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Pt Assmnt

First Responder Patient Assessment (AAOS 4th Ed.)

Why do we use BSI? To protect yourself and the patients from the spread of disease and infection via bodily fluids (including blood)
Name some examples of BSI equipment (i.e. PPE) Gloves, eye protection, masks, gowns
What is the first stepd in all incidents? [Scene] Safety
What are some questions you may want to ask yourself as a First Responder when you are "sizing up"/performing your scene assessment? What's the location?What type of incident- medical or trauma?If cars are involved, how many & Do any of the vehicles present safety concerns?Could the incident involve hazardous/toxic materials? Crime scene? Is there potential for violence (incl. crowds)?
What/who are some possible information sources for your patient? Family members, coworkers, other responders who are already on the scene trying to help, bystanders who witnessed the incident
Define Mechanism of Injury (MOI) An evaluation of the forces of energy that cuased the injury - "What caused the injury"
Define Nature of Illness (NOI) An evaluation of the illness that has resulted in the patient's presenting medical condition - "what's making them sick/what's wrong"
What is the purpose of determining the Mechanism of Injury (MOI)? The MOI can lead first responders to injuries that might not otherwise be suspected
What are some considerations or things to look for when determining the mechanism of injury for the scene of an automobile accident? Assess damage to vehicles, the area of that was damaged, the amount of damage, the existence & type of damage to the interior of the vehicle (incl. airbags, etc...), loose items that could've been turned into projectiles
What are some things to consider when determining the Mechanism of Injury for a fall? The height of the fall, the surface the victim landed on, how the patient landed, what caused the patient to fall
What are some considerations for determining the Mechanism of Injury for an assault? Consider the existence, type and size of weapons involved; and from what direction the assault occurred
What are some considerations for determining the Mechanism of Injury for an Industrial accident? Assess whether or not chemicals were involved, or the involvement of heavy machinery
What are some questions you can ask (either yourself or someone else) that may help you determine a patient's Nature of Illness? Why were EMS resources called to this location?, What is the patient's chief complaint?, What home medical equipment is present?, Is there any pertinent past medical history?, What medications is the patient taking?
List the steps of your Scene Size-up (according to Registry skill sheets and AAOS) [Review Dispatch information], Observe body substance isolation procedures, Ensure scene safety, Determine MOI/NOI, Determine number of patients, Determine the need for additional resources, Determine the need for spinal stabilization
List the steps of your Initial Assessment - in order! (according to Registry skill sheets and AAOS) Form a general impression, Assess LOC/responsiveness (AVPU), Determine chief complaint/apparent life threats, Check Airway, Check Breathing, Check Circulation (incl. severe bleeding), Update Responding EMS units
List the steps of Patient Assessment - in order! (According to Registry skill sheets and AAOS) 1) Scene Size-up, 2) Initial Assessment, 3) Physical examination, 4) Patient's Medical History, 5) Ongoing Assessment
What is included in the Physical Examination portion of your Patient Assessment? Determine the patient's vital signs, Inspect for signs of injury - Examine the patient from head to toe
What is included in the Patient's Medical History portion of your Patient Assessment? Check for medical ID, Obtain history from patient/relatives/bystanders, Obtain SAMPLE history
What does the pneumonic SAMPLE stand for? S - Signs & Symptoms, A - Allergies (ALL), M - Medications (ALL - incl. OTC, noncompliance, & anything started or stopped within the past 2 weeks for elderly), P - Pertinent Past History, L - Last Oral Intake, E - Events leading up to illness or injury
What is the difference between a sign and a symptom? Signs are objective, they are facts/measurable, and you can find them out for yourself. Symptoms are subjective, you basically have to ask the patient how they feel
What is included in the Ongoing Assessment part of your Patient Assessment? [Repeat Scene Size-up] Repeat Initial Assessment, Repeat the Physical exam as needed, Check the effectiveness of treatments, Calm & reassure the patient, [Get another set of vital signs (if possible),] Provide a hand-off report
What is the purpose of performing the Initial Assessment? The sole purpose of the Initial Assessment is to identify and treat [immediate] life threats
What are some examples of immediate life-threatening conditions? An obstructed airway, Inadequate breathing/no spontaneous respirations, Uncontrolled bleeding, Signs & Symptoms of Shock (hypoperfusion), Cardiac arrest
When/How do you form a general impression? As you enter the scene, as the patient first enters your view on your approach (i.e. "from the doorway"), & by using all of your senses
What does the pneumonic AVPU stand-for/mean? A - Alert, V - Verbal [stimuli], P - Painful/Physical [stimuli], U - Unresponsive [to ALL stimuli]
A person is considered to be Alert [on AVPU scale] if: they are conscious, alert and oriented (i.e. eyes are open; is responding appropriately to your questions according to their normal LOC/alert & orientation baseline)
How do you check for LOC/Physical response on an infant? By tapping the infant on the bottom of the foot, DO NOT use a sternal rub
Name some methods you can use for checking patient responsiveness Sternal rub, pinching/twisting the ear lobe, rolling a pen/pencil across the cuticle & lunula part of a finger nail, pinching & twisting the eyebrow, pinching the superclavicular skin, flicking foot for infants
What are the two ways to open an patient's airway? (Bonus: When should each be used?) Head-tilt, chin-lift - (used in cases with no suspected trauma); jaw-thrust manuever - (used in cases where there IS suspected head, neck or back trauma/injuries)
What 3 things should you do in order to assess a patient's breathing? (Bonus: How long should you do this for?) Look for chest rise, listen for air movement, and feel for air movement (you should look, listen & feel for no longer than 10 seconds on a pt - unless the pt is hypothermic, then 30-45 seconds;[up to 1 minute in some protocols!])
List the normal respiratory ranges for adults, children/infants, & newborns Adults - 12 to 20 breaths per min, Child/Infants - 15 to 40 breaths per min, Newlyborns - 30 to 50 breaths per min
Where are the 2 places pulses are assessed [in adults/children]? (Bonus: What type of pt would you check which on?) Radial pulse (should be used for alert patients) & carotid pulse (should be check on patients who are anything but alert on AVPU scale - i.e. ALL unconscious patients)
Where should you check for a pulse on a conscious & alert infant/young child? (Bonus: Where should you check for the pulse on an unresponsive infant/young child?) Brachial artery [in the upper arm] (Bonus: Brachial, femoral artery in the upper leg, or carotid artery in neck - if possible)
Which finger should you never use to check a patient's pulse and why? You should never use your thumb to check a patient's pulse because the thumb has its own pulse, which could be confused with that of the patient
Created by: ems_rc_edu