PATIENT ASSESSMENT/MANAGEMENT—TRAUMA

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PATIENT ASSESSMENT/MANAGEMENT—TRAUMA Start Time:_________________ Stop Time:__________________ Date:_________________ Candidate’s Name:___________________________________ Evaluator’s Name:___________________________________ Points Points Possible Awarded Takes, or verbalizes, body substance isolation precautions 1 SCENE SIZE-UP Determines the scene is safe 1 Determines the mechanism of injury 1 Determines the number of patients 1 Requests additional help if necessary 1 Considers stabilization of spine 1 INITIAL ASSESSMENT Verbalizes general impression of patient 1 Determines responsiveness/level of consciousness 1 Determines chief complaint/apparent life threats 1 Assesses airway and breathing Assessment 1 Initiates appropriate oxygen therapy 1 Assures adequate ventilation 1 Injury management 1 Assesses circulation Assesses/controls major bleeding 1 Assesses pulse 1 Assesses skin (color, temperature, and condition) 1 Identifies priority patients/makes transport decision 1 FOCUSED HISTORY AND PHYSICAL EXAM/RAPID TRAUMA ASSESSMENT Selects appropriate assessment (focused or rapid assessment ) 1 Obtains or directs assistant to obtain baseline vital signs 1 Obtains S.A.M.P.L.E. history 1 DETAILED PHYSICAL EXAMINATION Assesses the head Inspects and palpates the scalp and ears 1 Assesses the eyes 1 Assesses the facial areas including oral and nasal areas 1 Assesses the neck Inspects and palpates the neck 1 Assesses for JVD 1 Assesses for tracheal deviation 1 Assesses the chest Inspects 1 Palpates 1 Auscultates 1 Assesses the abdomen/pelvis Assesses the abdomen 1 Assesses the pelvis 1 Verbalizes assessment of genitalia/perineum as needed 1 Assesses the extremities 1 point for each extremity 4 includes inspection, palpation, and assessment of motor, sensory and circulatory function Assesses the posterior Assesses thorax 1 Assesses lumbar 1 Manages secondary injuries and wounds appropriately 1 point for appropriate management of secondary injury/wound 1 Verbalizes re-assessment of the vital signs 1 Total: 40 Critical Criteria ___ Did not take, or verbalize, body substance isolation precautions ___ Did not determine scene safety. ___ Did not assess for spinal protection ___ Did not provide for spinal protection when indicated ___ Did not provide high concentration of oxygen ___ Did not find, or manage, problems associated with airway, breathing, hemorrhage or shock (hypoperfusion) ___ Did not differentiate patient’s need for transportation versus continued assessment at the scene ___ Did other detailed physical examination before assessing airway, breathing, and circulation ___ Did not transport patient within (10) minute time limit

Transcript of PATIENT ASSESSMENT/MANAGEMENT—TRAUMA

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PATIENT ASSESSMENT/MANAGEMENT—TRAUMAStart Time:_________________Stop Time:__________________ Date:_________________Candidate’s Name:___________________________________Evaluator’s Name:___________________________________

Points PointsPossible Awarded

Takes, or verbalizes, body substance isolation precautions 1SCENE SIZE-UPDetermines the scene is safe 1Determines the mechanism of injury 1Determines the number of patients 1Requests additional help if necessary 1Considers stabilization of spine 1INITIAL ASSESSMENTVerbalizes general impression of patient 1Determines responsiveness/level of consciousness 1Determines chief complaint/apparent life threats 1Assesses airway and breathing Assessment 1

Initiates appropriate oxygen therapy 1Assures adequate ventilation 1Injury management 1

Assesses circulation Assesses/controls major bleeding 1Assesses pulse 1Assesses skin (color, temperature, and condition) 1

Identifies priority patients/makes transport decision 1FOCUSED HISTORY AND PHYSICAL EXAM/RAPID TRAUMA ASSESSMENTSelects appropriate assessment (focused or rapid assessment) 1Obtains or directs assistant to obtain baseline vital signs 1Obtains S.A.M.P.L.E. history 1DETAILED PHYSICAL EXAMINATIONAssesses the head Inspects and palpates the scalp and ears 1

Assesses the eyes 1Assesses the facial areas including oral and nasal areas 1

Assesses the neck Inspects and palpates the neck 1Assesses for JVD 1Assesses for tracheal deviation 1

Assesses the chest Inspects 1Palpates 1Auscultates 1

Assesses the abdomen/pelvis Assesses the abdomen 1Assesses the pelvis 1Verbalizes assessment of genitalia/perineum as needed 1

Assesses the extremities 1 point for each extremity 4includes inspection, palpation, and assessment of motor,sensory and circulatory function

Assesses the posterior Assesses thorax 1Assesses lumbar 1

Manages secondary injuries and wounds appropriately1 point for appropriate management of secondary injury/wound 1Verbalizes re-assessment of the vital signs 1

