(VERY IMPORTANT) Patient Assessment. Learning Goals Scene size up 2 part patient assessment ( ...
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Transcript of (VERY IMPORTANT) Patient Assessment. Learning Goals Scene size up 2 part patient assessment ( ...
(VERY IMPORTANT)
Patient Assessment
Learning Goals
Scene size up 2 part patient assessment ( Intervention)
Confidence with patient assessment! Realize there are 1237498723489 unknowns
and the point of this is to cover the things that are most important
Understand why we do the patient assessment how we do it (if it makes sense to you you’ll do it right)
Get super comfortable taking vitals
Acronyms
ABCD (E)s MOI NOI LOR DCAP-BTLS PERRL SAMPLE OPQRST AVPU
Scene Size Up
Easy to be like OMG A PATIENT and ignore the surroundings Is it safe to enter the scene?
Examples of why it wouldn’t be?How will you treat and transport this patient?MOI vs. NOIAlways introduce yourself and gain permission to
help first. What is the chief complaint?Even if a patient looks fine, never rule anything
out until you have asked what happened.
Patient Assessment
“Fortunately, the process need not be daunting” Primary Assessment
Life threatening situation?? Unresponsive patient vs. responsive ABCDs
Secondary Assessment SAMPLE history Head-to-toe Vitals
Evaluating an Unresponsive Patient
Check for response by tapping the victims shoulder and shouting
Open airway, check for breathing and check carotid pulse
If breathing normally continue primary assessment
If there is no pulse, start chest compressions (CPR)
If there is a pulse but no breathing, start rescue breathing
ABCDs
Airway: having an open and patent airway which will remain open
Breathing: being able to breathe, so oxygen gets to the body’s tissues effectively and carbon dioxide is removed
Circulation: having blood moving through the vessels to perfuse the tissues
Disability: having a normal mental status and central and peripheral neurologic function, includes having no spinal injury
How to Open an Airway
Head-tilt, chin-lift maneuver
Jaw-thrust maneuver
Normal Vital Signs
Adult Child (1-8 years)
Infant (Birth-1 year)
Pulse 60 – 100 beats per minute
80 – 100 100 – 120
Respirations 12 – 20 respirations per minute
15 – 30 75 – 95
Blood Pressure Systolic Diastolic
90 – 140 mmHg60 – 90 mmHg
80 – 100 75 – 95
Temperature 97.0 – 100.4 97.0 – 100.4 97.0 – 100.4
How to Check Level of Responsiveness
Normal conditions: awake and oriented AAO x 4:
Awake, alerted and oriented to person, place, time and situation
If they miss the answer to even just one question it could signify a brain injury
Important to measure over timePediatric patients
Glasgow Coma Scale vs. AVPU
Glascow Coma Scale AVPU
Eyes • 4 opens eyes spontaneously • 3 opens eyes to verbal stimuli• 2 opens eyes to pain • 1 does not open eyes Verbal• 5 speaks coherently • 4 speaks confusedly • 3 mutters words in response to
pain• 2 moans in response to pain • 1 no verbal response to pain Motor • 6 follows commands• 5 localizes pain • 4 withdrawals from pain • 3 has a flexor response to pain• 2 has an extensor response to pain • 1 has no motor response to pain
A – Alert
V – Unresponsive, but responds to verbal stimuli
P – unresponsive, but responds to painful stimuli
U – unresponsive to pain
SAMPLE History
S – Signs and Symptoms What’s the difference between a sign and a
symptom? A – Allergies M – Medications P – Past medical history L – Last oral intake (Last ins and outs)E – Events leading to incident
OPQRST
O – onset When did the pain start? Was it sudden or gradual?
P – provocation and palliation Do they know what caused the pain? Does anything make it worse or
better? Q – quality
Describe the pain. Is it dull, sharp, throbbing? R – radiation
Point to where the symptoms are most intense. Does the pain stay in one spot?
S – severity Ask to rate the pain from 1 – 10. What is their worst pain?
T – time How long as the patient had this problem and has it changed over time?
Physical Exam (DCAP – BTLS)
D – deformity C – contusions A – abrasions/avulsionsP – punctures/penetrations B – burns/bleeding/bruisesT – tenderness L – lacerations S – swelling
Physical Exam
Do a head to toe physical exam Check eyes
Pupils are Equal, Round and Reactive to Light – PERRL, then check eye movement
Examine: head, neck, chest, abdomen, back, pelvis, extremities
Check for Vital Signs: Level of responsiveness, pulse rate, respiration rate,
blood pressure and body temperature Pulse: radial pulse (side of wrist), carotid pulse (neck),
brachial pulse (biceps), femoral pulse (leg and lower abdomen)
Adult Child (1-8yrs)
Infant (0-1)
Pulse 60-100 80-100 100-120
Respirations
12-20 15-30 25-50
Systolic BP 90-140 80-100 75-95
Diastolic BP
60-90
Temperature
97-100.4 97-100.4 97-100.4
Who’s heart rate has gone up?
Special Assessment Considerations
Unresponsive patients: CPR Check for breathing and pulse in less than 10 seconds Ask relatives, friends or bystanders for information ABCD MAINTAIN OPEN AIRWAY Everything else same as for a responsive patient minus
assessment of sensation and movement in extremities Cultural Diversity Communication Barriers Environmental Conditions