Patient Assessment

INITIAL ASSESSMENT

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Patient Assessment

Components of the Initial Assessment

• Develop a general impression• Assess mental status• Assess airway “A”• Assess the adequacy of

breathing “B”• Assess circulation “C”• Identify patient priority

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Patient Assessment

Develop a General Impression

• Looks for life-threatening conditions• Occurs as you approach the scene and

the patient

• Assessment of the environment

• Patient’s chief complaint

• Presenting signs and symptoms of patient

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Patient Assessment

Distinguishing Between Medical and Trauma

• Determination should come after assessment is finished.

• Patients may have traumatic injuries caused by a medical reason.

• Initially assume all patients have both medical and traumatic aspects to their condition.

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Patient Assessment

Level of Consciousness

• A Alert

• V Responsive to Verbal stimulus

• P Responsive to Pain

• U Unresponsive

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Patient Assessment

Assessing the Airway (Unconscious)

• Open the airway

• Head tilt, chin lift technique.

• Look, Listen, Feel for breathing for 5 seconds.

• If not breathing, give two initial breaths.

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Patient Assessment

Assessing the Airway (Conscious)

• Look for signs of airway compromise:

• Two- to three-word dyspnea

• Use of accessory muscles

• Nasal flaring and use of accessory muscles in children

• Labored breathing

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Patient Assessment

Assessing Breathing

• Are the patient’s respirations shallow or deep?

• Does the patient appear to be choking?

• Is the patient cyanotic (blue)?

• Is the patient moving air into and out of the lungs as the chest rises and falls?

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Patient Assessment

Managing Breathing

• If patient is having difficulty breathing re-evaluate airway.

• Consider assisting ventilations with a BVM or applying a nonrebreathing mask if patient’s respirations are greater than 24/min or less than 8/min.

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Patient Assessment

Unresponsive Patients

• Look, listen and feel for breathing about 5 seconds

• Consider spinal cord injury.

• Provide high-flow oxygen.

• Assist ventilations if needed.

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Patient Assessment

Assessing Circulation (1 of 2)

• Assess the pulse.

• Rate, rhythm and strength

• Assess and control external bleeding.

• Direct pressure

• Evaluate skin color.

• Cyanotic, flushed, pale or jaundiced

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Patient Assessment

Assessing Circulation (2 of 2)

• Evaluate skin temperature.

• Skin is an organ.

• Evaluate skin condition.

• Dry or moist

• Evaluate capillary refill.

• Should be less than 2 seconds

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Patient Assessment

Identifying Priority Patients• Poor general

impression

• Unresponsive

• Difficulty breathing

• Signs of poor perfusion (capillary refill)

• Uncontrolled bleeding

• Severe pain

• Severe chest pain

• Inability to move any part of the body

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Patient Assessment

Goals of Exam

• Identify life threatening conditions.

• Identify the patient’s chief complaint.

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Patient Assessment

The Golden Hour

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Patient Assessment

Trauma Assessment

• D Deformities

• O Open Wounds

• T Tenderness

• S Swelling

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Patient Assessment

Trauma Assessment

• D Deformities

• C Contusions

• A Abrasions

• P Punctures/ Penetrations

• B Burns

• T Tenderness

• L Lacerations

• S Swelling

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Patient Assessment

Assessing the Responsive Patient

• Ask general questions to find out the chief complaint.

• If they answer, they are conscious, breathing, and have a pulse.

• Listen to the patient.

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Patient Assessment

Review

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Patient Assessment

The Communication Process

• Do what you can to make the patient comfortable.

• Listen to the patient.• Make eye contact.• Base questions on the

patient's complaint.• Mentally summarize before

starting treatment.