Total: 40Critical Criteria

___ Did not take, or verbalize, body substance isolation precautions___ Did not determine scene safety.___ Did not assess for spinal protection___ Did not provide for spinal protection when indicated___ Did not provide high concentration of oxygen___ Did not find, or manage, problems associated with airway, breathing, hemorrhage or shock (hypoperfusion)___ Did not differentiate patient’s need for transportation versus continued assessment at the scene___ Did other detailed physical examination before assessing airway, breathing, and circulation___ Did not transport patient within (10) minute time limit

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Takes, or verbalizes, body substance isolation precautions 1

Voices opening the airway 1

Voices inserting an airway adjunct 1

Selects appropriately sized mask 1

Creates a proper mask-to-face seal 1

Ventilates patient at no less than 800 ml volume 1(The examiner must witness for at least 30 seconds)

Connects reservoir and oxygen 1

Adjusts liter flow to 15 liters/minute or greater 1

The examiner indicates the arrival of second EMT. The second EMT is instructed to ventilate the patientwhile the candidate controls the mask and the airway.

Voices re-opening the airway 1

Creates a proper mask-to-face seal 1

Instructs assistant to resume ventilation at proper volume per breath 1(The examiner must witness for at least 30 seconds)

BAG-VALVE-MASKAPNEIC PATIENTStart Time:

Stop Time: Date:Candidate’s Name:Evaluator’s Name:

PointsPossible

PointsAwarded

Critical Criteria___ Did not take, or verbalize, body substance isolation precautions___ Did not immediately ventilate the patient___ Interrupted ventilations for more than 20 seconds___ Did not provide high concentration of oxygen___ Did not provide, or direct assistant to provide, proper volume/breath

(more than two(2) ventilations per minute are below 800 ml)___ Did not allow adequate exhalation

11Total:

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SPINAL IMMOBILIZATIONSUPINE PATIENT

Start Time:_________________Stop Time:__________________ Date:_________________Candidate’s Name:___________________________________Evaluator’s Name:___________________________________

Points PointsPossible Awarded

Takes, or verbalizes, body substance isolation precautions 1Directs assistant to place/maintain head in neutral in-line position 1Directs assistant to maintain manual immobilization of the head 1Re-assesses motor, sensory and circulatory function in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device appropriately 1Directs movement of the patient onto the device without compromising the 1integrity of the spineApplies padding to voids between the torso and the board as necessary 1Immobilizes the patient’s torso to the device 1Evaluates the pads behind the patient’s head as necessary 1Immobilizes the patient’s head to the device 1Secures the patient’s legs to the device 1Secures the patient’s arms to the device 1Reassesses motor, sensory and circulatory function in each extremity 1

Critical Criteria___ Did not immediately direct, or take, manual immobilization of the head___ Released, or ordered release of, manual immobilization before it was maintained mechanically___ Patient manipulated, or moved excessively, causing potential spinal compromise___ Patient moves excessively up, down, left or right on the patient’s torso___ Head immobilization allows for excessive movement___ Upon completion of immobilization, head is not in the neutral position___ Did not reassess motor, sensory, and circulatory function in each extremity after immobilization to the

device___ Immobilized head to the board before securing the torso

Total: 14

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SPINAL IMMOBILIZATIONSEATED PATIENT

Start Time:_________________Stop Time:__________________ Date:_________________Candidate’s Name:___________________________________Evaluator’s Name:___________________________________

Points PointsPossible Awarded

Takes, or verbalizes, body substance isolation precautions 1Directs assistant to place/maintain head in neutral in-line position 1Directs assistant to maintain manual immobilization of the head 1Reassesses motor, sensory and circulatory function in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device behind the patient 1Secures the device to the patient’s torso 1Evaluates torso fixation and adjusts as necessary 1Evaluates and pads behind the patient’s head as necessary 1Secures the patient’s head to the device 1Verbalizes moving the patient to a long board 1Reassesses motor, sensory and circulatory function in each extremity 1

Critical Criteria___ Did not immediately direct, or take, manual immobilization of the head___ Released, or ordered release of, manual immobilization before it was maintained mechanically___ Patient manipulated, or moved excessively, causing potential spinal compromise___ Device moved excessively up, down, left or right on patient’s torso___ Head immobilization allows for excessive movement___ Torso fixation inhibits chest rise, resulting in respiratory compromise___ Upon completion of immobilization, head is not in the neutral position___ Did not reassess motor, sensory and circulatory function in each extremity after voicing immobilization

to the long board___ Immobilized head to the board before securing the torso

Total: 12

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ischial strap)

immobilize the hip

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BLEEDING CONTROL/SHOCK MANAGEMENT

Start Time:Stop Time: Date:Candidate’s Name:Evaluator’s Name:

Takes, or verbalizes, body substance isolation precautions 1

Applies direct pressure to the wound 1

Elevates the extremity 1

Note: The examiner must now inform the candidate that the wound continues to bleed.

