Chapter 012ems.jbpub.com/shade/intermediate1999/docs/lecture_notes/Chapter... · Title: Microsoft...

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Chapter 12

Patient Assessment

Chapter Goal

Integrate principles of history taking & techniques of physical examination to perform patient assessment on emergency patient

Learning Objectives

Describe, recognize, & differentiate common hazards found at scene of trauma patient from those found at scene of medical patient

Differentiate safe from unsafe scenes

Describe methods for making an unsafe scene safe

Discuss common mechanisms of injury

Predict patterns of injury on basis of MOI

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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Learning Objectives Discuss reasons for identifying total number of

patients at scene

Explain reasons for identifying need for additional help or assistance

Summarize reasons for forming general impression of patient

Review methods of assessing mental status & level of consciousness in adult, child, & infant

Learning Objectives

Discuss methods of assessing airway in adult, child, & infant

State reasons for management of cervical spine once patient is declared trauma patient

Analyze scene to determine if spinal precautions are required

Describe methods used for assessing patient breathing

Learning Objectives Differentiate between patient with adequate breathing &

one with inadequate breathing (minute ventilation)

Distinguish between methods of assessing breathing in adult, child, & infant

Compare methods of providing airway care to adult, child, & infant

Describe methods used to locate & assess pulse

Differentiate between locating & assessing pulse in adult, child, & infant


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Learning Objectives

Discuss need for assessing patient for external bleeding

Describe normal & abnormal findings when assessing skin color

Describe normal & abnormal findings when assessing skin temperature

Describe normal & abnormal findings when assessing skin condition

Learning Objectives Explain reasons for prioritizing patient for care &

transport

Identify patients who require expeditious transport

Describe evaluation of patient’s perfusion status based on findings in initial assessment

Describe orthostatic vital signs & evaluate their usefulness in assessing patient in shock

Apply techniques of physical examination to medical patient

Learning Objectives Differentiate between assessment done for patient who

is unresponsive or has altered mental status & assessment done for other medical patients

Discuss reasons for reconsidering MOI

State reasons for doing rapid trauma assessment

Recite examples & explain why patients should receive rapid trauma assessment

Apply techniques of physical examination to trauma patient


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Learning Objectives Describe areas included in rapid trauma assessment &

discuss what should be evaluated

Identify cases where rapid assessment may be altered to provide patient care

Discuss reasons for doing focused history & physical examination

Describe when & why detailed physical examination is necessary

Discuss components of detailed physical examination in relation to techniques of examination

Learning Objectives State areas of body evaluated during detailed exam

Explain what additional care should be provided while doing detailed physical examination

Distinguish between detailed physical examination performed on trauma patient & one performed on medical patient

Differentiate between patients who require detailed physical examination & those who do not

Discuss reasons for repeating initial assessment as part of ongoing assessment

Learning Objectives

Describe components of ongoing assessment

Describe trending of assessment components

Discuss medical identification devices, systems


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Introduction

Patient assessment Structured

Looking for & recognizing• Symptoms

• Signs

Continues throughout time spent with patient

6 phases

Introduction

Scene Size-Up

General approach: Potential scene hazards Ensure safe environment Anticipate potentially

hazardous situations Call for appropriate

resources


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Scene Size-Up

General approach Before care given—rapid

assessment based on: • Dispatch information

• Previous knowledge

• On-scene observations

Scene Size-Up

BSI precautions Formerly called universal

precautions

CDC recommendations—guidelines are law

Scene Size-Up

BSI precautions


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Scene Size-Up

Ensuring scene safety Main purpose

Consider environment

Situation hostile

Special equipment

Ensure your personal protection

Scene Size-Up

Determine MOI & NOI

Initial Assessment

Rapid, organized, systematic evaluation

General impression

Life-threatening problems, injuries

Mental status—AVPU


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Initial Assessment

Airway status Trauma patient

• Stabilize C-spine

• Perform jaw-thrust maneuver

Initial Assessment

Assess airway status

Initial Assessment

Assess patient’s breathing

Palpate chest for equal expansion


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Initial Assessment

Assess patient’s circulation Patient unresponsive— check

carotid pulse first

Pulse present—estimate BP• Carotid—60 mm Hg systolic

• Femoral—70 mm Hg systolic

• Radial—80 mm Hg systolic

Initial Assessment

Check for major bleeding Assess skin—determine

perfusion status

Places where color assessed

Abnormal skin colors: • Red

• Pale

• Yellow

• Mottled red or pale

• Cyanosis

Initial Assessment

Capillary refill—subject of controversy


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Initial Assessment

Identify “priority” patients Require more advanced-level care

Availability of care

Lights & siren

Guidelines for identifying “priority” patients

Initial AssessmentResuscitation

Focused History & Physical Exam

Trauma patient

Medical patient

Mechanism of injury, transport decision help identify “priority” patients

Infants & small children

Rapid trauma assessment—DCAP-BTLS


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Focused History & Physical Exam

Hidden injuries

Rapid medical assessment

Focused history & physical exam Trauma patient

Medical patient—OPQRST

Detailed Physical Examination

Organized

Specific

“Priority” patients

Detailed Physical Examination


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Ongoing Assessment

Stable patient

Unstable patient

Parameters

Definitive field management

Transportation Specialty centers Helicopter transport The “3 Rs”

Contacting medical direction

Summary

Patient assessment—structured method of evaluating patient’s physical condition

During scene size-up, evaluate “whole picture” of call

The initial assessment—organized approach

Focused history & physical exam—evaluate patient on basis of suspected condition

Summary

Following rapid trauma assessment—obtain baseline vital signs

Detailed assessment—more detailed exam that is patient & injury specific

Patient assessment is ongoing process

Many conditions cannot be completely managed in field


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Questions?


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