Patient Assessment

Patient Assessment EMT-Basic Chapter 9

THIS IS ONE OF THE MOST IMPORTANT SKILLS YOU NEED TO MASTER AS AN EMT!!!

5 Main Parts of Assessment • Scene Size-Up • Primary Assessment • History Taking • Secondary Assessment • Reassessment

Symptom vs. Sign • Symptom: Subjective finding that the patient feels and tells you • Sign: objective finding that you observe or measure

Scene Size-Up • Ensure safety of yourself, your partner, and patient • Determine MOI/NOI • Determine number of patients • Call for additional resources, if necessary • Put on appropriate PPE

Primary Assessment • Sick or Not Sick • Level of consciousness (AVPU or A&O X4) • ABCs • Identifying life threats • Assessment of vital functions • Initial general impression

AVPU • A=Alert • V=Responsive to Verbal Stimuli • P=Responsive to Pain • U=Unresponsive

A & O X 4 • Person: Able to remember own name • Place: Able to identify current location • Time: Able to tell you current year, month, or day of week • Event: Able to describe what happened

ABCs • Make sure airway is open • Head tilt vs. jaw thrust • Make sure breathing is present and adequate • Ask yourself: • Is the patient breathing? • Is the patient breathing adequately? • Is the patient hypoxic? • What do I need to do?

ABCs • Consider positive-pressure ventilations with airway adjunct when: • Respirations exceed 28 breaths/min • Respirations are fewer than 8 breaths/min • Oxygenation goal for MOST patients is an oxygen saturation of approximately 94% to 99%.

ABCs • Skin should be Pink, Warm, Dry • If unresponsive—palpate carotid pulse. If no pulse, begin CPR. • If unresponsive but have a pulse, can check capillary refill. Should be < 2 seconds. • Assess & control external bleeding, if necessary.

Rapid Scan • Scan body to identify injuries that must be managed or protected before patient is transported • Take 60 to 90 seconds to perform. • Not a systematic or focused physical examination • Decide “load and go” or “stay and play”

History Taking • Investigate the chief complaint (OPQRST) • Determining mechanism of injury/nature of illness • Discover signs and symptoms • Is their family, bystander, medical jewelry? • SAMPLE

OPQRST • O= onset • P= provocation • Q= quality • R= region/radiation • S= severity • T= timing

SAMPLE • S: signs and symptoms • A: allergies • M: medications • P: pertinent past medical history • L: last oral intake • E: events leading up to the injury or illness

Secondary Assessment • May be performed on-scene, in the back of the ambulance en route to the hospital, or not at all • May be a systematic head-to-toe secondary assessment or an assessment that focuses on a certain area or system of the body • Inspect (DCAP-BTLS), Palpate, and Auscultate

DCAP-BTLS • D= deformities • C= contusions • A= abrasions • P= punctures/penetrations • B= burns • T= tenderness • L= lacerations • S= swelling

Performing Secondary Assessment • MEMORIZE pgs. 349-353 and ALL 23 Steps!!

Focused Assessment • Performed on patients who have nonsignificant MOIs or on responsive medical patients • Typically based on the chief complaint • Goal is to focus your attention on the body part or systems affected by the priority problems

Take Vitals

When assessing pupils… • PEARRL is a useful assessment guide: • Pupils • Equal • And • Round • Regular in size • React to Light

Glasgow Coma Scale

When to reassess… • If patient’s condition is stable, reassess vital signs every 15 minutes. • If patient’s condition is unstable, reassess vital signs every 5 minutes.

Reassess chief complaint • Is the current treatment improving the patient’s condition? • Has an already identified problem gotten better? • Has an already identified problem gotten worse? • What is the nature of any newly identified problems?

Reassess Interventions • Check all interventions. • Most important are the patient’s ABCs. • Ensure management of bleeding. • Ensure adequacy of other interventions, and consider the need for new interventions.

Questions?

Patient Assessment