Ch 13 - Patient Assessment

pt assessment includes

1. scene size up

2. primary assessment

3. secondary assessment

4. reassessment

primary assessment

• determine the nature of the problem

• manage any immediate life threats

• establish treatment priorities

steps of the primary assessment

1. general impression

2. assess conscious

3. assess airway

4. assess breathing

5. assess oxygenation

6. assess circulation

7. determine priorities

general impression

• see if the pt is stable or unstable

• find the chief complaint

• observe the environment

• identify and control major bleeding or life threats

• estimate the pt’s age

• note the sex

• trauma or medical

self-restriction for spine motion restriction

• pt is instructed to align their head, neck, umbilicus and don’t move

• instruct to keep his toes in line with his nose and navel

if there is no evidence of a spine injury, where can you put the pt

on a stretcher

if there is evidence of a spine injury or the pt is unreliable,

put a cervical collar and place on the stretcher

penetrating trauma

caused by force the pierces the skin and body tissues

blunt trauma

caused by a force that impacts the body, but does not penetrate it

what can offer clues about a pt’s medical condition?

the environment

obtaining the chief complaint

• the reason why EMS was called

• do not assume the original chief complaint is the actual one

what are life threats the require immediate management

• airway is compromised by an object or substance

• obvious open wound in the chest

• paradoxical movement of a segment of the chest (inward on inhalation and outward on exhalation)

• major bleeding

• unresponsive with no or abnormal breathing

in line stabilization

• used when there is a suspected spine injury

• place on hand on each side of the pts head

• bring the head into an in-line position

• place the head in a neutral position

what do you use to assess the level or responsiveness/consciousness

the mnemonic: AVPU

• Alert (can you follow me with your eyes)

• Verbal (can you speak, also shows an open airway)

• Pain (trap/armpit pinch, supraorbital pressure, sternal rub, earlobe pinch, nailbed pressure, pinching the web between the thumb and index finger)

• Unresponsive

what are normal vs abnormal responses to painful stimuli

• norm: movement toward or away from the stimulus

• abnormal: flexion or extension posturing

What type of pts are high priority

unresponsive ones bc it indicates an inability to maintain an airway

how to assess circulation

• pulse

• bleeding

• skin color, temperature, condition

• capillary refill (not always the best, mainly for children)

skin color meanings

• pale/mottled - low perfusion, shock

• cyanotic - low oxygen

• red/flushed - vasodilation

• yellow (jaundice) - liver dysfunction

skin temperature meanings

• hot - environment or high temperature

• cool - environment or low perfusion

• cold - frostbite, hypothermia

• cool, clammy - shock, nervousness, fright

skin condition meanings

• dry - dehydrated, heat stroke, spinal shock, medical conditions

• moist - environment, exertion, shock, medical conditions

secondary assessment

• after the primary to find additional injuries or conditions

• differs between medical or trauma or minor or serious complaints

components of a secondary exam

• physical exam

• baseline vital signs

• history

physical exam

• conducted systematically going from the head to the feet

• look for DCAPPBTLS

  • deformities

  • contusions

  • abrasions

  • punctures

  • penetrations

  • burns

  • tenderness

  • lacerations

  • swelling

in neck during physical assessment, look for

• jugular vein distention

• see if trachea is in place

• subcutaneous emphysema - bubble wrap texture, indicates leak in airway

in chest/ thorax check

• ribs and sternum

• clavicle in place

• auscultate the lungs in “z” motion

in abdomen, during physical assessment,

• separate into 4 sections

• palpate each quadrant looking for distention, discoloration, peritonitis,

• avoid palpating pulsating masses

in pelvis, during physical assessment

• injuries here are critical

• don’t palpate if injuries are obvious

• check for priapism in males

in lower extremities check

• edema (swelling)/sign of injury

• check deep vein thrombosis

• check PMS

in upper extremities check

• injury

• stroke assessment with arm drift

• PMS

pneumatics for obtaining pt history

• SAMPLE

• OPQRST

SAMPLE

• symptoms

• allergies

• medications

• past medical history

• last oral intake

• events prior to incident

OPQRST

• symptoms expanded

• onset

• provocation/palliation

• quality

• radiation

• severity

• time

during secondary assessment what do you reevaluate

priority level of the pt