EMT CH 10

assessment process

1. scene size

2. primary assessment

3. history taking

4. secondary assessment

5. reassessment

signs

Objective findings that can be seen her felt smelled or measured

Symptoms

subjective finding that the patient feels but can be identified by only the patient

Field impression

conclusion about the cause of the patient’s condition after considering the situation, history and examination findings

Understanding the causes and presentations of common emergencies helps you form a

Field Impression

Primary assessment

1.form a general impression

2.Assess level of consciousness

3. Access the ABC, A, for airway, B for breathing, see for circulation,

4. Identify entry life threats

5. performed primary assessment

6. Determined priority of patient care and transport

Primary assessment

1.form a general impression

2.Assess level of consciousness

3. Access the ABC, A, for airway, B for breathing, see for circulation,

4. Identify entry life threats

5. performed primary assessment

6. Determined priority of patient care and transport

History taking

investigate the chief complaint equals history of present illness

• Obtain SAMPLE history

secondary assessment

• perform a general systematic assessment of the patient

• Perform a focus systematic assessment of patient

reassessment

• repeat the primary assessment

• Reassess vital signs

• Reassess the chief complaint or chief concern

• recheck interventions

• Identify and treat Changes in the patient’s condition

• Reassess the patient

• Unstable patients every five minutes stable patients every 15 minutes

how often do you reassess an unstable patient?

Every five minutes

How often do you reassess a Stable patient?

every 15 minutes

scene size up definition

A step within patient assessment process that involves a quick assessment of the scene in the surroundings to Provide information About

• scene safety

• mechanism of injury

• nature of wellness before you enter and begin

seeing size up conditions prior to responding categories

• Weather, traffic and road conditions

• Time of day

• Currently available resources

• Other incidents in the same response district

scene size up understanding, dispatcher information examples

• Incident hazards

• Fire hazardous materials extrication

• Ingress and egress to the location

• Equipment needed

• Physical threats of violence

• Patient’s age

• Observations of the scene

what is your focus of attention when you arrive on the scene?

Scene size up

what is necessary throughout an entire call?

Situational awareness

Situational awareness definition

Knowledge and understanding of once surroundings and the ability to recognize potential risks to the safety Of the patient or EMS team

scene size of overall important points

• Ensure scene safety

• determine mechanism of injury/nature of illness

• Take standard precautions

• Determine main number of Patients

• Consider additional/specialized resources

how to ensure a scene safety

1. Look for signs of danger

2. Ask yourself if it’s safe for your team to enter the scene

3. If it’s unsafe, call for extra help from other branches like police or firefighters

seen safety hazard examples

• Environmental hazards

• Physical hazards

• Biohazard

• Chemical hazard

• Electrical hazard

• Water hazard

MOI

mechanism of injury

mechanism of injury definition

The forces or energy transmission applied to the body that cause injury

traumatic injuries result from physical forces applied to

The outside of the body

indications of MOI need for spinal motion Restriction

• Pain or tenderness on palpation of the neck or spine

• patient report of pain and neck or Back

• Deformity of the spine

• Paralysis or neurologic complaint

• Altered mental status

• Intoxication

• Difficulty communicating

• Distracting injuries

distracting Injuries definition

injury that prevents the patient from noticing other injuries, even severe injuries

• painful femur or to be a fracture that prevents the patient from noticing back pain associated with spinal fracture.

Nature of illness definition

General type of illness a patient is experiencing

chief complaint Definition

The reason a patient called for help. Also the patient’s response to question such as what’s wrong or what happened.

Chief concern definition

The condition requiring the most urgent intervention as determined by the clinicians assessment of the patient

• Not always the same as the chief complaint

to determine NOI or nature of illness

• talk with the patient, family or bystanders

• Check the scene for clues

example, examples of MOI

• Falls

• Vehicle crashes

• Assaults

• Burns

• Industrial accidents

NOI examples

• seizures

• Heart attacks

• Syncope

• Diabetic problems

• Poisonings

Standard precautions Definition

Protective measures that have traditionally been developed by the CDC for use and dealing with objects, blood body, fluids, and other potential exposure risks of communicable diseases

PPE definition

personal protective equipment

• Protective equipment that blocks exposure to a pathogen or a hazardous material

examples of standard precautions

• handwashing

• Glove

• Eye protection

• Masks

• Gowns

Dictated by local standards

when do you take standard precautions?

