Patient Assessment Part 2

Scene Size-Up

• Ensure Scene Safety

  • Critical first step, regardless of call nature (violent or benign)

  • Example: Law enforcement may stage for violent incidents (assaults, stabbings, gunshot wounds)

  • Always check safety before entering the scene

• Information from Dispatch

  • Varies in detail depending on the call

  • Example: Dispatch indicating "abdominal pain"

    • Consider worst-case scenarios:

      • Abdominal aortic aneurysm

      • Ectopic pregnancy

      • Hepatitis flare-up

      • Acid reflux pain

      • Diverticulitis

      • Appendicitis

• Mechanism of Injury (MOI) vs. Nature of Illness

  • Distinguish between trauma (MOI) and medical (nature of illness) situations

  • Example MOIs:

    • Falls: height matters (falls from a house vs. standing)

    • Ages of individuals involved

    • Type of accident (pedestrian vs. vehicle)

• Standard Precautions

  • Always wear gloves before exiting the ambulance

  • Consider additional PPE (mask, eye protection, gown) based on situation

• Determine Number of Patients

  • Assess how many patients are involved in the incident

  • Deciding factors for additional resources such as:

    • Further medical assistance needed (i.e., additional ambulances)

    • Fire department or law enforcement presence if the scene is unsafe

Primary Assessment Overview

• Form General Impression

  • Approach the patient and assess their condition along with scene environment

  • Examples of scenarios:

    • Patient comfortably seated vs. unresponsive on the floor

    • Clean environment vs. chaotic debris

• Assess Level of Consciousness

  • Use the APPU scale:

    • Alert (A): Patient responds fully

    • Verbal (V): Patient responds only to verbal prompts

    • Painful (P): Patient responds to painful stimuli (e.g., sternal rub)

    • Unresponsive (U): No response to any stimulus

  • Orientation assessment:

    • Check awareness of Person (identity), Place (location), Time (date/year), Event (current situation)

• Assess Airway, Breathing, Circulation (ABC)

  • Airway: Check if it's open/patent

    • Techniques:

      • Head tilt-chin lift for non-trauma patients

      • Jaw thrust for suspected trauma

  • Check for obstructions:

    • Clear airway of blood, vomit using suction if necessary

    • Maintain openness with OPA/NPA as needed

  • Breathing: Determine rate and quality of respiration

    • Normal: No distress, not using accessory muscles

    • Abnormal signs may include:

      • Stridor, snoring, gurgling, shallow breaths

  • Circulation: Assess for any major bleeding and manage:

    • Direct pressure and control on major bleeds

    • Skin color/temperature/moisture/capillary refill

      • Normal skin color: pink

      • Jaundice: yellow (potential liver issue)

      • Cyanosis: blue (indicates lack of oxygen)

      • Temperature: check if warm, cool, or hot

      • Moisture: sweatiness indicates diaphoretic conditions

      • Capillary refill: should be under 2 seconds for good perfusion

Performing Primary Assessment - Rapid Exam

• Conduct a head-to-toe scan rapidly for any life threats

  • Focus on significant findings, not detailed examinations

• Transport Decision: Assess injury severity/ illness for deciding:

  • Which hospital to transport to

  • Method of moving patient to ambulance

  • Utilizing lights and sirens if necessary

Questioning Airway Management

• Is the Airway Open?

  • Clear patient airway by checking responsiveness, ensuring they can speak or cry (for pediatric)

• Managing an Unresponsive Patient:

  • Positioning techniques to aid airway management

  • Use adjuncts (OPA/NPA) and ventilate if needed

• Signs of Full Airway Obstruction

  • Absent breaths indicate a serious emergency

  • Other audible signs: Stridor, snoring, gurgling, shallow breaths

• Respiratory Assessment Essentials

  • Considering factors such as:

    • Positioning, speech status, respiratory rate, and oxygen saturation

• Circulation Checks:

  • Address any major bleeding before proceeding to other assessments

  • Assess skin properties: Color, temperature, moisture

  • Determine capillary refill effectiveness with a two-second return time as normal