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PATIENT ASSESSMENT

PATIENT ASSESSMENT. Scene Size-Up Initial Assessment Focused History. Scene Size-Up / Assessment.

emily-olson
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PATIENT ASSESSMENT

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  1. PATIENT ASSESSMENT Scene Size-Up Initial Assessment Focused History

  2. Scene Size-Up / Assessment • Definition: - an assessment of the scene and surroundings to assure the safety of the individual EMT-B, the partner and crew safety, and to provide potentially useful information about the patient and what occurred.

  3. Scene Size-Up / Assessment • Body Substance Isolation • Need eye protection? • Gloves? • Gown & mask if necessary.

  4. Is it safe to approach the patient? • Crash / Rescue scenes. • Toxic substances - low oxygen areas. • Crime scenes - potential for violence. • Unstable surfaces - slope, ice, water. • Protection of the patient - environmental. • Protection of bystanders - avoid injury. • If scene is unsafe, make it safe or do not enter.

  5. Nature of Illness - Medical • Determine from patient, family or bystanders why EMS was activated. • Determine total number of patients. If more than unit can effectively handle, notify dispatch - activate mass casualty plan. • Obtain additional help prior to contact with patients. • Begin triage.

  6. Mechanism of Injury - Trauma • Determine from patient, etc. and inspection of the scene, the mechanism of injury. • Ejection from vehicle. Falls > 20 feet. • Death in same compartment. Roll-over. • High-speed vehicle collision. Bicycle crash. • Vehicle-pedestrian collision. Motorcycle. • Determine total number of patients. Spinal?

  7. The Initial Assessment The general impression is extremely valuable. EMT-Bs will hone this “sixth sense” as you assess more and more patients.

  8. General Impression of the Patient • Formed to determine priority of care and is based on the immediate assessment of the environment and the patient’s chief complaint. • Determine if ill (medical) or injured (trauma). If injured, determine mechanism. • Age • Sex

  9. General impression of the patient • Don’t be too quick to base your general impression of the patient strictly on dispatch information. • Avoid “tunnel vision”!

  10. Determine if a life-threat exists! • Assess the patient and determine if the patient has a life-threatening condition. • If a life-threatening condition is found - treat immediately. • Assess the nature of illness or mechanism of injury.

  11. Assess Patient’s Mental Status • Maintain spinal immobilization if needed. • Speak to the patient, introduce yourself. • LEVELS OF MENTAL STATUS • Alert. • Responds to Verbal stimuli. • Responds to Painful stimuli. • Unresponsive - no gag or cough.

  12. Altered Level of Consciousness? • Patient should be oriented to – • PERSON • PLACE • TIME

  13. Assess Patient’s Airway Status • Responsive patient - • Is the patient talking or crying? • If yes, assess for adequacy of breathing. • If no, open the airway. • Unresponsive patient - • Is the airway open?

  14. MEDICAL patients - perform the head-tilt, chin-lift Clear Not-clear, clear the airway TRAUMA patients, or unknown illness - cervical spine precautions with jaw-thrust maneuver Clear Not-clear, clear the airway Airway positioning is patient - , age - , and size-specific.

  15. Assess Patient’s Breathing • If breathing is adequate and patient is responsive, oxygen may be indicated. • All responsive patients breathing <29 or >8 breaths per minute should receive high flow oxygen (15 lpm, nonrebreather mask)

  16. Patient’s Breathing (cont’d.) • Unresponsive, breathing is adequate - open and maintain the airway, providing high-concentration oxygen. • Breathing inadequate - open and maintain the airway, assist patient’s breathing and utilize ventilatory adjuncts with oxygen. • Not breathing, open and maintain airway, ventilate using ventilatory adjuncts with oxygen.

  17. Assess the Patient’s Circulation • Assess the patient’s pulse by feeling the carotid. If alert, may check the radial pulse. Patient 1 year old or less - brachial pulse. If no pulse at radial or brachial, check carotid. • If pulseless medical patient > 9,* start CPR and apply automated external defibrillator, (AED). Medical patient < 9,* start CPR. Trauma patient, start CPR. • *pediatric electrodes available?

