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Patient Assessment
EMS Patient Assessment
| Question | Answer |
|---|---|
| Goal of the Primary Assessment | To form a General Impression (Chief Complaint) quickly Find out ALL that is wrong for this patient. Don't remain focused only on the Chief Complaint |
| Chief Complaint | What is the patient complaining about? Using the patient's own words is an appropriate practice if they can describe their symptoms. Examples: Chest pain, dizzy, etc Chief Complaint is NOT the cause of the injury. |
| The order of Patient Assessments | 1) Scene Size Up - what might kill in 90 secs 2) Primary Assessment - don't miss anything 3) Secondary Assessment - focus in on findings |
| Scene Size Up | A quick overview of the incident AND its surroundings BSI L I S A Resources # patients Make sure to look around and take in the wider view of the incident Quick - should take no more than 30 seconds |
| L I S A | Considerations during Scene Size-up Life Threats - things that can kill in the next 90 secs. If needed jump into this first Impression - chief complaint - what got us here (MOI, NOI) Spinal (head) - potential for spine or head injury AVPU |
| MOI | Mechanism of Injury What caused the trauma? Examples: fell hit head, hurt shoulder, car ejection, gun shot, etc |
| NOI | Nature of Illness Medical/health conditions, patient is sick or ill Examples: chest pains, asthma attack, fever |
| Primary Assessment (Goal and Steps) | To form a General Impression. Doing ok or not ok? Level of urgency. Life Threats. Identify and treat immediate life threats May take 2-3 minutes B A B C D E Don't miss anything! |
| B A B C D E | 1) Bleeding - major bleeds 2) Airway - open/clear O S O 3) Breathing - inspect regularity O I P A S 4) Circulation - confirm, strength, regularity (no rate) V C R S 5) Disability / Decision (transport now or wait) 6) Expose - to skin |
| Blood Sweep | A pat down looking for blood Start at head Pat all areas - check hands often Don't focus on minor bleeding Potential for bleed out trumps all. |
| O S O | The airway part of patient assessment 1) Open airway - open if needed 2) Suction - remove materials 3) OPA/NPA (oral / nasal conduits) - insert |
| O I P A S | The Breathing part of Primary Assessment "Oh I Passed" Oxygen - supplemental if saturate is low Inspect - visual - depth, regularity, bilateral? Palpate - touch - pain Auscultate - listen - gurgling Seal - sucking chest wounds |
| Palpate | touch or feel |
| Auscultate | Listen listening to the heart and lung sounds of patients EMS focuses mostly on is it normal or abnormal? If abnormal try to classify (gurgle, hissing, crackling, irregular, etc) |
| V C R S | Circulatory Check Voids - check for bleeding Carotid Pulse - for the unconscious OR Radial - for the conscious Skin - check skin color |
| A V P U | Used to rapidly grade a patient's gross level of consciousness A = awake, alert, and oriented V = alert to voice, but not oriented, inappropriate responses P = alert to painful stimuli only, pinch U = unresponsive to voice or painful stimuli |
| C U P S | Ratings used to help prioritize the patient for transport: · C = critical · U = unstable · P = potentially unstable · S = stable |
| General Impression | Summary of Primary Assessment Age, sex, skin color, chief complaint, LOC, MOI/NOI, findings from BABC |
| LOC | Level of Consciousness A V P U |
| S A M P L E | History Assessment: Symptoms / Signs Allergies - Meds, food, insects Medications - Rx, OTC, recreational Past Medical History Last Meal Events leading up to this event |
| O P Q R S T | Pain Assessment: Onset of event - when started Provocation / Palliation - worse/better Quality of Pain - describe it Radiation / Region Severity - rate it Time - how long has it hurt? |
| Sign vs Symptom | Sign - something about the patient you can see, hear, smell, feel. Symptom - something the patient tells you |
| DCAP – BTLS | Physical Exam - after a trauma injury Deformities Contusions Abrasions Penetrations/Pneumothorax Burn Tenderness Lacerations Swelling |
| Provocation vs Palliation | Provocation - what makes the pain worse? Palliation - what make the pain better? |
| Epistaxis | Bleeding from the nose |
| Paradoxical Movement | When something should move one way but is moving a different way. Chest wall with multiple fractures may raise and fall in the reverse direction as would be expected. |
| PERRL | Indicator of potential brain conditions through a quick eye exam. Pupils Equal size Round Reactive (to) Light Note: Both should change with light in one Note: On sunny days cover the eyes for 10-15 second then uncover |
| Pupillary Light Reflex | Normally the pupils will dilate under dark conditions and constrict with light. Light shone into one eye should cause both pupils to constrict. |
| Pulse Oximeter | Device to measure blood oxygen saturation (Sa02) <94% start O2 Warning: Can't tell the difference between O2 and CO2 |
| Rates for Patient Reassessment | Unstable re-evaluate every 5 mins Stable -re-evaluate every 10 mins |
| P A T | Ratings for B A B C [D E] Present Adequate Threatened Example: Breathing is Adequate |
| Secondary Assessment - Purpose | To obtain more information about the specific problem after the quick Primary Assessment. Focus in on the Chief Complaint and any findings ABCD |
| Primary Assessment - Purpose | A quick assessment stopping to treat critical issues and to confirm the MOI/NOI. Check all key areas. Don't miss anything. |
| Provocation | Things that make the symptom worse |
| Palliation | Thing that ease pain |
| Assessment - Skin Color - Observational Terms | Pink Pale Cyanotic Red/Flushed Jaundiced Blotchiness |
| Assessment - Skin Color - what to check | C T C Color - Pink, Pale, Cyanotic, Red, Jaundiced, Blotchy Temperature - hot, warm, cool, cold Condition - dry, clammy, moist |
| Methods to check for unresponsiveness | If patient is not responding to voice or tapping Sternal Rub - knuckles on sternum Trapezius Squeeze - Vulcan neck pinch Supraorbital Pressure - thumb on eyebrow Nailbed Press - roll your pen over their finger nail |
Created by:
danfar
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