(Fergus) Chapter 10: Patient Assessment in EMS + The Review Questions that where at the end of the slides

Patient Assessment

The foundation of quality EMS care that helps identify life threats, make decisions, and guide treatment in the field.

Sign (Sx)

An Objective condition that can be observed or measured, such as bleeding, cyanosis, or abnormal vital signs.

Symptom (Si)

A Subjective condition that the patient feels and reports, such as pain, dizziness, or shortness of breath.

Scene Size-Up

Ensure the scene is safe and identify the situation

Primary Assessment

identifying and managing immediate life threats.

History Taking

The gathering of the patient's medical history and chief complaint.

Secondary Assessment

Performing a focused or full-body physical exam based on the patient's condition.

Reassessment

rechecking vital signs and evaluating response to treatment.

Minimum PPE

Gloves and eye protection

Scene Hazards

• Environmental conditions (weather, terrain)

• Traffic hazards

• Unstable structures

• Violence or hostile individuals

• Downed power lines or fire

Key Considerations for Scene Entry

Do not enter until the scene is confirmed safe and plan your exit route accordingly.

Emergency Scenes are ____

Dynamically changing environments that require continuous situational awareness.

Delayed Entry is better than ___

becoming a second victim.

Mechanism of Injury (MOI)

• What type of force was involved?

• How much force was applied?

• For how long?

• Where did it impact the body?

Nature of Illness (NOI)

• Difficulty breathing

• Possible seizure

• Altered mental status

• Unknown cause

Ingress

The act of entering or accessing the scene.

Egress

The act of exiting or leaving the scene.

How to determine Spinal Immobilization

• Does dispatch information suggest potential spine injury?

• Example: fall from height, rollover crash, unresponsive patient

MOI involves:

• Sudden deceleration

• Blunt trauma

• Axial loading (e.g., diving injury)

• Ejection or rollover

GLC MARCH stands for ___

G => Form a General Impression

L => Determine the LOC

C => Inquire about Chief Complaint

M => Assess and STOP Massive Bleeding.

A => Assess and manage Airway

R => Assess and treat inadequate Respirations

C => Assess and treat inadequate Circulation

H => Assess and treat Hypothermia - Shock Management

Level of Consciousness (LOC)

A measure of a patient's awareness and responsiveness.

Chief Complaint

the patient's main reason for calling 911

how to be Professional

• Remain calm, respectful, and nonjudgmental

• Do not label patients (e.g., "frequent flyer")

• A frequent caller may present with a new, serious problem

Purpose of General Impression

Determine priority of care, decide if the patient is 'Big Sick' or 'Little Sick', identify immediate or potential life threats.

What to Observe in General Impression

Level of distress, position of the patient, massive bleeding, breathing effort, skin signs, eye tracking and responsiveness.

AVPU Scale

A method to assess responsiveness: A - Alert, V - Responsive to Voice, P - Responsive to Pain, U - Unresponsive.

A&O Status

Alert and Oriented ×1-4: Person, Place, Time, Event.

what 3 things does Glasgow Coma Scale (GCS) assess

A standardized tool used to assess a patient's level of consciousness by scoring Eye Opening, Verbal Response, Motor Response.

GCS Score range

Ranges from 3 (deep coma) to 15 (fully alert).

Why Use GCS

Establishes a baseline neurologic status, detects changes in mental status, guides triage, transport priority, and receiving facility.

Localizes Pain (GCS Motor Score: _)

5 - The patient purposefully moves a hand or arm toward the source of pain, indicating a higher level of brain function.

Withdraws From Pain (GCS Motor Score: _)

4 - The patient pulls away or withdraws the limb when pain is applied, indicating a lower level of neurologic response.

Decorticate Posturing

The patient flexes the arms and wrists and extends the legs, indicating damage to the area of the brain above the brainstem.

GCS Motor Score for Decorticate Posturing

3

Decerebrate Posturing

The patient extends the arms and legs, arches the head, and rotates the hands outward, indicating damage at the level of the brainstem.

GCS Motor Score for Decerebrate Posturing

2

Altered Mental Status

Any deviation from alert and oriented ×4 or any change from the patient's normal baseline. Any change from the patient's normal baseline, which may be significant even if they're normally confused.

Memory Evaluation

Includes long-term, intermediate, and short-term memory assessments.

Massive Bleeding

Pooling, Soaking, Spurting

Four Ds of Massive Hemorrhage

Detect, Direct pressure, Devices, Don't Dilute.

how to assess airway?

• Stay alert for signs of airway obstruction

• Ensure the airway is open (patent)

• Confirm it is adequate to support breathing

how to assess respiratory status

• Rate - fast, slow, or absent

• Rhythm - regular or irregular

• Quality - shallow, deep, labored, or gasping

• Medical Assessment add:

• Lung sounds - present, equal, or abnormal

• Pulse oximetry (SpO₂) - check oxygen saturation

• Establish the patient's normal baseline if they have chronic respiratory disease.

• If breathing is inadequate or signs of hypoxia are present:

• Initiate oxygen therapy as indicated

• Assist ventilations if necessary

signs of obstruction of ariway

• Obvious trauma, blood, vomitus, or other obstructions in the mouth or airway

• Snoring

• Gurgling or bubbling

• Crowing or other abnormal upper airway sounds

• Very shallow or absent breathing

Jaw-Thrust Maneuver

Used to open the airway if trauma is suspected.

