Patient Assessment (Class Notes)

Why We Assess Our Patients

  • All our patents need and deserve good care, which starts with assessment.

  • Basic EMT’s need to master assessment skills.

  • Assessment lays the foundation for competent care.

Five Steps

Size-Up

  • General impression of the call upon arrival.

Primary

  • ABC’s

  • SAMPLE

  • Whether they are going to die or not.

History

  • Past medical history.

Secondary

  • More in depth.

  • Diagnosis.

Reassessment

  • Did what we do work?

Signs and Symptoms

They have differences.

Signs are objective.

  • Vomiting

  • Measure discovers find.

Symptoms are subjective.

  • Nausea

  • Describe what they are feeling.

Scene Size-Up

  • Your evaluation of the conditions in which you will be operating.

  • Scene size-up combines the dispatcher’s basic information and gather information, observation of the scene, maintaining situational awareness.

  • Situational Awareness is important and ALWAYS know what is going on.

    • Do not enter until the scene is safe for you and your team.

  • Consider terrain.

NOI vs MOI

  • Mechanism of Injury (Trauma)

    • Type or amount of force

    • How long it was applied

    • Where it was applied to the body

  • Nature of Illness (Medical)

    • How long has this been occurring.

Determine # of patients.

  • Triage.

Specialized resources

  • Fire

  • Law Enforcement

  • Does the scene pose a threat to me, my patient, others?

  • HAZMAT.

  • Animal Control

  • Public Works. Social services.

Primary Assessment

Physically examine the patient and assess

  • LOC

  • ABC’s

    • Scan for signs of uncontrolled bleeding.

      • During chief complaint.

      • Look again when we get to C in ABC’s.

      • Do they have adequate breathing?

      • Circulation: PALE, COOL, CLAMMY, they are in shock.

        • Oxygen. Keep the patient warm. Proper positioning.

      • Decision to transport.

General Impression

  • Formed to determine the priority of care. Stable or unstable.

  • First part of primary assessment

  • Make a note of the person’s, age, sex, race, level of distress, and overall appearance.

  • Quick, one sentence.

  • Address life threats.

AVPU

LOC - Level of Consciousness.

AMS - Altered Mental Status

Conditions that cause sudden death:

  • Airway obstruction

  • Respiratory failure

  • Respiratory arrest

  • Shock

  • Severe bleeding

  • Primary cardiac arrest

ABC’s Expanded

  • ABC’s

    • Scan for signs of uncontrolled bleeding.

      • During chief complaint.

      • Look again when we get to C in ABC’s.

      • Do they have adequate breathing?

      • Circulation: PALE, COOL, CLAMMY, they are in shock.

        • Oxygen. Keep the patient warm. Proper positioning.

      • Decision to transport.

Signs of obstruction in an unconscious patient.

  • Obvious trauma

  • Noisy breathing

  • Extremely shallow or absent breathing.

Make sure Airway is open.

Make sure the patient’s breathing is present and adequate.

  • Is the patient hypoxic? Getting enough oxygen to the brain. The goal for oxygenation for most patients is an oxygen saturation of 94% to 99%.

  • Consider providing positive pressure.

    • Respiration is inadequate!

    • Are shallow and exceed 28breaths/min

    • Respirations are fewer that 8breaths/min

Observe how much effort is required for the patient to breathe.

  • Retractions

  • Use of accessory muscles

  • Nasal flaring

  • Two- to three-word dyspnea

  • Tripod Position/Sniffing position

Respiratory Distress

  • Increased work of breathing

  • Increased effort and rate

  • Respiratory failure

    • Occurs when the blood is inadequately oxygenated, or ventilation is inadequate to meeting the oxygen demands of the body.

Assess Circulation

Assess Pulse.

  • The pressure wave of the blood going through the arteries.

  • Palpate (feel) the pulse.

  • If you cannot palpate a pulse in an unresponsive patient, begin CPR.

Skin Condition

  • Temperature and Color.

  • Pallor - Whether it is pale or not. The palm of the skin.

  • Grey - Profound shock.

  • Capillary Refill. Good in younger people.

  • Bleeding.

OPQRST

Onset - How long did it take to get here.

Provocation/Palliation - Better or worse when __

Quality - What does it feel like?

Radiation - Where does it go to?

Severity - (0-10)

Time

SAMPLE

Signs and Symptoms

Allergies

Medications - Blood Thinners for example.

Past Medical History - Primarily important to the situation

Last Oral Intake

Events leading up to this

Secondary Assessment

Do a more detailed vital check of patients. Usually focus on organ systems.

  • We always assess three organ systems at a minimum.

    • Organ system related to chief complaint.

    • We are always going to assess nuero, cardiovascular, and respiratory.

    • Integumentary - Rashes, bruises, hives, itching.

  • Gastrointestinal

  • Diabetic.