Chapter 7 Patient Assessment BRADY National Ski Patrol

Objectives 7. 1 Describe the two parts of the overall assessment process. 7. 2 Describe the importance of scene safety. 7. 3 List the two parts of a patient assessment. 7. 4 Describe and demonstrate how to perform a primary assessment and manage the ABCDs. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 7. 5 Describe and demonstrate how to perform a secondary assessment. 7. 6 Define the following terms: a. b. c. d. e. assessment chief complaint DCAP-BTLS sign symptom continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 7. 7 List and describe the key components of a patient history. 7. 8 Describe how environmental conditions can affect patient assessment. 7. 9 Describe and demonstrate how to obtain a SAMPLE history. 7. 10 Describe and demonstrate how to assess pain using the OPQRST mnemonic. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 7. 11 Describe and demonstrate how to assess the eyes (pupils and movement). 7. 12 Describe and demonstrate how to assess a patient’s level of responsiveness using the following: a. b. AVPU Glasgow Coma Score continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 7. 13 Describe and demonstrate the procedure for obtaining the following vital signs: a. b. c. Respiratory rate Blood pressure Heart rate 7. 14 Describe and demonstrate how to reassess a patient. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Scene Size-up l Patient Assessment l Chapter Summary BRADY National Ski Patrol,

Case Presentation You are called to help a male in his mid-50 s who fell approximately 6 feet to the ground while rock climbing. He is wearing a helmet and did not lose consciousness. He is having difficulty breathing and is complaining of upper left chest pain that he describes as being “hit with a baseball bat. ” BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Scene Size Up l Use all senses to evaluate scene for potential hazards l Control the risk – Scene safety ◦ What should you do to ensure that the rescuers are safe? continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Scene Size Up Copyright J. Selkowitz BRADY National Ski Patrol, Outdoor Emergency Care, 5

General Impression l Chief ◦ ◦ complaint What is the most important symptom? Traumatic? Medical? Specific location? Life threatening? l MOI or NOI ◦ What likely caused the injury? ◦ What is the source of the medical concern? BRADY continued National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

General Impression l Initial patient appearance ◦ What do you see when you look at the patient? • • Expressions of pain? Blood? Deformities? Skin color? l May allow establishment of priorities for care and transport BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment l The formal process in which injuries and illnesses are identified l The most important skill in patient care l Allows for assessment to be performed in a systematic, organized manner each time l Includes the primary and secondary assessments BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Primary Assessment l Identify/Assess ◦ ◦ all life threats Airway Breathing Circulation Disability • C-Spine • CSM of extremities ◦ Level of consciousness • AVPU / Glasgow Coma Scale BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update You ask permission to assess and treat the patient. The patient says, “Yes. ” The patient is awake and speaks to you in two- or three-word sentences. His airway is open, he is having trouble breathing. His pulse is 100/rpm. The patient complains of a persistent pain on the left side of his chest. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Secondary Assessment Medical History SAMPLE Signs/Symptoms l Allergies l Medications l Past med history l Last oral intake l Events leading up to the incident l BRADY OPQRST Onset l Provocation/Palliation l Quality l Radiation l Severity l Time l National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Secondary Assessment Physical Exam l Systematic head-to-toe, hands-on assessment l Initiate BSI l Look, then touch ◦ ◦ Head (scalp, face, ears, eyes) Neck (C-Spine) Trunk (chest, abdomen, back, pelvis) Extremities continued l Expose BRADY as appropriate National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Secondary Assessment Physical Exam l DCAP ◦ ◦ ◦ ◦ BRADY – BTLS Deformity Contusions Abrasions/Avulsions Punctures/Penetrations Burns / Bleeding / Bruises Tenderness Lacerations Swelling National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Secondary Assessment Vital Signs l Vital Signs ◦ Level of Consciousness • AVPU scale ◦ Pulse • Rate and quality ◦ Respirations • Rate and quality ◦ Blood Pressure • Regular and Orthostatic ◦ Temperature BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Special Assessment Considerations l Unresponsive patient ◦ Assume C-Spine injury l Communication barriers l Cultural diversity l Aggressive behavior l Pediatric patients l Geriatric patients BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Environmental Considerations l Assess just enough to provide urgent care and ensure safe transport ◦ ◦ BRADY Temperature Slope/incline Bright sun Wind, dust, rain, dark National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Reassessment l Patient condition is dynamic, so assessment must be ongoing l Frequency determined by patient condition ◦ More severe = more frequent checks l ABCDs BRADY and vitals should be tracked National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Disposition You call for backup and perform a physical exam on the patient. You notice some discoloration on the left upper portion of the patient’s chest. He has some tenderness in his lower back, near his spine. Pulses in both the upper and lower extremities are equal and strong. The vital signs are normal. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Your first priority is scene safety. l Assess the ABCDs first. l The chief complaint is the patient’s primary concern. l Stabilize all potential threats to life before performing a secondary assessment. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l. A significant MOI for a patient who has no signs of physical injury should raise your suspicions. l A minor MOI does not mean that the patient has no serious injury. l Use SAMPLE, OPQRST, and DCAPBTLS when performing a secondary assessment. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Know the normal values of vital signs. Any abnormalities should raise your level of concern. l Reassess the patient frequently. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