Patient Assessment during Influenza Epidemics Patient Assessment during Influenza Epidemics An...

Patient Assessmentduring Influenza Epidemics

Patient Assessmentduring Influenza Epidemics

An Outline of theApproach to Patients

An Outline of theApproach to Patients

Raymond L. Fowler, M.D., FACEPRaymond L. Fowler, M.D., FACEP

Associate Professor of Emergency MedicineAssociate Professor of Emergency Medicineandand

Co-Chair of the Section onCo-Chair of the Section onEMS, Disaster Medicine, and Homeland SecurityEMS, Disaster Medicine, and Homeland Security

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Chief of Medical OperationsChief of Medical OperationsThe Dallas Metropolitan BioTel SystemThe Dallas Metropolitan BioTel System

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Associate Professor of Emergency MedicineAssociate Professor of Emergency Medicineandand

Co-Chair of the Section onCo-Chair of the Section onEMS, Disaster Medicine, and Homeland SecurityEMS, Disaster Medicine, and Homeland Security

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Chief of Medical OperationsChief of Medical OperationsThe Dallas Metropolitan BioTel SystemThe Dallas Metropolitan BioTel System

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An immediate responseis requiredto problems foundduring patientassessment

An immediate responseis requiredto problems foundduring patientassessment

For example,an obstructed

airway can bringdeath in a matter

of a coupleof minutes

For example,an obstructed

airway can bringdeath in a matter

of a coupleof minutes

As we assess patients,we must quickly determine

fundamental parametersof their respiratory

and circulatory status.

As we assess patients,we must quickly determine

fundamental parametersof their respiratory

and circulatory status.

Copyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEPCopyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEP

Approaching thePatient

Approaching thePatient


“See what you see!”“See what you see!”

““People look, but theyPeople look, but theydon’t see”don’t see”

……A. Fowler, Jr.A. Fowler, Jr.

““People look, but theyPeople look, but theydon’t see”don’t see”

……A. Fowler, Jr.A. Fowler, Jr.


Alertness? Level of distress?Noises?Respirations?The pulse rate?Skin?Obvious things (bleeding)

Alertness? Level of distress?Noises?Respirations?The pulse rate?Skin?Obvious things (bleeding)


History Taking:This seems to be a “lost black art” for

so many medical providers

What happened?When?LOC?

Major system symptoms?Co-morbid conditions?

Above all: RISK???Above all: RISK???

History Taking:This seems to be a “lost black art” for

so many medical providers

What happened?When?LOC?

Major system symptoms?Co-morbid conditions?

Above all: RISK???Above all: RISK???

Techniques ofPatient Assessment

Techniques ofPatient Assessment

Primary SurveySecondary Survey

Third Survey


Third Survey

Scene Survey/Mechanism/# pts.Scene Survey/Mechanism/# pts.

LOC/Airway/CspineLOC/Airway/Cspine

Respiratory Rate and LaborRespiratory Rate and Labor

Pulses R & Q, N & WSkin CMT/CRT/External Bleeding


Neck appearance, JVD, TracheaNeck appearance, JVD, Trachea

Chest appearance, BS, HTChest appearance, BS, HT

Quick survey of abdomen, pelvis,extremities, and back

Quick survey of abdomen, pelvis,extremities, and back

The Primary SurveyThe Primary Survey

Abbreviations:

R & Q – Rate and Quality

N & W – Neck and Wrist

CMT – Color, Moisture, Temperature

CRT – Capillary Refill Time

JVD – Jugular Venous Distension

BS – Breath Sounds

HT – Heart Tones

Abbreviations:

R & Q – Rate and Quality

N & W – Neck and Wrist

CMT – Color, Moisture, Temperature

CRT – Capillary Refill Time

JVD – Jugular Venous Distension

BS – Breath Sounds

HT – Heart Tones

Scene Survey/Mechanism/# pts.

LOC/Airway/Cspine

Respiratory Rate and Labor


Neck appearance, JVD, Trachea

Chest appearance, BS, HT

Quick survey of abdomen, pelvis,and extremities

Scene Survey/Mechanism/# pts.

LOC/Airway/Cspine

Respiratory Rate and Labor


Neck appearance, JVD, Trachea

Chest appearance, BS, HT

Quick survey of abdomen, pelvis,and extremities Reveals threats to

Basic PhysiologyReveals threats toBasic Physiology

. . .the vital elements of the Primary Survey. . .the vital elements of the Primary Survey

The Order of the SurveyThe Order of the Survey

11

22

33

44

55

…flows in an orderly way from head to toe…flows in an orderly way from head to toe

HeadHead

NeckNeck

Upper ExtremitiesUpper Extremities

ChestChest

AbdomenAbdomen

PelvisPelvis

Lower ExtremitiesLower Extremities

The Secondary SurveyThe Secondary Survey

LOCLOC

AirwayAirway

BreathingBreathing

CirculationCirculation

Any other pertinent positive or negative

found in the primary or

secondary surveys

Any other pertinent positive or negative

found in the primary or

secondary surveys

The Third SurveyThe Third Survey

For example, if wheezing was found

and treated in theprimary survey,is the wheezing

still there?

If external bleedingwas found and a

dressing put on it,is the bleedingstill stopped?

For example, if wheezing was found

and treated in theprimary survey,is the wheezing

still there?

If external bleedingwas found and a

dressing put on it,is the bleedingstill stopped?