Before patient contact

Patients that present with cough, stiff neck with headache, sore throat, or fever with shortness of breath should?

• Wear a mask. You should wear one too.

if assessment reveals a need for higher PPE?

Regroup and upgrade your protection

if you suspect you’ve been exposed to a communicable disease without proper PPE?

Follow the local protocols for post exposure reporting / testing

How to accurately identify the total number of patients?

1. use the incident command system

2. Established command

3. Identify the number of patients

4. Begin triage

The fire department may be able to provide

Hazardous materials management and technical rescue services

law-enforcement personnel may assist with

Traffic or seen ctrl the end should be the first to enter crime scenes in hostile environments

if any situation presents itself as a danger to you, your partner or your patient you must?

Retreat to a safe area

to determine if additional resources are required, ask yourself

• Does a scene pose a threat?

• How many patients are there?

• Do we have the resources to assess and treat them?

when sizing up a scene in a geriatric patient that lives alone

1. Police or fire department assistance may be required to access the home if patient’s condition prevents them from letting You in

2. Look for Clues that might explain the patient’s medical history or current problem

c if their living conditions are un

sizing up a scene with geriatric patient that lives in a nursing home or residential care facility

1. Locate the patient’s room and find a staff member who can explain why you were called

2. Presence of a hospital bed, oxygen tanks or therapeutic device devices can give you a clue to the patient’s medical history

NOI may be difficult to determine an older people who have

• Altered mental status

• Dementia

• Multiple disease process

sizing up a scene with geriatric patients that are difficult to determine NOI for

• Ask family members caregivers or bystander for relevant information

• Chest pain, shortness of breath, altered level of consciousness are considered serious

when arriving at an emergency scene, what is your first priority as an EMS?

Ensure the scene is safe for you and your team

You arrive at a multi patient crash scene with hazardous fluid leaking. What is your best action?

Retreat until hazmat personnel and additional ambulances arrive

patient assessment begins when you?

Greet the patient and start the primary assessment

primary assessment definition

A step within inpatient assessment process that identifies and initiates treatment of a immediate and Potential life threats

what is the goal of a primary assessment?

To identify and treat immediate or eminent life threats by assessing the patient’s level of consciousness and ABCs or XABC

What does ABC stand for?

Airway, Breathing, circulation

primary assessment steps

1. Form a general impression

2. assess level of consciousness

3. Assess the ABCs and identify and treat life threats

4. Perform Primary assessment

5. Determine priority of patient care and transport

what is your role as an EMT?

To determine if a life threat is present to address it

when you arrive on seeing a patient may be?

• Unconscious

• Severely sick or injured and stops being able to communicate and lose is consciousness

if a patient is unconscious or loses consciousness, what should you do?

• Prioritize resolving an obstructed airway To prevent cell death or sudden death

General conditions that cause sudden death

• Airway obstruction

• Respiratory failure or arrest

• Shock

• Severe bleeding

• Cardiac arrest

• Intercranial event = acute hemorrhage

General impression definition

Overall initial impression that determines the priority for patient care based on the patient surroundings, mechanism of injury, signs and symptoms, and the chief complaint

factors that impact general impression

• Age

• Sex

• Race

• Distress

• Overall appearance

after introducing yourself, you ask

1. About the chief complaint → Insight into level of consciousness, airway, patency, respiratory status, and overall circulatory status

Interventions for obvious life-threatening conditions

• administering oxygen or assisting ventilations

• Performing CPR

• Administering glucose

• Assisting with nitroglycerin, aspirin or inhalers

Uncontrolled external bleeding

life threatening

• must be recognized during your general impression

• Large amount of bleeding that is squirting or gushing, has soaked through clothing or is pulling under the patient should be considered life-threatening

• Attempt to control it before assessment continues

non-life-threatening bleeding can

Occur following your focus assessment

AVPU scale definition

Method of assessing the level of consciousness by determining whether the patient is

