EMT 12

Primary assessment

Rapid, systemic assessment used to identify and treat immediate threats to life

Six parts of primary assessment

1: General impression

2: Mental status

3: Airway

4: Breathing

5: Circulation

6: Priority

What determines the order in which you address airway, breathing, and circulation

Patient’s immediate threats; Treat the problem most likely to kill the patient first

ABC during primary assessment

Airway, breathing, circulation

Significance of agonal / gasping respirations

Not adequate normal breathing, should be treated as a sign requiring a pulse check and possible CPR

What should you do if you discover a life threatening problem during primary assessment

Immediately perform the appropriate intervention to correct it

Why is depressed mental status concerning

It can indicate a life threatening problem such as inadequate oxygen reaching the brain or shock and may increase risk of airway problems

Signs that an airway may be threatened or obstructed

Depressed responsiveness, being supine, noisy breathing

Appropriate interventions for obstructed or threatened airway

Open the airway, suction, use an airway adjunct, perform airway clearance procedures as indicated

After ensuring an open airway, what three things do you assess about breathing

Rate, depth, and adequacy

When is positive pressure ventilation indicated

When the patient is not breathing or is breathing inadequately

Three things assessed when evaluating circulation

Pulse, skin, bleeding

Skin findings that suggest shock

Pale, cool, clammy / moist skin

Three patient priority classifications

Stable, potentially unstable, unstable

Stable patient

No immediate / imminent life threat and vital signs in normal range or slightly abnormal

Potentially unstable patient

No immediate life threat, condition could deteriorate; Transport should not be unnecessairly delayed

Unstable patient

Serious / immediate threat to life or significant risk of deterioration requiring rapid transport and primarily lifesaving care on scene

Indications of high transport priority

Poor general impression, unresponsiveness, responsive but not following commands, difficulty breathing, shock, complicated child birth, cardiac type chest pain / discomfort, uncontrolled bleeding , severe pain

General impression based on

Environment, chief complaint, patient appearance

Look test

Quickly observing the environment and patient for clues about the patients condition and severity

Clinical judgment

Judgment developed through experience observing and treating patients that helps recognize the seriousness of a patients condition

Relationship between clinical judgment and systematic assessment

Clinical judgment helps guide assessment, but systematic approach is still necessary to avoid missing life threats

SMR

Spinal motion restriction - Restricting movement of the head, neck, and spine when spinal injury is possible or likely

Priority over maintaining spinal motion restriction

Lifesaving interventions such as airway maintenance, ventilation, or control of life threatening bleeding

Three components of Pediatric Assessment Triangle

Appearance, work of breathing, circulation to skin