InfluenzaInfluenza

A viral illness producing primarilyA viral illness producing primarilya respiratory illness with fever, a respiratory illness with fever,

coughing, headache, muscle coughing, headache, muscle aches, and sometimes GI Sxaches, and sometimes GI Sx

A viral illness producing primarilyA viral illness producing primarilya respiratory illness with fever, a respiratory illness with fever,

coughing, headache, muscle coughing, headache, muscle aches, and sometimes GI Sxaches, and sometimes GI Sx

Influenza usuallyInfluenza usuallyproduces a mild toproduces a mild to

moderate illnessmoderate illness

Influenza usuallyInfluenza usuallyproduces a mild toproduces a mild to

moderate illnessmoderate illnessEitherEither......EitherEither......

•Cough and feverCough and fever•Severe myalgias & HASevere myalgias & HA•GI SymptomsGI Symptoms

•Cough and feverCough and fever•Severe myalgias & HASevere myalgias & HA•GI SymptomsGI Symptoms

Or a combinationOr a combinationof any of theseof any of these

Or a combinationOr a combinationof any of theseof any of these

Pandemic InfluenzaPandemic Influenza

A small percent of patientsdevelop much more

severe signs and symptoms

A small percent of patientsdevelop much more

severe signs and symptoms

Pandemic InfluenzaPandemic Influenza

•Hemorrhagic pneumonia•Encephalitis

•Severe GI symptoms

•Hemorrhagic pneumonia•Encephalitis

•Severe GI symptoms

Hemorrhagic PneumoniaHemorrhagic Pneumonia

•Profound shortness of breath•Cyanosis and low pulse ox

•Severe coughing•Bloody cough

•Respiratory failure

•Profound shortness of breath•Cyanosis and low pulse ox

•Severe coughing•Bloody cough

•Respiratory failure

EncephalitisEncephalitis

•Fever•Headache

•Altered mental status, confusion•Delirium

•Fever•Headache

•Altered mental status, confusion•Delirium

GastrointestinalGastrointestinal

•Nausea and vomiting•Diarrhea

•Bloody diarrhea•Abdominal pain

•Nausea and vomiting•Diarrhea

•Bloody diarrhea•Abdominal pain

Evaluating theInfluenza PatientEvaluating the

Influenza Patient

FIRSTPROTECT

YOURSELF

FIRSTPROTECT

YOURSELF


Influenza Patient


Third Survey


Third Survey


Influenza PatientAltered LOC?

Respiratory distress?Nature of sputum?Blood pressure?

Nature of any vomitus?Nature of any diarrhea?

Altered LOC?Respiratory distress?Nature of sputum?Blood pressure?

Nature of any vomitus?Nature of any diarrhea?


Influenza Patient

- Altered LOC? *Possible encephalitis*Possible encephalitis- Respiratory distress? *Viral pneumonia or*Viral pneumonia or secondary infectionsecondary infection- Nature of sputum? *Hemoptysis?*Hemoptysis?- Blood pressure? *Shock?*Shock?- Nature of any vomitus? *Bloody?*Bloody?- Nature of any diarrhea? *Bloody?*Bloody?

- Altered LOC? *Possible encephalitis*Possible encephalitis- Respiratory distress? *Viral pneumonia or*Viral pneumonia or secondary infectionsecondary infection- Nature of sputum? *Hemoptysis?*Hemoptysis?- Blood pressure? *Shock?*Shock?- Nature of any vomitus? *Bloody?*Bloody?- Nature of any diarrhea? *Bloody?*Bloody?

Managing theInfluenza Patient

Managing theInfluenza Patient

- Altered LOC? *Sedation, ?airway, *Sedation, ?airway, treat infection?treat infection?- Respiratory distress *Respiratory support,*Respiratory support, treat infections?treat infections?- Shock *Circulatory support*Circulatory support- Vomiting and diarrhea *Volume support*Volume support

- Altered LOC? *Sedation, ?airway, *Sedation, ?airway, treat infection?treat infection?- Respiratory distress *Respiratory support,*Respiratory support, treat infections?treat infections?- Shock *Circulatory support*Circulatory support- Vomiting and diarrhea *Volume support*Volume support

Signs of ShockSigns of ShockWeak, thirsty, lightheaded

Pale, then sweatyTachycardiaTachypnea

Diminished urinary output

Weak, thirsty, lightheadedPale, then sweaty

TachycardiaTachypnea

Diminished urinary output

HypotensionAltered LOC

Cardiac arrestDeath

HypotensionAltered LOC

Cardiac arrestDeath

EarlyEarly

LateLate

Synthesis

Synthesis

A influenzapandemic will

present one of thegreatest challenges

to social andmedical

infrastructureever seen

A influenzapandemic will

present one of thegreatest challenges

to social andmedical

infrastructureever seen

Local, State, andNational Preparedness

are Essential…

Local, State, andNational Preparedness

are Essential…

……if we are to be ableif we are to be ableto make a difference…to make a difference………if we are to be ableif we are to be ableto make a difference…to make a difference…

Drop a lineif you haveany questionsor comments

Drop a lineif you haveany questionsor comments

[email protected]@doctorfowler.com

www.utsw.wswww.utsw.ws““the emergency medicine education website”the emergency medicine education website”

www.utsw.wswww.utsw.ws““the emergency medicine education website”the emergency medicine education website”

mailto:[email protected]

mailto:[email protected]

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