Chapter 5 Patient Assessment EMR 5 1 Introduction

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Chapter 5 Patient Assessment EMR 5 -1

Chapter 5 Patient Assessment EMR 5 -1

Introduction • An Emergency Medical Responder (EMR) is often the first trained responder on

Introduction • An Emergency Medical Responder (EMR) is often the first trained responder on the scene and is vital in the initiation of patient assessment • Assessment protocols may differ depending on the condition of the patient and his level of consciousness • An EMR must assess the overall patient presentation to see the complete medical picture • Being familiar with systematic assessment guidelines and having critical thinking skills help EMRs obtain pertinent information to make appropriate treatment decisions EMR 5 -2

Learning Objective 1 Medical Patient and Trauma Patient ASSESSING MEDICAL AND TRAUMA PATIENTS •

Learning Objective 1 Medical Patient and Trauma Patient ASSESSING MEDICAL AND TRAUMA PATIENTS • Medical patient is one who verbalizes • Trauma patient is one who has an injury that may or may not be visible • EMR must assess the overall patient presentation • Systematic assessment guidelines and critical thinking skills EMR 5 -3

Learning Objective 1 Medical Patient and Trauma Patient PENMAN ASSESSMENT • Personal and personnel

Learning Objective 1 Medical Patient and Trauma Patient PENMAN ASSESSMENT • Personal and personnel safety • Environmental hazards • Number of victims • Mechanism of injury or nature of illness • Additional resources needed from your agency • Need for resources outside your agency EMR 5 -4

Learning Objective 1 Medical Patient and Trauma Patient SPINAL STABILIZATION • Upon approaching the

Learning Objective 1 Medical Patient and Trauma Patient SPINAL STABILIZATION • Upon approaching the patient, state your name, agency, and credentials • Position yourself at the head of the patient • Avoid “yes” and “no” questions EMR 5 -5

Learning Objective 1 Medical Patient and Trauma Patient PRIMARY SURVEY • Begins with assessing

Learning Objective 1 Medical Patient and Trauma Patient PRIMARY SURVEY • Begins with assessing LOC • Responsiveness initially assessed with AVPU v v Alert Verbally responsive Painful stimuli response Unresponsive EMR 5 -6

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • No

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • No signs of life-sustaining perfusion • Critical interventions • Rapid survey • Immediate transportation Cont. EMR 5 -7

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • CAB

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • CAB for unresponsive patient v v v Circulation Airway Breathing Cont. EMR 5 -8

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • Hands-only

Learning Objective 2 Unresponsive and Responsive Patients UNRESPONSIVE MEDICAL OR TRAUMA PATIENT • Hands-only CPR or compression-only CPR • Defibrillation • Rapid survey • Transport EMR 5 -9

Learning Objective 2 Unresponsive and Responsive Patients RESPONSIVE MEDICAL OR TRAUMA PATIENT • Varying

Learning Objective 2 Unresponsive and Responsive Patients RESPONSIVE MEDICAL OR TRAUMA PATIENT • Varying degrees of responsiveness • Breathing and pulse are evident • May be inadequate perfusion • Continually monitor the patient’s status Cont. EMR 5 -10

Learning Objective 2 Unresponsive and Responsive Patients RESPONSIVE MEDICAL OR TRAUMA PATIENT • Primary

Learning Objective 2 Unresponsive and Responsive Patients RESPONSIVE MEDICAL OR TRAUMA PATIENT • Primary survey v Orientation v Airway v Breathing v Circulation EMR 5 -11 Cont.

Learning Objective 2 Unresponsive and Responsive Patients BASELINE VITAL SIGNS • Blood pressure by

Learning Objective 2 Unresponsive and Responsive Patients BASELINE VITAL SIGNS • Blood pressure by auscultation v Systolic reading and the diastolic reading v Blood pressure cuff in addition to stethoscope • Blood pressure by palpation v Only the systolic pressure can be obtained EMR 5 -12

Learning Objective 2 Unresponsive and Responsive Patients SECONDARY OR RAPID SURVEY • Used on

Learning Objective 2 Unresponsive and Responsive Patients SECONDARY OR RAPID SURVEY • Used on both trauma victims and medical patients • If unstable or complications suspected • Detailed secondary survey performed on stable patient • Start assessment at the feet of a responsive child EMR 5 -13

Learning Objective 3 Medical Acronyms Used to Assess Patients ASSESSMENT TOOLS • SAMPLE—basic information

Learning Objective 3 Medical Acronyms Used to Assess Patients ASSESSMENT TOOLS • SAMPLE—basic information • DOTS—medical and trauma • TIC—muscular or joint trauma • CMS —extremities Cont. EMR 5 -14

Learning Objective 3 Medical Acronyms Used to Assess Patients ASSESSMENT TOOLS • PERRL—eyes •

Learning Objective 3 Medical Acronyms Used to Assess Patients ASSESSMENT TOOLS • PERRL—eyes • DRGERM—abdomen • OPQRST—pain assessment EMR 5 -15

Learning Objective 3 Medical Acronyms Used to Assess Patients APPLYING ASSESSMENT TOOLS • Areas

Learning Objective 3 Medical Acronyms Used to Assess Patients APPLYING ASSESSMENT TOOLS • Areas to be assessed with tools v v v Head Eyes Face Ears and nose Mouth Neck Cont. EMR 5 -16

Learning Objective 3 Medical Acronyms Used to Assess Patients APPLYING ASSESSMENT TOOLS • Areas

Learning Objective 3 Medical Acronyms Used to Assess Patients APPLYING ASSESSMENT TOOLS • Areas to be assessed with tools v v v Chest Abdomen Pelvis Legs Arms Back EMR 5 -17

Learning Objective 3 Medical Acronyms Used to Assess Patients REASSESSMENT • EMR has the

Learning Objective 3 Medical Acronyms Used to Assess Patients REASSESSMENT • EMR has the responsibility to reassess patients • Unstable patients every five minutes or less • Stable patient every 15 minutes unless a change in the patient’s status • Dialogue is essential in reassessment EMR 5 -18

Learning Objective 3 Medical Acronyms Used to Assess Patients TRANSPORTATION DECISIONS • An EMR

Learning Objective 3 Medical Acronyms Used to Assess Patients TRANSPORTATION DECISIONS • An EMR must make the decision to rapidly package • Method of packaging depends on the MOI v v v Condition of patient Resources available Environmental issues • Medications and legal documents also transported EMR 5 -19

Learning Objective 4 Critical Thinking and EMRs CRITICAL THINKING • Assess, treat, communicate, and

Learning Objective 4 Critical Thinking and EMRs CRITICAL THINKING • Assess, treat, communicate, and make transportation decisions • Identification and evaluation of evidence to guide decision making • Knowledge base, experience, skills, and protocols EMR 5 -20

Summary • Care provided by an EMR is based on a complete and accurate

Summary • Care provided by an EMR is based on a complete and accurate assessment of the patient’s condition • An EMR uses assessments such as PENMAN, spinal stabilization, patient assessment, proper interventions, reassessment, and transportation decisions to provide care • Systematic assessment tools and using critical thinking skills help the EMR • Obtaining pertinent patient data is vital to give appropriate, life-saving medical treatment EMR 5 -21