Lecture Two: Patient Assessment Definitions

Patient Assessment Definitions Patient Assessment Definitions for Pharmacistsfor Pharmacistsfor Pharmacistsfor Pharmacists

Anas Bahnassi PhD

Anas Bahnassi PhD CDM CDE 2

Basic Definitions:Basic Definitions:Scene Size‐up :p

Steps taken by first aid providers hen approaching the emergencwhen approaching the emergency

scene.Determinee scene safetyTake BSI precautions, noting the mechanism of injury or patient’s nature of illnessDetermine the number of patients, and deciding what, if any additional resources are needed including

BSI stands for body substance isolation. It means the gloves, gowns, masks an other objects weg

Advanced Life Support.gowns, masks an other objects we use to protect ourselves from our patients blood, vomit, feces, saliva and other substances

3Anas Bahnassi PhD CDM CDE

Basic Definitions:Basic Definitions:

Initial Assessment:

The process used to identify and treat life‐p ythreatening problems, concentrating on Level of Consciousness, Cervical Spinal Stabilization Airway Breathing andStabilization, Airway, Breathing, and Circulation. You will also be forming a General Impression of the patient to determineImpression of the patient to determine the priority of care based on your immediate assessment and determining if h i i di l ithe patient is a medical or trauma patient. The components of the initial assessment may be altered based on the patient


presentation.

Basic Definitions:Basic Definitions:Golden Hour

May be defined as the period during which all efforts are made to save a life before irreversible pathological changes can occur p g gthereby reducing or preventing death in the second and third phase.

The first platinum 10 minutes becomes important to make this golden hour effective and should be distributed aseffective and should be distributed as follows to make it fruitful:

Assessment of the victim and primary survey 1 minAssessment of the victim and primary survey 1 min

Resuscitation and stabilization 5 min

Immobilization and transport to nearby hospital 4 min


Basic Definitions:Basic Definitions:Focused History and Physical Exam:Focused History and Physical Exam:

In this step you will:p yReconsider the mechanism of injuryDetermine if the Rapid Trauma Assessment or a Focused Assessment is neededa Focused Assessment is neededAssess the patient’s chief complaintAssess medical patients complaints and signs and symptomsand symptoms Obtain a baseline set of vital signs, and perform a SAMPLE history. Th t f thi t b lt dThe components of this step may be altered based on the patient’s presentation.


OPQRST HISTORYOPQRST HISTORY

• Branch of SAMPLE History• Focuses on Signs and SymptomsFocuses on Signs and Symptoms • Gives a clearer picture of patient’s

li i l d i iclinical case and its severity


OPQRST HistoriyOnset

O O t• O = Onset• When the complaint first startedstarted.

• The patient’s activities at the time of onset/immediatelytime of onset/immediately before• “What were you doing when this started”• Chest pain patient – mowing lawn• Anaphylaxis patient – stung by beep y p g y• Diabetic patient – Working in hot day without food


OPQRST HistoryProvocation

• P = Provocation • What actions make the symptoms better/worse• “Is there anything thatIs there anything that makes it better? Anything that makes it worse?”• Chest pains – Worse with activity Better with rest

• SOB – Better when sitting• SOB – Better when sitting Worse when lying flat

• Etc…


OPQRST History Crushing

Quality• Q = QualityQ Quality

• Subjective description ofdescription of complaint in pt own words

Stabbing

own words• “Would you please describe the paindescribe the pain. What does it feel like” Burning

• Chest pains –Crushing, vice‐like, elephantelephant


OPQRST HistoryRadiation

• Is the pain local or does it travel to another part of the bodybody• “Is the pain in one place or

does it spread to other partsdoes it spread to other parts of your body?”• Chest pains

• L shoulder, arm, jaw, neck ,back 13Anas Bahnassi PhD CDM CDE

OPQRST HistorySeverity

• Severity• Severity• 1‐10 scale gauging pain

• “On a scale of 1‐10, 1 ,being the least pain you’ve felt and 10 being the worst pain you’ve ever felt can you rate the pain?”


OPQRST HxTime

• T = Time• Duration of the clinical case and associated complaints• “How long has this been going on?”How long has this been going on?

• Chest pains – Woke pt from sleep that night• Allergic rxn‐ 15‐20 min


Basic Definitions:Basic Definitions:Rapid Trauma Assessment:

This is performed on patients with significant mechanism of injury to determine potential life threateningdetermine potential life threatening injuries. In the conscious patient, symptoms should b ht b f d d i th R idbe sought before and during the Rapid Trauma assessment. You will estimate the severity of the injuries, re‐consider your transport decision, reconsider Advanced Life Support, consider the platinum 10 minutes and the Golden Hour, rapidly assess the patient from head to toe. Obtain a baseline set of vital signs, and


Obtain a baseline set of vital signs, and perform a SAMPLE history.

Rapid Trauma AssessmentRapid Trauma Assessmenthttp://www.youtube.com/watch?v=nmgYYCxOrJo



Rapid Medical Assessment:

This is performed on medical patientsThis is performed on medical patients who are unconscious, confused, or unable to adequately relate their chief complaint. This assessment is used toThis assessment is used toquickly identify existing or potentially life‐threatening conditions. You will

f h d idperform a head to toe rapid assessment. obtain a baseline set of vital signs, and perform a SAMPLE history.


