11)Initial Assessment
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Transcript of 11)Initial Assessment
Initial Assessment
Initial Assessment
• Rapid means of assessing:• Pt condition• Life threats• Priority of care
• “Stay & Play”• “Load a& Go”
• Quickly evaluate the 3 major organ systems
• Respiratory• Circulatory• Nervous
• Identify and treat most life threatening conditions and transport.
• AVPU• ABC
General Impression
• Helps form a general sense of severity of pt• Based on immediate assessment of scene and C/C
• Cardiac arrest• Medical or Trauma• MOI/NOI• Age, Sex, Race
• If life threatening condition is found treat immediately• Unresponsive• Inadequate breathing• Inadequate perfusion• Severe bleeding
Life Saving Treatments
• Airway management• + pressure ventilation• Supplemental O2• Bleeding control• CPR• Defibrillation• Medical direction• ALS intercept• Rapid transport
Assessment of Mental Status
• Mental status is most sensitive indicator of CNS activity• Level of consciousness (LOC) = CNS function
• AVPU• A-Alert
• Pt alert to Person/Place/Time • Alert and Oriented X 3---- AOX3
• Pt alert to Person/Place/Time/Event• Alert and Oriented X 4---- AOX4
• V-Verbal• Pt responds to verbal stimuli
• P-Painful• Pt unresponsive to verbal but responds to pain• Sternal run, pinch nail beds, etc
• U-Unresponsive • Pt unresponsive to both verbal and painful stimuli
• C-Spine control if trauma suspected/unresponsive• Log Roll to supine if not
Sternal Rub
Log Rolling
• Log rolls• Movement of a supine/prone pt
• EMT 1: Maintain C-spine• EMT 2 & 3: Position kneeling at pt
side• EMT 2: Raise pt nearest arm over
pt head• EMT 2: Place 1 hand on pt shoulder
the other on pt hip• EMT 3: Place 1 hand on pt waist
and the other at knees• EMT 2 & 3: On count of 3 from EMT
1, roll pt onto side• Place pt on backboard, transport
Measuring C-Collars
• All pts who have sustained significant trauma • Est early manual stabilization of C-Spine and maintain it until
pt immobilized to LBB.• How to measure a c-collar
• Bring pt head gently into neutral position• Measure distance between bottom of the pt chin and the top
of the pt shoulders with a hand• Compare measurement with indicator lines on c-collar• Side c-collar behind pt neck moving it as little as possible• Hold the front of the collar while bringing the back around the neck
and velcro in place• Make sure pt can still swallow and breathe
Manual Stabilization by 1 rescuer
Measuring C-Spine
Sizing C-Collar
Securing C-Collar
Maintaining C-Spine Control
Airway
• Responsive Patient• Is the pt talking/crying
• Yes = Assess adequacy• No = Open airway
• Unresponsive Patient• Is the airway open?
• Open it • Assess if clear• If not clear it
• Medical Pt• Head tilt chin lift
• Trauma Pt • Jaw thrust
Breathing
• Look – Listen – Feel• If pt breathing and responsive
• Oxygen may be dictated by MOI/NOI• Breathing more than 24 bpm or less than 8 bpm
• Receive high flow oxygen/BVM• If unresponsive and breathing:
• Maintain airway and provide high flow oxygen• If breathing is inadequate:
• Open and maintain airway, assist in ventilation, use adjuncts. • If pt is not breathing:
• Open and maintain airway with adjuncts, assume ventilatory support
Circulation
• Assess the pt pulse• Unresponsive
• Carotid• Responsive
• Radial• 1 y/o or younger
• Brachial• Absent pulseless
• CPR & AED• Assess for major bleeding
• If found, Treat it:• Direct Pressure• Elevation• Pressure Points• Tourniquet
Skin
• Clues to perfusion and oxygenation• Components
• Color• Temp• Moisture• Capillary Refill
Skin Color
• Locations of assessment• Nail beds, oral mucosa, conjunctiva• Pediatric
• Palms of hand/Sole of feet• Normal = Pink• Abnormal
• Pale• Poor Perfusion
• Cyanotic• Blue/grey= Poor oxygenation/perfusion
• Flushed• Heat or CO exposure
• Jaundiced • Liver/Gallbladder problems
Temperature
• Place back of gloved hand on pt skin• Normal = Warm• Abnormal
• Hot• Fever/Heat exposure
• Cool• Poor perfusion/Cold exposure
• Cold• Extreme cold exposure• Excessively dead…
• Also check for moisture• Diaphoresis or extremely dry
Capillary Refill
• Evaluation• Press on pt nail bed until it
is blanched/white• Release and count time
until pink returns
• Normal• 2 seconds or less
• Abnormal• More than 2 seconds
Identify Priority Patients
• Consider transport decision• Load and Go• Stay and Play
• Priority Patients• Poor General Impression• Unresponsive (No gag)• AMS• SOB• Shock• Complicated childbirth• Chest pain with systolic pressure less than 100mmHg• Uncontrollable bleeding• Severe pain
• Provide lifesaving treatment throughout initial assessment as needed• Transport unstable pt and pt with conditions needing immediate
hospital treatment
Remember…
It all starts with your ABC’S!!!