EMT 100EMT 100

Patient Assessment

Vital SignsVital Signs

*SIGNS OF LIFE*

PulsePulse

Is the heart rate expressed in beats per minute

Radial Artery Palpation

Carotid Artery Palpation

Normal Pulse ValuesNormal Pulse Values

Adult – 60-100Children – 80-100Infants – 100-140

Rapid Weak Pulse May Be A Rapid Weak Pulse May Be A Sign Of Shock!Sign Of Shock!

RespirationRespiration

Expressed in breaths per minuteEach breath consists of an inspiration and

an expirationLook, Listen, and Feel!

Normal Respiration RatesNormal Respiration Rates

Adults = 12-20Children = 20-40Infants = 30-50

Rapid And Shallow Rapid And Shallow Respirations May Be A Sign Respirations May Be A Sign

Of Shock!Of Shock!

TemperatureTemperature

Normal = 98.6F or 37CWarm, dry skin

Cool, Clammy Skin May Be A Cool, Clammy Skin May Be A Sign Of Shock!Sign Of Shock!

Skin ColorSkin Color

Pale, white ashen appearance, ie Pallor, may be a sign of shock!

Bluish, gray skin, ie Cyanosis, shows poor oxygenation of the blood

Yellowish-orange skin, ie Jaundice, may be a sign of liver disease or blood disease

PupilsPupils

Normally are the same size and react equally to light

Level of Consciousness (LOC)Level of Consciousness (LOC)assessed by asking:assessed by asking:

Who are you? (Orientation to self)What were you doing? (Orientation to

situation)Where are you ? (Orientation to place)What day of the week is it? (Orientation to

time)

LOC LOC continuedcontinued

Questions must be asked in this orderMay need to assess every few minutesAs patients become disoriented, they lose

the ability to answer the questions in the reverse order that they are asked

Psychological ConcernsPsychological Concerns

Extremely aberrant behavior by the patient may be a manifestation of illness or injury

Psychological Concerns Psychological Concerns ((continuedcontinued))

Be in controlBe supportiveBe honest

Golden RuleGolden Rule

Treat each patient the way you would want to be treated if you were

the patient!

Patient Assessment Patient Assessment SequenceSequence

Perform scene size-up.Perform primary assessment.Obtain SAMPLE History.Secondary assessment—head to toe exam.Perform on-going re-assessment.

Step I: Scene Size-upStep I: Scene Size-up

Maintain body substance isolation.Maintain scene safety.Determine mechanism of injury or

nature of illness.Determine need for additional

resources.

Step II: Step II: Perform Primary Perform Primary

AssessmentAssessmentLook for Life-Look for Life-

Threatening ConditionsThreatening Conditions Form general impression of patient. Assess responsiveness. Check airway. Check breathing. Check circulation.

Primary Assessment:Primary Assessment:Assess ResponsivenessAssess Responsiveness

AVPU ScaleAVPU Scale

AAlert

VVerbal

PPain

UUnresponsive

Primary Assessment: Primary Assessment: Check Patient’s AirwayCheck Patient’s Airway

Head tilt–chin lift technique

– The tongue is the most common cause of obstruction in

an unconscious person

Jaw-thrust technique

Inspect mouth

Insert airway if needed

Primary Assessment: Primary Assessment: Check Patient’s BreathingCheck Patient’s Breathing

If conscious: – Check rate and quality.– Check for any difficulty.

If unconscious:– Look, listen, and feel for breathing.– Start rescue breathing, if needed.

Primary Assessment:Primary Assessment:Check Patient’s Check Patient’s

CirculationCirculationCheck carotid or radial pulse.Check for severe bleeding.Check skin color and temperature:

– Pale - decreased circulation– Flushed - excess circulation– Yellow - liver problems

Step III: Patient’s Medical Step III: Patient’s Medical HistoryHistory

SSigns/Symptoms (Chief Complaint)AAllergiesMMedicationsPPertinent, past medical historyLLast oral intakeEEvents associated with or leading to

the injury or onset of illness

Step IV: Seconday Step IV: Seconday Assessment - Physical Assessment - Physical

ExaminationExaminationCheck patient from head to toe

for non-life-threatening conditions.Purpose of exam is to locate and begin

initial management of injury or illness.

Physical Exam: Physical Exam: Examine the Patient from Head Examine the Patient from Head

to Toeto Toe• Look and feel for signs of injury:

• Deformity• Open injuries• Tenderness• Swelling

• Search all areas of body in a clear, concise, consistent format.

Examine Patient’s Head and Examine Patient’s Head and EyesEyes

• Examine head:– Use both hands.– Do not move patient’s head.– Remove eyeglasses.– Remove wigs if necessary.

• Examine eyes: – Cover one eye for 5 seconds. – Watch for pupil contraction.

Examine Patient’s Neck and Examine Patient’s Neck and ChestChest

• Examine neck:– Examine each side; check for pain.–Check neck veins.–Check for a medical identification tag.

Examine Patient’s ChestExamine Patient’s Chest

• Examine chest:

– Check for pain on inhalation/exhalation.

– Look for signs of difficult breathing.

– Note injuries, bleeding, or abnormal, unequal, or painful movement.

– Check for collarbone or rib fractures.

Examine Patient’s AbdomenExamine Patient’s Abdomen

• Look for signs of external bleeding, penetrating injuries, or protruding parts. • Check for stomach rigidity or swelling.• Check for soiled clothing.• Check genital area for external injuries.

Examine Patient’s Pelvis Examine Patient’s Pelvis • Examine pelvis:

– Check for obvious bruising, bleeding, or swelling.– Check for pain if no pain has been reported.

• Examine back:– Stabilize head and neck and log-roll– Check one side of the back at a time.

Examine the ExtremitiesExamine the ExtremitiesObserve the extremity.Examine for tenderness.Check for movement.Check for sensation.Assess the circulatory status.

Step V: On-going Step V: On-going ReassessmentReassessment

Monitor patient’s vital signs:

– Every 5 minutes if unstable.

– Every 15 minutes if stable.

Maintain an open airway.

Monitor breathing and pulse.

Monitor skin color and temperature.

It is time for lab!

Check and record the radial/carotid pulse and the respirations of 5 fellow students

Primary SurveyPrimary Survey

Looks for life-threatening conditions!

Determine whether victim is Determine whether victim is conscious or unconscious, conscious or unconscious,

then check:then check:

AirwayBreathingCirculationHemorrhageShock

Secondary SurveySecondary Survey

Is a head to toe survey that looks for other injuries/problems

Secondary Survey (Secondary Survey (contcont.).)

Neck Skull Face, Nose, and Mouth Chest and Lungs Abdomen Pelvis, Genitals, Incontinence Extremities Back and Buttocks Reassure!

Don’t Overlook:Don’t Overlook:

Situation Bystanders, Family or

Friends Medications and

Medical History Wallet Cards Vial of Life Med-Alert Tags