Rapid Medical AssessmentRapid Medical Assessmenthttp://www.youtube.com/watch?v=vvsQmxjPD_Y


Basic Definitions:Basic Definitions:Focused History and Physical Exam:Focused History and Physical Exam:‐Trauma

This is used for patients, with no significant mechanism of injury, that have been determined to have no life threateningdetermined to have no life‐threatening injuries. This assessment would be used in place of your Rapid Trauma Assessment. Youh ld f th ti t’ hi fshould focus on the patient’s chief complaint. An example of a patient requiringthis assessment would be a patient who has sustained a fractured arm with noother injuries and no life threatening conditions.


Basic Definitions:Basic Definitions:Focused History and Physical Exam:Focused History and Physical Exam:‐Medical

This is used for patients with a medical complaint who are conscious, and able to adequately relate their chief complaint toadequately relate their chief complaint to you, and have no life‐threatening conditions. This assessment would be used in place of

R id M di l A t Y h ldyour Rapid Medical Assessment. You should focus on the patient’s chief complaint using OPQRST, obtain a baseline set of vital signs, and perform a SAMPLEhistory.


Basic Definitions:Basic Definitions:Detailed Physical Exam: y

This is a more in‐depth assessment that builds on the Focused Physical E am Man of o r patients ma not req ire a Detailed Ph sical E amExam. Many of your patients may not require a Detailed Physical Exam because it is either irrelevant or there is not enough time to complete it.This assessment will only be performed while enroute to the hospital or if there is time on‐scene while waiting for an ambulance to arrive.

Patients who will have this assessment completed are patients with significant mechanism of injurypatients with significant mechanism of injury, unconscious, confused, or unable to adequately relate their chief complaint. In the Detailed Physical Exam you will perform a head to toe assessment to find isolatedwill perform a head to toe assessment to find isolated and non‐life‐threatening problems that were not found in the Rapid Assessment and also to further explore h l d d i h R id


what you learned during the Rapid assessment.

Basic Definitions:Basic Definitions:Ongoing Assessment:g g

This assessment is performed during transport on all patients. TheOngoing Assessment ill be repeated e er 15 min tes for the stableOngoing Assessment will be repeated every 15 minutes for the stablepatient and every 5 minutes for the unstable patient. This assessmentis used to answer the following questions:

1. Is the treatment improving the patient’s condition?2 Are any known problems getting better or worse?2. Are any known problems getting better or worse?3. What is the nature of any newly identified problems?


Acronyms used during patient assessment: MOI – stands for mechanism of injury

AVPU – used to classify the patient’s mental status:• A = awake, alert, and orienteda a e, a e t, a d o e ted• V = alert to voice, but not oriented• P = alert to painful stimuli only• U = unresponsive to voice or painfulU = unresponsive to voice or painful

stimuli

CUPS used as an additional tool toCUPS – used as an additional tool to prioritize the patient for transport:• C = critical

bl• U = unstable• P = potentially unstable• S = stable


Priority Illness/Injury severity TransportDecisionDecision

Critical Patients either receiving CPR, in respiratory arrest or requiring and receiving life‐ sustainingarrest, or requiring and receiving life sustaining ventilatory /circulatory support

C.U.PUnstable Poor general impression

Scene Size‐up

Unstable

P

Unresponsive with no gag or cough reflexes

Responsive but unable to follow commands

Initial AssessmentPotentially Unstable

pDifficulty breathingPale skin or other signs of poor perfusion (shock)Complicated childbirth Rapid Assessment

And Transport

Complicated childbirthUncontrolled bleedingSevere pain in any area of the bodySevere chest pain especially with aSevere chest pain, especially with asystolic BP of less than100 mmHgI bilit t t f th b d


Inability to move any part of the body

Priority Illness/Injury severity TransportDecisionDecision

Mi ill i i l t d i j

SStable Minor illness, minor isolated injury,

uncomplicated extremity injuries, and/or anypatient that cannot be categorized as

Scene Size‐up

Critical, Unstable, or Potentially unstable.

Initial Assessment

Focused AssessmentAnd Transport


Mechanisms of InjuryMechanisms of InjuryVehicle‐pedestrian: Collision Motorcycle

crash

Death in the same passenger compartment: High‐speed vehicle collision

Medium speed vehicle collision Roll‐over of vehicle(infants and children)

Falls greater than 20 feet (adults): Ejection from vehicle

Falls greater than 10 feet (infants and children): Bicycle collisionFalls greater than 10 feet (infants and children): Bicycle collision

Penetrations of the head, chest, or abdomen: (infants and children)


Patient Assessment Practice SheetPatient Assessment Practice Sheet


Patient Assessment Practice SheetPatient Assessment Practice SheetInitial Assessment


Patient Assessment Practice SheetPatient Assessment Practice Sheet


Clinical Pharmacy VI:Clinical Pharmacy VI:yyFirst AidFirst AidAnas Bahnassi PhD CDM CDEAnas Bahnassi PhD CDM CDE

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Lecture Two: Patient Assessment Definitions

Education

Transcript of Lecture Two: Patient Assessment Definitions