PCT Patient Assessment

Components of Patient Assessment

1. Information gathering (MOI for trauma, NOI for medical, ascertain Hx, SAMPLE)

2. Physical examination (ABC or CAB, appropriate examination for medical/trauma)

BLS-PCS 10-12

Fundamental components of Patient Assessment

Identify problems (surveys), set priorities (primary and RTM/RMA), develop a care plan (interventions), execute the plan (perform interventions and ALWAYS REASSESS)

Scene Survey

Confirm the Call

Environment

MOI/NOI

Casualty Count

Additional/Allied Resources

PPE

Level of Consciousness

1. Introduction

2. AVPU

3. Hx of Event

   1. C-Spine (Y/N)

Pt primary survey

1. Scene

2. LOC

3. (a) Conscious

Airway (patency, OPA/NPA indicated, look for obstructions)

Breathing (Look - RRV breathing, SpO2, position, expose and observe; Listen - Auscultate x 4, stridor, wheezes, etc.; Feel - tracheal deviation, subcutaneous emphysema, intercostal indrawing, diaphragmatic breathing, tenderness)

Circulation (Compare radial vs carotid, RRV of pulse, skin colour/temp, capillary refill, wet check, JVD, Apply cardiac monitor, 12 lead?)

3. (b) Unconscious

C - pulse? No → CPR, Yes, move to A

A - patency? No → Use A/W clearing maneuvers, Yes, move to B

B - Are they Breathing? No → PPV via BVM, Yes, do they need O2? Mode of delivery?, YES to all three, move to

4. (a) TRAUMA

Neck (Tracheal deviation, JVD, palpate c-spine for tenderness & step, deformity, CLAPS/TICS, Apply cervical collar)

Abdomen (CLAPS/T or DR GERM, guarding, previous surgeries, palpate for rebound tenderness rigidity)

Pelvis (check 3 plains - in down & up, CLAPSS/TICS)

Femur (CLAPS/TICS)

4. (b) MEDICAL

Disability - altered LOC?

• Stroke Assessment

• OPQRST - pain assessment

• Check PEARL

• Note patient positioning

Treat & GO

• you must get pt to ER but you must first decide on a Tx. This will be based on current findings from primary survey

• decide on an extrication plan

• ANY PT WITH CARDIAC, RESP, ALTERED LOC - DO NOT WALK THESE PTS

• History Taking must be completed before Tx

Primary Survey Overview

CEMCAP

1. LOA

2. Manual C-spine

3. A or C

4. B or A

5. C or B

6. Critical Injuries and gross bleed check

7. critical interventions

Medical General Impression

Is my pt hurt?

How bad?

Trauma General Impression

Is my pt sick?

If so, how sick are they?

signs of significant distress

• altered mental status

• anxiousness

• laboured breathing

• difficulty speaking

• diaphoresis

• poor colour

• obvious pain

• obvious deformity, guarding, or splinting

• gross external hemorrhage

AVPU

Alert and Oriented

Verbal stimulus is required

Painful stimulus is required

Unconscious

Chief Complaint

Verbal - Pt tells you

Non-Verbal - What you can ascertain

Second-Hand - What other people say

SMR

Spinal Motion Restriction (BLS-PCS pg 34)

ABCDE

Airway (open airway, clear, insert npa or opa), Breathing (Assess, bvm, oxygen), Circulation (assess pulses, CPR, pt unconscious → CAB), Disability (pupillary response + neuro deficits), Expose (inspect the pt, cut away clothing)

Airway Status questions

Is the airway open and patent? (how it pt positioned, fbao?)

Is it likely to remain so? (Sonorous sounds, are there gurgling or bubbling sounds)

Airway adjuncts

oropharyngeal or nasopharyngeal airway, king-LT

open and clear the airway

chin lift and/or modified jaw thrust

visualize oropharynx

suction and/or remove foreign bodies

insert oral airway if the pt has decreased LOC and NO gag reflex (holds back tongue)

insert nasal airway if the pt has a decreased LOC and a gag reflex

V-VAC

Suction device, measure from corner of mouth to tragus, no more than 10 sec intervals adult 380mmHG, child 170mmHG, adequate oxygenation between intervals

King LT different sizes in adults

depends on height

yellow 4-5 feet

red 5-6 feet

purple over 6 feet

Supraglottic Airway Directive

Need for ventilatory assistance or airway control and other airway management is ineffective

PT must be in cardiac arrest, contraindications are inability to clear the airway, stridor, active vomiting, airway edema, caustic ingestion

max attempts is 2

Confirm placement with ETCO2 (non-waveform device), auscultation, chest rise, waveform capnogrpahy

Breathing Assessment questions

Is pt breathing?

If pt is breathing, is breathing adequate?

Minute volume

RR*Vt

Breathing Assessment

Look - for rise and fall of the chest

Listen - for the sound of moving air

Feel - for breath on your hand or cheek

determine whether pt is breathing and then whether the pt is breathing adequately, determine approx. rate, rhythm, and quality

Inadequate breathing

<8-10rpm = assist ventilations

>28 rpm with decreased LOC = assist ventilations

Adequate → provide supplemental oxygen prn

PRN

pro re nata - as needed

CLAPS/TICS-D

injuries to thorax and lungs

C- Contusions

L- Lacerations

A- Abrasions

P- Penetrations

S- Subcutaneous Emphysema

ribs, sternum, clavicles

T- Tenderness

I- Instability

C- Crepitus

S- Swelling

D- Dwelling

Auscultations

Listen in at least 4 sites comparing base to base and apex to apex

Are they present and equal in all fields?

Adequate?

Adventitious?

Symmetrical? Accessory muscle use

ACLS

Advanced Cardio Life Support