Head Tilt-Chin Lift

Used to open the airway if no trauma is suspected.

If breathing is inadequate or signs of hypoxia are present:

• Initiate oxygen therapy as indicated

• Assist ventilations if necessary

observe how much effort the patient uses to breathe by looking for:

• Retractions (intercostal, supraclavicular)

• Use of accessory muscles (neck, shoulders, abdomen)

• Nasal flaring (especially in pediatric patients)

• Two- to three-word dyspnea - patient can only speak a few words at a time

• Tripod position - seated, leaning forward, hands on knees

• Sniffing position - head forward, chin out

• Labored breathing - visible struggle or fatigue with each breath

Respiratory Distress

Condition where the patient is breathing but with increased work and effort.

Respiratory Failure

Condition where breathing is inadequate to meet the body's oxygen demand, requiring immediate intervention.

Normal adult pulse rate

60-100 bpm.

Tachycardia

Fast pulse that may indicate shock, fever, stress, or blood loss.

Bradycardia

Slow pulse that may be normal in athletes or due to hypothermia or head injury.

where should u check for pulse

radial/pedial first then carotid if no radial/pedial pulse

Irregular rhythm May indicate _?

a cardiac abnormality or poor perfusion.

Strong quality pulse May indicate _?

Indicates normal circulation.

Weak or thready pulse May indicate _?

possible shock or poor perfusion.

Bounding pulse May indicate _?

fever, hypertension, or anxiety.

Normal skin color

Pink and well-perfused.

Abnormal skin color

Pale (poor perfusion), flushed (heat/fever), cyanotic (hypoxia), or mottled (shock).

Normal skin temperature

Warm.

Cool or cold skin

May indicate shock or hypoperfusion.

Hot skin

Suggests fever or environmental heat exposure.

Capillary refill

Used to assess how well the circulatory system restores blood to the capillaries.

Normal capillary refill time

< 2 seconds.

Delayed capillary refill

May indicate shock, cold environment, or poor perfusion.

Control External Bleeding

Apply direct pressure over the wound or a tourniquet if direct pressure is not effective.

Hypothermia

A critical factor in trauma care that can worsen patient outcomes if not addressed early.

Trauma Triad of Death

A combination of hypothermia, acidosis, and reduced clotting ability that can occur in trauma patients.

Acidosis

Develops as shock progresses, interfering with oxygen delivery.

Reduced Clotting Ability

The blood becomes too thin or unable to form effective clots.

Pale, cool, diaphoretic skin

An early indicator of shock even before blood pressure drops.

Rapid Trauma Assessment

A quick head-to-toe check to find life-threatening injuries that must be treated or protected before transport.

Significant MOI

Mechanism of Injury that is severe enough to warrant a Rapid Trauma Assessment.

Transport Priority

Determined after the Primary Assessment based on airway, breathing, circulation, and bleeding control.

The Golden Hour

The critical time frame from injury to definitive care that greatly impacts survival outcomes.

High-Priority Patients

Patients who are unresponsive, have difficulty breathing, uncontrolled bleeding, altered LOC, severe chest pain, pale skin, complicated childbirth, or severe pain.

Transport Decision Factors

Consider patient condition, advanced care availability, distance to facility, and local protocols when making transport decisions.

Code 2

Non-Emergent Transport with no lights and sirens, used for stable patients not experiencing a life-threatening emergency.

Code 3

Emergent Transport with lights and sirens activated for patients with life-threatening injuries or illness requiring immediate intervention.

Spinal Motion Restriction (SMR)

Considered when a spinal injury is suspected or found during assessment.

Signs of Spinal Injury

Include significant mechanism of injury, pain or tenderness in the neck or spine, numbness, tingling, weakness in extremities, altered mental status, or distracting injuries.

Failure to immobilize a spine-injured patient

Can result in permanent neurological damage.

Reassess airway, breathing, circulation

A step to ensure major bleeding is controlled and critical interventions are in place before transporting the patient.

Transport Decision Factors: Patient Condition

Refers to whether the patient is stable or unstable, which influences transport decisions.

Transport Decision Factors: Local Protocols

Guidelines that dictate destination and transport mode based on patient condition.

Immediate life threat

A condition that may require delaying transport to manage before proceeding.

Choosing the Appropriate Receiving Facility

Based on the patient's condition and local EMS protocols.

Trauma Center

Severe injuries with significant MOI, penetrating trauma, unstable vitals

Stroke Center

Sudden neurologic changes (e.g., facial droop, slurred speech, arm drift)

STEMI/Cardiac Center

Chest pain, ECG changes, cardiac history

OB/Perinatal Center

Complicated childbirth, high-risk pregnancy

Closest Appropriate Facility

For general medical care if the patient is stable

Initial general impression

What you first notice as you approach the patient, but before physical contact is made.

Focused assessment

Takes place during the secondary assessment, if appropriate.

Cyanosis

A bluish discoloration of the skin due to inadequate oxygen.

Gurgling respirations

A sound indicating fluid in the airway.

Severe bleeding

A significant loss of blood that can lead to shock.

Rapid heart rate

An increased heart rate that may indicate stress or shock.

Mechanism of injury

The method by which damage to skin, muscles, organs, and bones occurs.

Penetrating trauma

Injury that occurs when an object pierces the skin and enters the body.

High-risk pregnancy

Pregnancy with potential complications that could affect the mother or fetus.