1 patient assessment in the field ems professions temple college
TRANSCRIPT
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Patient Assessment in The Field
EMS Professions
Temple College
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Patient Assessment
Problem-oriented evaluation to identify potentially life-threatening injury or disease
Followed by clinical decision-making to determine course of action
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Components
Dispatch InformationScene Size-UpMOI or Nature of IllnessSafety ConsiderationsGeneral Impression Initial AssessmentFocused History Physical Exam: Detailed, Focused & Ongoing
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Dispatch Information
May Provide: Mechanism Hazards No. of patients Special resources
required
Example: “Respond to a car vs.
train with car fire. Multiple victims.”
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Size-Up
Begins with dispatch infoCreate a mental image of the scene
Update the image as new info is available
Finalize the image on arrival
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Visual Size-Up on Approach
What do you see? Hazards Mechanism Est. No. of patients Special Needs
Radio Size-Up What is involved? Mechanism Severity Actions taken &
resources neededWhat is your size-up of this incident?
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Scene Assessment
Who is the patient? More than one = triage
Special resources or actions needed Extrication/Rescue Haz Mat Additional transport & manpower
What really happened? “Tell me a story”
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General Impression of the Scene
MOI or Nature of IllnessThe EnvironmentLocation & Position of Patient(s)General Appearance & BehaviorObvious Injuries or IllnessPatient’s Activity & Awareness
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Scene Size-Up Practice
#1#1
#2
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Safety Considerations
Safety What types of specific
hazards might you encounter in these situations & how can you minimize your risk of injury/illness?
Violent actsMVCIll person in a building
Group Discussions
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General Impression
Sick or Not Sick Is there an obvious emergent problem? Is there a potentially life-threatening
condition? Does the patient need immediate
interventions?What is your overall summation of
the patient’s condition?
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Initial Assessment(Primary Survey / ABCDEs)
Cervical Spine (if indicated)Manual immobilization in neutral position
AirwayObvious Difficulty or abnormal soundsClear & Position as needed
BreathingEst Rate, Pattern, Effort & SymmetryLung sounds - present or absentVentilate, Oxygen, Decompression, Occlusion
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Initial Assessment(Primary Survey / ABCDEs)
CirculationCentral & Peripheral pulsesAmplitude, Regularity, Est Rate ID CauseSkin color, moisture & temp Severe hemorrhage Control
Disability/DefibrillationMental Status - LOCPosturingObvious sensory or motor deficitsCardiac arrest - The Hunt for VF!
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Initial Assessment(Primary Survey / ABCDEs)
ExposureRemove clothing as neededPrevent from overexposure to environment
Determine PriorityTreat Life-Threatening problems
immediately; Load & Go OR Slightly Delayed
Direct Baseline Vital Signson scene or en route
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Initial Assessment(Primary Survey / ABCDEs)
Branching Points Rapid Trauma AssessmentOr Detailed Physical ExamOr Focused Physical Exam
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The Rapid Trauma Assessment
Objective: Identify whether the patient needs to be transported now and why
Rapid Head to ToeWhat specifics structures or findings are
you interested in assessing in the rapid trauma assessment?
Group Discussions: 1) Head to chest, 2) Abdomen to Pelvis and back, 3) Extremities & Others
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Patient Priority
What are examples of patients with a high priority requiring immediate transport? Why are they a
high priority?
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Detailed vs Focused Physical Exam
What determines the need for the detailed vs the focused physical exam? What is included in the focused physical exam?
Which systems and structures? What is included in the detailed physical exam?
Group Discussions: What additional examinations or tests would you do in the detailed that were not done in the rapid trauma assessment?
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Preparation & Reassess
Preparation for Immediate Transport Backboard, C-Collar, CID, 10 pt. Straps MAST & Splints applied if appropriate Cover and protect from environment Secure all if heli transport
Reassess Reassess all interventions & vital signs Early notification to receiving facility
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History of the Present Illness - Sample History
SAMPLE History Symptoms - Current symptoms Allergies - specifics, focus on meds Medications - current prescribed medications
and OTC meds Past medical History - significant, pertinent Last oral intake - potential surgical
candidates Events preceding the incident
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History of the Present Illness - Current Health Status
Current Health Status Current Medications and OTC meds Risk factors for disease Family history Alcohol and/or substance abuse Immunizations Occupation or environmental factors
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History of the Present Illness - OPQRST
Onset - What was occurring at onset? Contributing factors
Provocation/Palliation - What makes it worse or better?
Quality - Describe specifically. Prompt with example choices
Region/Radiation - Exactly where is the pain? Does it radiate? Where?
Severity - How bad? Rate on a scale of 10. Time - Time of onset. Duration of pain/symptoms. Associated Symptoms & Pertinent Negatives
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History of the Present Illness
Gathering history is like charting a map Identify pertinent negatives to rule out
possibilities Continue looking for evidence
supporting a specific diagnosis or limited differential dx.
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Additional Diagnostics
Blood glucose levelPulse oximetryECGDiagnostic (12 Lead) ECGCincinnati Prehospital Stroke ScaleFuture
Cardiac Enzymes, Predictive instruments, Abdominal Ultrasound
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Neurologic System ExamLOC, Pulse, Motor and Sensory are the basicsCranial Nerves
Pupillary response to light (III) Ocular movement (III, IV, VI) Clench teeth (V) Show teeth; Raise eyebrows (VII) Open mouth and stick out tongue (XII) Gag Reflex (IX, X) Shrug shoulders (XI)
Symmetry, Pain response, Point discrimination
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Develop a plan
Likely DiagnosisAppropriate
TherapiesWhat if? Plan for the
worstStay two steps aheadMD Consult if neededTransport
appropriately