(VERY IMPORTANT)

Patient Assessment

Learning Goals

Scene size up 2 part patient assessment ( Intervention)

Confidence with patient assessment! Realize there are 1237498723489 unknowns

and the point of this is to cover the things that are most important

Understand why we do the patient assessment how we do it (if it makes sense to you you’ll do it right)

Get super comfortable taking vitals

Acronyms

ABCD (E)s MOI NOI LOR DCAP-BTLS PERRL SAMPLE OPQRST AVPU

Scene Size Up

Easy to be like OMG A PATIENT and ignore the surroundings Is it safe to enter the scene?

Examples of why it wouldn’t be?How will you treat and transport this patient?MOI vs. NOIAlways introduce yourself and gain permission to

help first. What is the chief complaint?Even if a patient looks fine, never rule anything

out until you have asked what happened.

Patient Assessment

“Fortunately, the process need not be daunting” Primary Assessment

Life threatening situation?? Unresponsive patient vs. responsive ABCDs

Secondary Assessment SAMPLE history Head-to-toe Vitals

Evaluating an Unresponsive Patient

Check for response by tapping the victims shoulder and shouting

Open airway, check for breathing and check carotid pulse

If breathing normally continue primary assessment

If there is no pulse, start chest compressions (CPR)

If there is a pulse but no breathing, start rescue breathing

ABCDs

Airway: having an open and patent airway which will remain open

Breathing: being able to breathe, so oxygen gets to the body’s tissues effectively and carbon dioxide is removed

Circulation: having blood moving through the vessels to perfuse the tissues

Disability: having a normal mental status and central and peripheral neurologic function, includes having no spinal injury

How to Open an Airway

Head-tilt, chin-lift maneuver

Jaw-thrust maneuver

Normal Vital Signs

Adult Child (1-8 years)

Infant (Birth-1 year)

Pulse 60 – 100 beats per minute

80 – 100 100 – 120

Respirations 12 – 20 respirations per minute

15 – 30 75 – 95

Blood Pressure Systolic Diastolic

90 – 140 mmHg60 – 90 mmHg

80 – 100 75 – 95

Temperature 97.0 – 100.4 97.0 – 100.4 97.0 – 100.4

How to Check Level of Responsiveness

Normal conditions: awake and oriented AAO x 4:

Awake, alerted and oriented to person, place, time and situation

If they miss the answer to even just one question it could signify a brain injury

Important to measure over timePediatric patients

Glasgow Coma Scale vs. AVPU

Glascow Coma Scale AVPU

Eyes • 4 opens eyes spontaneously • 3 opens eyes to verbal stimuli• 2 opens eyes to pain • 1 does not open eyes Verbal• 5 speaks coherently • 4 speaks confusedly • 3 mutters words in response to

pain• 2 moans in response to pain • 1 no verbal response to pain Motor • 6 follows commands• 5 localizes pain • 4 withdrawals from pain • 3 has a flexor response to pain• 2 has an extensor response to pain • 1 has no motor response to pain

A – Alert

V – Unresponsive, but responds to verbal stimuli

P – unresponsive, but responds to painful stimuli

U – unresponsive to pain

SAMPLE History

S – Signs and Symptoms What’s the difference between a sign and a

symptom? A – Allergies M – Medications P – Past medical history L – Last oral intake (Last ins and outs)E – Events leading to incident

OPQRST

O – onset When did the pain start? Was it sudden or gradual?

P – provocation and palliation Do they know what caused the pain? Does anything make it worse or

better? Q – quality

Describe the pain. Is it dull, sharp, throbbing? R – radiation

Point to where the symptoms are most intense. Does the pain stay in one spot?

S – severity Ask to rate the pain from 1 – 10. What is their worst pain?

T – time How long as the patient had this problem and has it changed over time?

Physical Exam (DCAP – BTLS)

D – deformity C – contusions A – abrasions/avulsionsP – punctures/penetrations B – burns/bleeding/bruisesT – tenderness L – lacerations S – swelling

Physical Exam

Do a head to toe physical exam Check eyes

Pupils are Equal, Round and Reactive to Light – PERRL, then check eye movement

Examine: head, neck, chest, abdomen, back, pelvis, extremities

Check for Vital Signs: Level of responsiveness, pulse rate, respiration rate,

blood pressure and body temperature Pulse: radial pulse (side of wrist), carotid pulse (neck),

brachial pulse (biceps), femoral pulse (leg and lower abdomen)

Adult Child (1-8yrs)

Infant (0-1)

Pulse 60-100 80-100 100-120

Respirations

12-20 15-30 25-50

Systolic BP 90-140 80-100 75-95

Diastolic BP

60-90

Temperature

97-100.4 97-100.4 97-100.4

Who’s heart rate has gone up?

Special Assessment Considerations

Unresponsive patients: CPR Check for breathing and pulse in less than 10 seconds Ask relatives, friends or bystanders for information ABCD MAINTAIN OPEN AIRWAY Everything else same as for a responsive patient minus

assessment of sensation and movement in extremities Cultural Diversity Communication Barriers Environmental Conditions