Reviving Your Patient Assessment - Dan Limmerdanlimmer.com/handouts/Revising Patient Assessment.pdf1...
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1 Reviving Your Patient Assessment Daniel Limmer, EMT-P Goals • Define early assessment and interventions • Improve overall patient assessment • Define the need and conditions for ALS intercept • Patient assessment tips and tricks Medical vs Trauma Assessment
Transcript of Reviving Your Patient Assessment - Dan Limmerdanlimmer.com/handouts/Revising Patient Assessment.pdf1...
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Reviving YourPatient Assessment
Daniel Limmer, EMT-P
Goals
• Define early assessment andinterventions
• Improve overall patient assessment• Define the need and conditions for
ALS intercept• Patient assessment tips and tricks
Medical vs TraumaAssessment
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Medical Assessment
• History-based• Conscious versus Unconscious• Interventions may help
80% History20% Exam
Trauma Assessment
• Examination based• Mechanism of injury• Platinum ten minutes/Golden Hour• Limited interventions
20% History80% Exam
Trauma Assessment Timeline
• Size-up• Initial assessment• Rapid trauma exam• Vitals• History• Transport
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Scene Size-up
• Safety• Mechanism of Injury• Resources needed• Number of patients• BSI
General Impression
• What is it?• What does it do for us?
Identifying Critical Patients
• Altered mental status orunconsciousness
• Unable to maintain own airway• Respiratory distress• Chest pain
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Classic Postures
Identifying Critical Patients
• Poor skin color and diaphoresis• Severe pain anywhere
The “Look Test”
• Sleepy, head bobbing, AMS• Positioning indicating difficulty
breathing or chest pain• Poor skin color and diaphoresis
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Communicating Effectively
• Body language and position• Listen to your patient• Observe
Initial Assessment
• Identify and correct life threats!• Airway• Breathing• Circulation• Disability• Expose
Primary SurveyVs
Initial Assessment
Airway
• Is it open?• Is it clear?• Will it remain open if I divert my
attention somewhere else?
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Patients who recover fromcardiac arrest are likely to die
from aspiration pneumonia
Suction isimportant!
Breathing
• Is the patient breathing?• Is the patient breathing enough to
support life?• Oxygen administration• Assisting ventilations
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Circulation
• Is there a pulse?• Is there serious bleeding?
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Disability
• AVPU• Pupils• Neuro status
Expose
• Strip ‘em and Flip ‘em
Initial Assessment
What have we learned?
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ALS Intercept
• When do we call for assistance?• Why do we call for assistance?
ALS Capabilities
• Severe respiratory distress• Cardiac problems• Medical shock• Anaphylaxis• Overdose• Trauma?
Sometimes the closest ALSis the Hospital.
Don’t waste time waiting forALS when the hospital is closer
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Intercepts
• Scene• Enroute• Air evacuation
After theInitial Assessment
What is next?
A
B
C
D
E
Medical Patient
• History taking provides a majorityof the clues
• SAMPLE History
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Medical Patient History
• Big 5 Questions
•Heart problems•Respiratory Problems•Stroke•Diabetes•Seizures
Medical Patient History
• Rephrase questions
• Do you have any medical problems?• Do you take any medications?• Do you see a doctor for anything?• Have you ever been admitted to the
hospital?
Trauma Patient
• Mechanism of injury
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Trauma Patient
• Mechanism of injury
Significant
Rapid TraumaAssessment
Not significant
Focused PhysicalExamination
Rapid Trauma Assessment
• Head, neck, chest, abdomen,extremities, posterior
• Quick• “Big picture” view of the patient• Detailed exam may be done in
route - time permitting to checknooks and crannies
Focused Physical Exam
• One specific part of the body• When there is no possibility of
hidden injuries
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From the home office :
Top TenPatient Assessment Tips
10 Patient Assessment Tips
• Don’t splint your patient to death
10Ten Patient Assessment Tips
• Listen to gut feelings (look test)• Experienced clinicians use it
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Ten Patient Assessment Tips
• Roll vomiting patients away fromyou
8Ten Patient Assessment Tips
• Assure adequate breathing
7Ten Patient Assessment Tips
• Patients with fractured femursnever feel relief--no matter howmuch traction you apply
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Ten Patient Assessment Tips
• In serious trauma patients you maynever get to palpate the ankles
• And that is OK
5Ten Patient Assessment Tips
• Don’t be distracted by obviousinjuries
4Ten Patient Assessment Tips
• Don’t be distracted by obvious injuries• Keeping “in order” with the process is
good.
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Ten Patient Assessment Tips
• Don’t wait for low blood pressureto consider shock
3Ten Patient Assessment Tips
• Before the BP drops• Skin color• Respirations• Pulse• GI/nausea and vomiting
Ten Patient Assessment Tips
• Bring your defibrillator• 1 minute = 10%
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Ten Patient Assessment Tips
• Treat your patient as you wouldwant your Grandmother treated(unless you hate your Grandmother)
1Dan Limmer, EMT-P
P.O. Box 292Kennebunkport, Maine 04046
