Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

The Initial AssessmentThe Initial Assessment

IntroductionIntroduction

Purpose is to rapidly identify and Purpose is to rapidly identify and manage the life-threats. manage the life-threats.

Every patient should receive an Every patient should receive an initial assessment.initial assessment.

Treat any life-threats immediately.Treat any life-threats immediately. Most patients do not have life-Most patients do not have life-

threatening problems.threatening problems.

Your General ImpressionYour General Impression

The environment (ie: bottom of stairs, The environment (ie: bottom of stairs, out in the cold, tripod position, pool of out in the cold, tripod position, pool of blood)blood)

Patient’s MOI/NOIPatient’s MOI/NOI Patient’s age and sexPatient’s age and sex Patient’s degree of distressPatient’s degree of distress Listen for the chief complaintListen for the chief complaint Keep the priority of care in focusKeep the priority of care in focus© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Mental StatusMental Status

Are they conscious or unconscious? (if Are they conscious or unconscious? (if unconscious do CPR quick-check)unconscious do CPR quick-check)

Introduce yourselfIntroduce yourself What’s your name? (oriented to person)What’s your name? (oriented to person) Do you know where you are? (oriented to Do you know where you are? (oriented to

place)place) What day of the week is it? (oriented to day)What day of the week is it? (oriented to day) How can I help you today? (chief complaint)How can I help you today? (chief complaint)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

A V P UA V P U

AAlert – oriented to person, place, and lert – oriented to person, place, and day (“big three”)day (“big three”)

VVerbal – cannot answer the “big three” erbal – cannot answer the “big three” correctlycorrectly

PPainful – either appropriate, ainful – either appropriate, inappropriate, or posturing inappropriate, or posturing (decorticate/decerebrate)(decorticate/decerebrate)

UUnresponsivenresponsive© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway StatusAirway Status

The 3 key questions:The 3 key questions: Is the airway open?Is the airway open? Will the airway stay open?Will the airway stay open? Does anything endanger the airway?Does anything endanger the airway?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway StatusAirway Status

Factors to consider:Factors to consider: UnconsciousnessUnconsciousness Suspected spinal injurySuspected spinal injury ObstructionObstruction

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Airway StatusAirway Status

Complex airway problems:Complex airway problems: Impaled object(s)Impaled object(s) Significant MOI (i.e.: gunshot)Significant MOI (i.e.: gunshot) BurnsBurns Crushed or fractured larynxCrushed or fractured larynx

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

BreathingBreathing

The 6 key questions:The 6 key questions: Is the patient breathing?Is the patient breathing? What’s the respiratory rate?What’s the respiratory rate? Is the rate adequate?Is the rate adequate? Does anything endanger breathing?Does anything endanger breathing? Can the patient take a deep breath?Can the patient take a deep breath? Is the patient having trouble breathing?Is the patient having trouble breathing?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

BreathingBreathing

AdequacyAdequacy DyspneaDyspnea Chest wall stabilityChest wall stability

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Circulatory StatusCirculatory Status

Ask the 3 key questions:Ask the 3 key questions: Does the patient have a pulse?Does the patient have a pulse? What is the quality of the pulse?What is the quality of the pulse? Is there any major bleeding that needs Is there any major bleeding that needs

to be controlled?to be controlled?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Assess the PulseAssess the Pulse

Distal vs. proximalDistal vs. proximal Infant and child pulsesInfant and child pulses External hemorrhageExternal hemorrhage Skin signs (CTC): Skin signs (CTC):

ColorColor TemperatureTemperature ConditionCondition

Capillary refill (in children)Capillary refill (in children)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Make a Priority Decision!Make a Priority Decision!

High or low priorityHigh or low priority Transportation decisionTransportation decision Is ALS needed (consider an intercept)Is ALS needed (consider an intercept)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

ConclusionConclusion

Quickly assess for life-threats!Quickly assess for life-threats! Remember the key steps of the initial Remember the key steps of the initial

assessment (MS-ABC).assessment (MS-ABC). Make a priority and transport Make a priority and transport

decision! decision!