Patient Assessment Lesson 2 Lesson 2 Patient Assessment

Patient Assessment Lesson 2

Lesson 2 – Patient Assessment Sequence Scene size-up Primary assessment Secondary Ongoing Refer assessment to skills checklist

Primary Assessment This evaluation is designed to locate and manage lifethreatening injuries or illness and to determine the patient's triage priority. 1. General Impression 2. Level of Consciousness 3. Airway and Breathing 4. Circulation

Lesson 2 – General Impression Primary Assessment Initial assessment Second step in assessment process Occurs only after scene is safe and under control All patients receive primary assessment Main goal – identify lifethreatening conditions

Lesson 2 – Primary Assessment Sequence Importance Steps include: Form general impression Assess level of consciousness Assess airway and breathing Assess circulation

Lesson 2 – General Impression: overall sense or feeling about a patient Use senses to look, listen, and smell

Lesson 2 – General Impression Approaching a Patient Identify State yourself you are there to help Speak even if patient appears unconscious Obtain expressed consent Implied consent

Lesson 2 – General Impression Chief Complaint The reason EMS was called to scene Is the Patient Stable? Stable but potentially unstable Unstable

Lesson 2 – General Impression Assess Life Threats If life threats discovered, stop assessment and provide treatment Common life threats • Airway blocked or partially blocked • Lack of pulse • Major bleeding • Major open chest wounds • Paradoxical movement

Lesson 2 – Level of Consciousness (LOC) Measurement of responsiveness to stimuli Assessed with AVPU check • (A) Alert • (V) Responds to verbal stimuli • May open eyes or move body in response to voice • If no response, instruct to “squeeze my hand” • If patient does not do this, administer painful stimuli • (P) Responds to painful stimuli • (U) Unresponsive

Lesson 2 – Level of Consciousness Responds to Painful Stimuli (P) Stimuli • Trapezius squeeze • Other painful stimuli Observe patient’s response If no response – considered unresponsive

Lesson 2 – Airway and Breathing Assessing the ABCs Airway, Breathing, Circulation Assess the Airway If patient talking, assume open airway Examine mouth and throat for obstructions, remove Listen stridor for abnormal sounds like

Lesson 2 – Airway and Breathing Open the Airway occlusion (blockage) common in unresponsive patients Open the airway Head-tilt, chin-lift maneuver Jaw-thrust Continue maneuver to reassess and maintain airway

Lesson 2 – Airway and Breathing Assess Breathing Look: chest rising and falling Listen: air entering and exiting Feel: breath moving in and out Normal adult rate 12 -20 breaths per minute

Lesson 2 – Airway and Breathing Status Normal breathing rates • Adults 12 -20 breaths/min • Children 15 -30 breaths/min • Infants 25 -50 breaths/min • Newborns 30 -60 breaths/min Depth of breathing: deep, shallow, or normal

Lesson 2 – Airway and Breathing Difficulties Respiratory Signs distress of difficulties: Noisy or abnormal breathing sounds Nostril Neck flaring muscle bulging Intercostal Excessive retractions use of abdominal muscles Tripod position

Lesson 2 – Airway and Breathing Managing Breathing Oxygen should be administered to: • Patient experiencing abnormal breathing • Unresponsive patient • Cyanotic patient

Lesson 2 - Circulation Status ABC: Airway, Breathing, Circulation Assess: • Pulse • Severe bleeding • Skin • Capillary refill in children

Lesson 2 - Circulation Pulse Pressure wave of blood that surges through an artery Precise reading not necessary during primary assessment Is heartbeat slow, normal, fast or irregular?

Lesson 2 - Circulation Evaluate the Pulse Check by feeling with fingertips Radial pulse Carotid pulse Brachial If pulse no pulse, perform manual CPR immediately

Lesson 2 - Circulation Perfusion The distribution of blood to the cells in the body Evaluate the following: • Skin color • Skin temperature • Skin moisture • Capillary refill in children

Lesson 2 - Circulation Skin Color Areas that are usually pink: • Adults: nail beds, lips, inside of lower eyelids, inside of cheek • Infants and children: lips, palms of hands, soles of feet • Dark-skinned persons: palms of hands

Lesson 2 - Circulation Skin Temperature and Moisture Feel patient’s skin with back of your hand Normal circulation: dry or slightly moist skin Other findings may indicate a problem • Cool skin • Wet or sweaty skin • Hot and moist skin • “Goose pimples”

Lesson 2 - Circulation Capillary Refill Should be evaluated in children under 6 yrs. old Press on skin on top of hand, foot or kneecap and release Should take 2 seconds for pink color to return for normal circulation Not dependable if patient exposed to cold temperatures