  18. Patient Assessment (cont’d.) • Assess if major bleeding is present - control bleeding. • Assess patient’s perfusion by evaluating skin color and temperature; • look at nail beds, lips and skin inside eyelids • normal = pink • abnormal = pale, cyanotic, flushed, jaundice

  19. Pt. Assessment (cont’d.) • Assess patient’s skin temperature by feeling the skin. • Normal = warm • Abnormal = hot, cool, cold, clammy • Assess patient’s skin condition. • Normal = dry Abnormal = moist • Assess capillary refill in infants & children • Normal < two seconds Abnormal > two second

  20. Poor general impression. Unresponsive patients. Responsive, not following commands. Difficulty breathing. Hypoperfusion (shock). Complicated childbirth. Chest pain with BP < 100 systolic. Uncontrolled bleeding. Severe pain. Identify Priority Patients

  21. Determine a CUPS Status • Critical • Unstable • Potentially unstable • Stable • Expedite transport of the patient based on determination. • Consider ALS back up.

  22. Proceed to Focused History and Physical Examination • Important for EMT-B to separate patients requiring rapid assessment and critical interventions from those who can be managed using components of focused assessment.

  23. Focused History & Physical Exam TRAUMA

  24. Ejection from vehicle. Death in same passenger compartment. Falls > 20 feet. Roll-over of vehicle. High-speed vehicle collision. Vehicle-pedestrian collision. Motorcycle crash. Unresponsive or altered mental status. Penetrations of the head, chest, or abdomen. Reconsider Mechanism of Injury

  25. Infant and Child Considerations • Falls greater than 10 feet. • Bicycle collision. • Vehicle in medium speed collision.

  26. Consideration of Mechanism of Injury • Mechanism of Injury often results in specific hidden injuries. • Seat Belts • Airbags

  27. SEAT BELTS If buckled, may have injuries. Patient had seat belt on, does not mean they have no injuries. Shoulder injury resulting from shoulder harness. AIRBAGS Not effective without seat belt. Can hit wheel after deflation. “Lift and look” at wheel for deformity. Deformity = serious internal injury. Specific Hidden Injuries?

  28. Rapid Trauma Assessment • Perform rapid trauma assessment on patients with a significant mechanism of injury to determine life threatening injuries. • In the responsive patient, symptoms should be sought before and during the trauma assessment.

  29. Rapid Trauma Assessment Is Important In Order To: • Estimate the severity of injuries. • Make a CUPS status determination. • Make transport decisions. • Consider Advanced Life Support intercept. • Consider platinum ten minutes and the golden hour.

  30. Rapid Assessment • Rapid assessment should be interrupted to provide life saving interventions: • AIRWAY • BREATHING • CIRCULATION

  31. Performing a Rapid Trauma Assessment • Continue spinal immobilization. • Consider A.L.S. Request. • Reconsider transport decision. • Assess mental status. • As you inspect and palpate, look and feel for injuries or signs of injury using, • D C A P - B T L S

  32. DEFORMITIES CONTUSIONS ABRASIONS PUNCTURES / PENETRATIONS BURNS TENDERNESS LACERATIONS SWELLING Look and Feel for;

  33. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling CREPITATION FLUIDS / BLOOD from the head Assess the Head

  34. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling JUGULAR VEIN DISTENSION (JVD) CREPITATION Apply cervical spinal immobilization collar (CSIC) at this time. Tracheal Deviation Assess the Neck

  35. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling PARADOXICAL MOTION Crepitation BREATH SOUNDS present absent equal Assess the Chest

  36. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling FIRM SOFT DISTENDED Assess the Abdomen

  37. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling If No Pain is Noted, GENTLY COMPRESS THE PELVIS TO DETERMINE TENDERNESS OR MOTION Assess the Pelvis

  38. Deformities Contusions Abrasions Punctures / Penetrations Burns Tenderness Lacerations Swelling DISTAL PULSE SENSATION MOTOR FUNCTION CREPITATION Assess All Four Extremities

  39. Roll Patient Ensuring Spinal Integrity • Assess posterior body, inspect and palpate, examining for injuries or signs of injury.

  40. Assess baseline vital signs: Respirations - rate & quality Pulse - rate & quality Blood Pressure Pupils Skin - CTC Assess SAMPLE history: Signs & Symptoms Allergies Medications Pertinent History Last Oral Intake Events Leading Up To Vitals and SAMPLE

  41. Questions?

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