• A for awake and alert, responsive to Verbal stimuli or Pain or Unresponsive

Responsiveness definition

Way in which a patient response to external stimuli, including verbal, stimuli, tactile, stimuli and painful stimuli

orientation definition

Mental status of a patient as measured by memory of person, place time and event

• name

• current loc

• current yr month

• approx date

• what happened

altered mental status definition

A change in the way, a person thinks and behaves that may signal disease in the CNS or elsewhere in the body

The AVPU scale measures _____ to external stimuli

Responsiveness

when using the AVP scale, if a patient does not respond to verbal stimuli, determine if they will respond to

Painful stimuli by gently but firmly applying pressure to their trapezius area

after applying painful stimuli to a patient who becomes alert or responsive, evaluate their orientation by

• name

• current loc

• time

• event = MOI OR NOI

A patient that knows their name, current location, current year month and day and MOI OR NOI are considered

Alert and oriented x 4

• A&Ox4

why is eye protection recommended for every encounter?

Because patients may vomit or sees unexpectedly

perfusion definition

The flow of blood through body, tissues, and vessels

An airway obstruction can result in partial or complete blockage of air movement into and out of the lungs, and therefore Inadequate

Perfusion of the entire body

responsive patient definition

Patients who are talking or crying, have an open airway

adequacy of airway and status of breathing can be seen by

The way a patient speaks

• patient who can speak smoothly of breathing adequately however patients who can speak only one word at a time or have 2 to 3 dyspnea are having significant difficultly breathing

A conscious patient who cannot speak or cry, most likely has a

Severe airway obstruction

if you identify an airway problem

Stop and work to clear the patient’s airway. Difficulty breathing or not breathing can be corrected by

• Appropriate airway, oxygenation or ventilation management techniques

spontaneous, respirations definition

Breathing that occurs without assistance

how to determine if patient’s breathing is adequate

ask yourself

• is the patient breathing

• What is the patient’s Breathing rate rhythm and quality?

• Is the patient showing signs of hypoxia?

what to do if a patient is not breathing

Performed positive pressure ventilations

what to do if a patient is breathing adequately, but remains hypoxic

Administer oxygen

examples of respiratory distress

• Agitation, anxiety, restlessness

• Stridor, wheezing

• Accessory muscle use intercostal, retractions, neck muscle Use

• TACHYPNEA

• mild Tachycardia

• Nasal Flaring, Seesaw, breathing, head bobbing

respiratory failure examples

• Lethargy difficult to rouse

• TACHYPNEA with periods of Brady PNEA or agonal respirations

• In adequate chest rise/poor excursion

• Inadequate, respiratory rate or effort

• Bradycardia

• Diminished muscle tone

2 to 3 word, DYSPNEA definition

A severe breathing problem in which a patient Can speak only 2 to 3 words at a time without pausing to take a breath

individuals with 2 to 3 word DYSPNEA need

• Oxygen

• Medication

• Or assisted ventilation

if patient is breathing assessed the

Rate and depth of breathing

• Entering the Viola is critical issue, not the number of breaths

Irregular rhythm n depth

• shallow respirations

• Someone snoring and is often associated with head drama

shallow, respirations definition

respiration characterized by little movement of the chest wall = Reduce title volume or poor chest excursion

regular rhythm and depth

Inhale and exhale over one to two seconds with a short pause between each breath

breathing should appear

Effortless and non-labored

labored breathing definition

Breathing that requires greater than normal effort fr patient

• May be slower or faster than normal and characterized by grunting, strider, and accessory muscle use

accessory breathing muscles

Secondary muscles of respiration

• Sternocleidomastoids

• Pectoral major muscles

• Abdominal muscles

indications of inadequate breathing

• Retractions

• Nasal flaring

• Paradoxical chest motion

Retractions definition

Movement in which the skin pulls in around the ribs during inspiration

nasal flaring definition

Widening of the nostrils, indicating an airway obstruction

Paradoxical chest motion definition

respirations in which the chest moves inward during inhalation and outward during exhalation

• Opposite of the chest walls, normal motion during breathing

postures that indicate the patient is trying to increase air flow

• tripod

• sniffing