Applies an additional dressing to the wound 1

Note: The examiner must now inform the candidate that the wound still continues to bleed. The second dressing does not control the bleeding.

Locates and applies pressure to appropriate arterial pressure point 1

Note: The examiner must now inform the candidate that the bleeding is controlled.

Bandages the wound 1

Note: The examiner must now inform the candidate that the patient is now showing signs and symptoms indicative of hypoperfusion.

Properly positions the patient 1

Applies high concentration oxygen 1

Initiates steps to prevent heat loss from the patient 1

Indicates the need for immediate transportation 1

Critical Criteria

___ Did not take, or verbalize, body substance isolation precautions___ Did not apply high concentration of oxygen___ Applied a tourniquet before attempting other methods of bleeding control___ Did not control hemorrhage in a timely manner___ Did not indicate a need for immediate transportation

Total: 10

PointsAwarded

PointsPossible

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AIRWAY, OXYGEN, AND VENTILATION SKILLSUPPER AIRWAY ADJUNCTS AND SUCTION

OROPHARYNGEAL AIRWAYStart Time:_________________Stop Time:__________________ Date:_________________Candidate’s Name:___________________________________Evaluator’s Name:___________________________________

Points PointsPossible Awarded

Takes, or verbalizes, body substance isolation precautions 1

Selects appropriately sized airway 1

Measures airway 1

Inserts airway without pushing the tongue posteriorly 1

Note: The examiner must advise the candidate that the patient is gagging and becoming conscious.

Removes the oropharyngeal airway 1

Critical Criteria___ Did not take, or verbalize, body substance isolation precautions___ Did not obtain a patent airway with the oropharyngeal airway___ Did not obtain a patent airway with the nasopharyngeal airway___ Did not demonstrate an acceptable suction technique___ Inserted any adjunct in a manner dangerous to the patient

Total: 13

NOTE: The examiner must advise the candidate to suction the patient’s airway.

Turns on/prepares suction device 1

Assures presence of mechanical suction 1

Inserts the suction tip without suction 1

Applies suction to the oropharynx/nasopharynx 1

SUCTION

NOTE: The examiner must advise the candidate to insert a nasopharyngeal airway.

Selects appropriately sized airway 1

Measures airway 1

Verbalizes lubrication of the nasal airway 1

Fully inserts the airway with the bevel facing toward the septum 1

NASOPHARYNGEAL AIRWAY

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MOUTH TO MASK WITH SUPPLEMENTAL OXYGENStart Time:_________________Stop Time:__________________ Date:_________________Candidate’s Name:___________________________________Evaluator’s Name:___________________________________

Points PointsPossible Awarded

Takes, or verbalizes, body substance isolation precautions 1Connects one-way valve to mask 1Opens patient’s airway or confirms patient’s airway is open 1(manually or with adjunct)

Establishes and maintains a proper mask to face seal 1Ventilates the patient at the proper volume and rate 1(800–1200 ml per breath/10–20 breaths per minute)

Connects mask to high concentration of oxygen 1Adjusts flow rate to at least 15 liters per minute 1Continues ventilation of the patient at the proper volume and rate 1(800–1200 ml per breath/10–20 breaths per minute)

Note: The examiner must witness ventilations for at least 30 seconds

Critical Criteria___ Did not take, or verbalize, body substance isolation precautions___ Did not adjust liter flow to at least 15 liters per minute___ Did not provide proper volume per breath

(more than 2 ventilations per minute were below 800 ml)___ Did not ventilate the patient at a rate of 10–20 breaths per minute___ Did not allow for complete exhalation

Total: 8

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OXYGEN ADMINISTRATION

Takes, or verbalizes, body substance isolation precautions 1Assembles the regulator to the tank 1Opens the tank 1Checks for leaks 1Checks tank pressure 1Attaches non-rebreather mask to oxygen 1Prefills reservoir 1Adjusts liter flow to 12 liters per minute or greater 1Applies and adjusts the mask to the patient’s face 1Note: The examiner must advise the candidate that the patient is not tolerating the nonre-breather mask. The medical director has ordered you to apply a nasal cannula to the patient.

Attaches nasal cannula to oxygen 1Adjusts liter flow to six (6) liters per minute or less 1Applies nasal cannula to the patient 1Note: The examiner must advise the candidate to discontinue oxygen therapy

Removes the nasal cannula from the patient 1Shuts off the regulator 1Relieves the pressure within the regulator 1

Critical Criteria

___ Did not take, or verbalize, body substance isolation precautions___ Did not assemble the tank and regulator without leaks___ Did not prefill the reservoir bag___ Did not adjust the device to the correct liter flow for the non-rebreather mask

(12 liters per minute or greater)

___ Did not adjust the device to the correct liter flow for the nasal cannula (6 liters per minute or less)

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PointsPossible

PointsAwarded

Total:

Start Time:Date:Stop Time:

Candidate’s Name:Evaluator’s Name:

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