Scene Size Up Pt Assessment Scene Sizeup Body

Scene Size Up Pt Assessment

Scene Size-up Body substance isolation Scene Assessment – – Scene safety Location of all patients Mechanism of injury Nature of the illness Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Always stop to size up the scene before going in. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Scene Assessment Routes of extrication for crew and patient Number of patients Need for additional resources – Extrication equipment – Additional transport units – Additional manpower Use of all of your senses. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Scene Safety Natural hazards Fire Risk of violence Traffic Chemical/industrial agents Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Location of All Patients Scene size-up also includes a search of the area to locate all of the patients. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury External vehicle damage – Forces involved in the collision Interior vehicle damage – Structures damaged inside the vehicle Patient impact – Anatomic regions of the body struck Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Nature of Illness To determine the nature of illness: – Use bystanders, family members, or the patient. – Use the scene to give clues to the patient’s condition. Oxygen equipment in the home Medicine containers General appearance of environment – Remember that the patient’s illness may be very different from the chief complaint. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Initial Assessment Steps Form a general impression. Stabilize the cervical spine. Assess the baseline mental status. Assess the airway. Assess breathing. Assess circulation. Determine priority. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The General Impression The general impression is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mental Status Alert Verbal Painful stimuli Unresponsive Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Airway Assessment If the patient is responsive and can speak clearly, assume the airway is patent. If the patient is unconscious, the airway may be obstructed. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Breathing Assessment Altered mental status Shortness of breath Retractions Asymmetric chest wall movement Accessory muscle use Cyanosis Audible sounds Abnormal rate or pattern Nasal flaring Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Breathing (2 of 2) Rate Depth Presence of bilateral breath sounds Symmetry of chest movement – Observe for accessory muscle use. – Expose the chest wall and palpate for: Structural integrity Tenderness Crepitus Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Circulation Assessment The circulation assessment consists of evaluating the pulse and skin and controlling hemorrhage. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Top Priority Patients Poor general impression Unresponsive Conscious but cannot follow commands Difficulty breathing Hypoperfusion Complicated childbirth Chest pain and BP below 100 systolic Uncontrolled bleeding Severe pain Multiple injuries Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The Focused History and Physical Exam Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Types of Patients Trauma patient with significant mechanism of injury Trauma patient with isolated injury Responsive medical patient Unresponsive medical patient Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Trauma Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Predictors of Serious Internal Injury Ejection from vehicle Death in same passenger compartment Fall from higher than 20 feet Rollover of vehicle High-speed motor vehicle collision Vehicle-passenger collision Motorcycle crash Penetration of the head, chest, or abdomen Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury Considerations for Infants and Children Fall from higher than ten feet Bicycle collision Medium-speed vehicle collision with resulting severe vehicle deformity Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

DCAP-BTLS Deformity Contusion Abrasion Penetration Burns Tenderness Lacerations Swelling Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The Isolated-Injury Trauma Patient No significant mechanism of injury Shows no signs of systemic involvement Does not require an extensive history Does not require a comprehensive physical exam Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Examination of the Musculoskeletal System Observe, inspect, and palpate the joints, structure, and movement. Note: – – – Pain Swelling Deformity Symmetry Tissue changes – Compare strength – Range of motion – Crepitus Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Range of Motion (Active) Have patient position the joints. Watch for decreased or increased movement of the joint compared to the other side as well as the norm. Watch for pain with movement. Listen for crepitus or “popping. ” Watch for abnormal movements. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Range of Motion (Passive) Next position the joints passively, comparing the end points to the active. Note any decrease or increase in movement. Note pain with the movement. Listen for crepitus or “popping. ” Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The Responsive Medical Patient Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The History Chief complaint History of the present illness Past history Current health status Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Components of a Patient History Establishing rapport Chief complaint History of the present illness Past medical history Current health status – Family history – Psychosocial history Review of systems Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Patient Rapport – Active Listening Facilitation Reflection Clarification Empathy Confrontation Interpretation Asking about feelings Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Special Challenges (1 of 2) Silence Overly talkative patients Multiple symptoms Anxiety Depression Sexually attractive or seductive patients Confusing behaviors or symptoms Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Special Challenges (2 of 2) Patients needing reassurance Anger and hostility Intoxication Crying Limited intelligence Language barriers Hearing problems Blindness Talking with families or friends Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Appearance (1 of 2) Level of consciousness Signs of distress Apparent state of health Vital statistics Sexual development Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Appearance (2 of 2) Skin color and obvious lesions Posture, gait, and motor activity Dress, grooming, and personal hygiene Odors of breath or body Facial expression Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The History of the Present Illness (OPQRST-ASPN) Onset Provocation or Palliation Quality Region/Radiation Severity Time Associated Symptoms Pertinent Negatives Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Past Medical History General state of health Childhood and adult diseases Psychiatric illnesses Accidents and injuries Surgeries and hospitalizations Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Psychosocial History Chronic health conditions Job – Work schedule – Stress Family dynamics Support Safety issues – Car seat usage – Smoke and CO alarms Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The physical exam of the medical patient is aimed at identifying medical complications rather than signs of injury. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Examination Techniques Inspection Palpation Auscultation Percussion These 4 techniques are the foundation of the physical exam. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Review of Systems A system-by-system series of questions designed to identify problems your patient has not already identified: – – – – Skin Head Eyes Ears Nose Mouth/Throat Respiratory Cardiovascular – – – – Gastrointestinal Genitourinary Musculoskeletal Neurologic Psychologic Endocrine Hematologic Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Areas of Nervous System Exam Mental status and speech Cranial nerves Motor system Reflexes Sensory system Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

One-Minute Cranial Nerve Exam Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Measure vital signs early in the physical examination and, in the emergency situation, repeat them often and look for trends. Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessing the Unresponsive Medical Patient Initial assessment Rapid medical assessment Brief history Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ongoing Assessment Mental status Airway patency Breathing rate and quality Pulse rate and quality Skin condition Transport priorities Vital signs Focused assessment Effects of interventions Management plans Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

THE END Bledsoe et al. , Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