patient assessment, vital basics

chapter 13 on pearson

BP-DOC

Bleeding

Pain

Deformities

Open Wounds

Crepitus

crepitus

grating noise or the sensation felt when broken bone ends rub together

dorsalis pedis pulse

pulse located on top of the foot

jungular vein distention (JVD)

abnormal bulging of the veins of the neck indicating cardiac compromise or possible injury to the chest.

tracheal deviation

when the trachea shifts from its normal mid line position of the neck

medical patient steps (stable vs unstable)

on unstable patients, do SAMPLE at end of primary assessment.

for stable patients, do SAMPLE and chief complaint before vitals and focused assessment.

scene safety 

this is step 1.

check for hazards, like oil, broken glass, fires, fumes

determine # of patients

identify MOI or NOI

identify if additional help is needed

primary assessment for stable patients

1. general patient impression

2. assessing mental status

3. assessing ABC’s (ensure open airway + breathing for unstable. Then check for pulse)

4. care for uncontrolled bleeding

5. decide if they’re low or high priority patient for transport

secondary assessment

head to toe physical exam, also determine med history 

1. check head for bleeding/fluids + deformities (run hands through hair to check for blood)

2. look at patient’s eyes - PERRL, and check inner surface of eyelids

3. inspect ears and nose for CSF or blood

4. inspect mouth

5. palpate neck (check for any JVD)

6. palpate chest

7. palpate amdomin, ask if it hurts more when pressing down or when releasing pressure

8. inspect pelvis

9. feel lower back for pain, deformity, and blood

10. examine each leg and foot (check CSM)

11. examine arms from shoulders to finger tips (check CSM)

steps of care for stable medical patient

1. BSI and scene safety

2. primary assessment

3. get thorough med history (SAMPLE) - determine chief complaint and NOI

4. secondary assessment

5. obtain baseline vital signs

6. reassessment (mark changes in vital signs)

care steps for UNSTABLE medical patient

1. BSI and scene safety

2. primary assessment

3. very rapid secondary assessment (palpate head, neck, chest, each quadrant of abdomen, pelvis, back, all 4 extremities).

4. obtain baseline vital signs

5. get thorough med history (if possible) - determine chief complaint and NOI

6. reassessment (mark changes in vital signs)

STABLE trauma patient care steps

1. BSI and scene safety

2. primary assessment - determine MOI

3. secondary assessment, based on chief complaint

4. obtain baseline vital signs

5. med history (SAMPLE)

6. reassessment (mark changes in vital signs)

UNSTABLE trauma patient care steps

1. BSI and scene safety

2. primary assessment - determine MOI. Stabilize head + neck

3. rapid secondary assessment (palpate head, neck, chest, each quadrant of abdomen, pelvis, back, all 4 extremities).

4. obtain baseline vital signs

5. reassessment (mark changes in vital signs)

AVPU

alert

verbal

painful

unresponsive

high priority transport

if unresponsive, altered mental status, difficulties breathing, severe trauma/medical emergency

checking responsiveness in infants

gently flick bottom of infant’s foot

BP in infants and children

unreliable to detect shock - even with only half their blood, they can maintain normal BP then suddenly get worse

what is in vitals

respiration, pulse, BP, skin signs, pupils, mental status

multi-system trauma

injuries that may have affected multiple body systems

physical contact

ask for permission first, tell patient what you’re doing, use cupped hands

ABCDE (primary assesment)

airway

breathing

circulation

disability (AVPU)

exposure/environment (full body exposure as appropriate, also get out of cold or heat/environment)

DCAP-BTLS

Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling