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Chapter 38

Assessment-Based Management

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Objectives

• There are no 1985 objectives for this chapter.

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Assessment-Based Management

• You may have to provide care for patients who can’t answer questions for themselves.

• You must be able to assess the patient and the scene.• Draw clues from the environment.

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Effective Patient Assessment(1 of 3)

• Gathering Information – Critical to decision making

• The importance of history– 80% of patient’s diagnosis is attributed to the history

• The EMT-I’s knowledge will help guide in asking appropriate questions

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Effective Patient Assessment(2 of 3)

• Physical Assessment– Effectiveness may be compromised by some field

situations.• Patterns and Field Impression

– Compare information gathered with what you know about similar conditions.

– Look for patterns.– Patterns allow the EMT-I to formulate a plan of

action.

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Effective Patient Assessment(3 of 3)

• BLS/ALS Treatment– Standing orders/protocols– Correct impression essential to choosing appropriate

protocol– Adapt treatment plan to problem

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Choreographing Assessment and Management

• EMS teams need a plan for roles• Team leader

– Manages patient care• Patient Care Person(s)

– Gather scene information– Talk to relatives/bystanders

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The Right Stuff

• Getting the right equipment to a patient’s side is an important component of care.– Hope for the best, prepare

for the worst.– Incorrect equipment

compromises patient care.• Optional “Take In” equipment

– Medications, IV equipment

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Airway • Oral airways• Nasal airways• Suction (electric or manual)• Rigid Yankauer and flexible suction catheters

Breathing • Mouth-powered ventilation devices (pocket mask)• Manual ventilation bag-valve-mask• Spare masks• Oxygen tank and regulator• Oxygen masks, cannulas, and extension tubing• Occlusive dressings• Large-bore IV catheter for thoracic decompression

EMT-I Management (1 of 2)

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Circulation • Dressings• Bandages and tape• Infection control supplies: gloves, eye shields• Sphygmomanometer, stethoscope

Disability and dysrhythmia

• Rigid collars• Flashlight• AED

Exposure • Scissors• Space blanket or something to cover the patient

EMT-I Management (2 of 2)

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Aspects of Assessment/ Decision Making (1 of 2)

• Ensure nonjudgmental attitude.• Consider causes of uncooperative, restless, and

belligerent behavior.– Hypoxia– Hypovolemia– Hypoglycemia– Head injury

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Aspects of Assessment/ Decision Making (2 of 2)

• Distracting Injuries– Obvious injuries that look bad can divert your

attention from more serious injuries.• Environment may be distracting.

• Move patient to controlled area (ie, ambulance).

• Be organized to avoid confusion.

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General Approach (1 of 3)

• Calm, orderly demeanor– Have “preplan” before entering scene

• Initial assessment– Sets tone for patient encounter– Critical patients

• ABCs• Perform necessary interventions

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General Approach (2 of 3)

• Life-threatening problems– Cardiac/respiratory arrest– Respiratory distress/failure– Unstable dysrhythmias– Seizures– Coma/altered mental status– Shock/hypotension– Major trauma– Possible cervical spine injury

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General Approach (3 of 3)

• Noncritical patients– More contemplative approach– Immediate interventions not needed– Time for history and exam

• The role of experience: the more knowledge the EMT-I has, the more productive he or she will be in knowing what to look for and what questions to ask.

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Transferring the Patient (1 of 2)

• Effective communication and transfer of patient information is a vital component of care.– The way a patient is transferred is often the weak link

in care.– Methods

• Face to face• Telephone• Radio• In writing

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Transferring the Patient (2 of 2)

• Good presentation suggests effective assessment and care.

• Popular formats– SOAP

• Subjective information, Objective information, Assessment, Plan

– CHART• Chief complaint, History, Assessment, Rx/ treatment,

Transport

• Preprinted sheets help to organize.

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Drills for Common Prehospital Complaints

• Help develop skill level and knowledge base.• Common complaints

– Chest pain– Cardiac arrest– Abdominal pain or GI bleeding– Altered mental status– Dyspnea– Syncope– Trauma– Allergic reactions/bites/envenomation– Pediatric