decision
 Treatment
 Transport
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Terms While In Route
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Index of Suspicion – The anticipation that
certain types of accidents will result in
certain types of injuries
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Mechanism of Injury – The forces of
injury and how they were applied to the
body
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Terms Involving Exam
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Perfusion – The flow of blood through the
organs and tissue of the body
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RPM – An acronym that stands for
respirations, pulse and mentation
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Skin Signs – Observable indications of
circulation including skin color,
temperature and moisture
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Terms of Decision
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Sick – Someone who appears
physiologically unstable as indicated by
clinical indicators
 Critical
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/ Urgent / Unstable
Not Sick – Someone who appears
physiologically as indicated by adequate
respiration, pulse, mental status, skin color
and an appropriate body position
 Non-critical
/ Non-urgent / Stable
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The “Sick” Patient
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Appears to be unstable as indicated by clinical
signs
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Has life-threatening injuries that need to be
treated aggressively by both BLS and ALS crews
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This patient can die quickly unless you initiate
immediate treatment and rapid transport to an
appropriate facility
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Recognizing the Sick Patient
It may only take one of these to convince you!
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Index of Suspicion
Mechanism of Injury
Respirations
Pulse
Mental Status
Skin Signs
Body Position
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The “Not Sick” Patient
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Appears to be stable as indicated by clinical
signs
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This patient still has injuries at this time the
condition is not life threatening
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Even though this patient has no life threatening
injuries they still need and deserve treatment
and transport to the appropriate facility
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Gathering The Information
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Pre Plan While In Route
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Index of suspicion/Mechanism of injury
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Differential Diagnosis X 3
View the Clinical Picture Upon Arrival
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Chief complaint
Respirations
Pulse
Mental status
Skin color/signs
Body position
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Making The Decision
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What does the clinical picture tell you?
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Chief Complaint – Focus on injury
Mechanism of Injury (MOI) – How significant was the
mechanism and is there obvious trauma
Respirations – What is the rate or character
Pulse – Can it be palpated and what is its rate and character
Mental Status – Is the patient anxious, combative, drowsy,
lethargic or unconscious
Skin Signs – What is the color, temperature and moister
Body Position – meeting you at the door, tripod to breath,
unable to support weight
Is the patient likely to survive without immediate and
aggressive action?
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The Decision Made
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The clinical picture has been formed
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All information has been gathered quickly
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Sick/Not Sick
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Having a plan
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Taking action based on the decision
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Sick – ALS & rapid transport
Not Sick – Thorough on-scene exam with appropriate
treatment
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Changing The Decision
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It’s OK to switch from Not Sick to the Sick
decision
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Things may change in the patients status
You may discover more information during a thorough
exam
You may have a “Gut Feeling”
Don’t get caught
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Failing to respond to new information
Having tunnel vision
Not having a clear well thought out plan
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Treatment/Transport
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Formulate a plan based on the clinical decision
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Make a decision early in the call
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Take action quickly, add additional recourses
early and treat the patient aggressively
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Transport the patient to an appropriate
destination and inform them that you are coming
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Summary
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Speed up the delivery of care to critical patients
by determining Sick/Not Sick early
Create a plan while en-route based on
information from dispatch and other units onscene
Treat Sick patients aggressively with both BLS
and ALS crews
Understand the clinical signs and how they are
used to determine if a patient is Sick or Not Sick
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Summary
The sick patient appears unstable as indicated
by inadequacies in:
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Respirations
Pulse
Mental Status
Skin Signs
Body Position
Evidence of Significant Mechanism of Injury
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Questions?
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