Patient Assessment Scene size-up Initial assessment Focused
history and physical exam Vital signs History Detailed physical
exam Ongoing assessment Scene size-up Initial assessment Focused
history and physical exam Vital signs History Detailed physical
exam Ongoing assessment
Slide 3
Patient Assessment Process
Slide 4
Scene Size Up Dispatch information Inspection of scene Scene
hazards Safety concerns Mechanism of injury Nature of illness/chief
complaint Number of patients Additional resources needed Dispatch
information Inspection of scene Scene hazards Safety concerns
Mechanism of injury Nature of illness/chief complaint Number of
patients Additional resources needed
Slide 5
Body Substance Isolation Assumes all body fluids present a
possible risk for infection Protective equipment Latex or vinyl
gloves should always be worn Eye protection Mask Gown Turnout gear
Assumes all body fluids present a possible risk for infection
Protective equipment Latex or vinyl gloves should always be worn
Eye protection Mask Gown Turnout gear
Slide 6
Scene Safety: Potential Hazards Oncoming traffic Unstable
surfaces Leaking gasoline Downed electrical lines Potential for
violence Fire or smoke Hazardous materials Other dangers at crash
or rescue scenes Crime scenes Oncoming traffic Unstable surfaces
Leaking gasoline Downed electrical lines Potential for violence
Fire or smoke Hazardous materials Other dangers at crash or rescue
scenes Crime scenes
Slide 7
Scene Safety Park in a safe area. Speak with law enforcement
first if present. The safety of you and your partner comes first!
Next concern is the safety of patient(s) and bystanders. Request
additional resources if needed to make scene safe. Park in a safe
area. Speak with law enforcement first if present. The safety of
you and your partner comes first! Next concern is the safety of
patient(s) and bystanders. Request additional resources if needed
to make scene safe.
Slide 8
Mechanism of Injury Helps determine the possible extent of
injuries on trauma patients Evaluate: Amount of force applied to
body Length of time force was applied Area of the body involved
Helps determine the possible extent of injuries on trauma patients
Evaluate: Amount of force applied to body Length of time force was
applied Area of the body involved
Slide 9
Nature of Illness Search for clues to determine the nature of
illness. Often described by the patients chief complaint Gather
information from the patient and people on scene. Observe the scene
Search for clues to determine the nature of illness. Often
described by the patients chief complaint Gather information from
the patient and people on scene. Observe the scene
Slide 10
The Importance of MOI/NOI Guides preparation for care to
patient Suggests equipment that will be needed Prepares for further
assessment Fundamentals of assessment are same whether emergency
appears to be related to trauma or medical cause. Guides
preparation for care to patient Suggests equipment that will be
needed Prepares for further assessment Fundamentals of assessment
are same whether emergency appears to be related to trauma or
medical cause.
Slide 11
Number of Patients Determine the number of patients and their
condition. Assess what additional resources will be needed. Triage
to identify severity of each patients condition. Determine the
number of patients and their condition. Assess what additional
resources will be needed. Triage to identify severity of each
patients condition.
Slide 12
Additional Resources Medical resources Additional units
Advanced life support Nonmedical resources Fire suppression Rescue
Law enforcement Medical resources Additional units Advanced life
support Nonmedical resources Fire suppression Rescue Law
enforcement
Slide 13
C-Spine Immobilization Consider early during assessment. Do not
move without immobilization. Err on the side of caution. Consider
early during assessment. Do not move without immobilization. Err on
the side of caution.
Slide 14
Patient Assessment Process
Slide 15
Initial Assessment Develop a general impression. Assess mental
status. Assess airway. Assess the adequacy of breathing. Assess
circulation. Identify patient priority Develop a general
impression. Assess mental status. Assess airway. Assess the
adequacy of breathing. Assess circulation. Identify patient
priority
Slide 16
Develop a General Impression Occurs as you approach the scene
and the patient Assessment of the environment Patients chief
complaint Presenting signs and symptoms of patient Occurs as you
approach the scene and the patient Assessment of the environment
Patients chief complaint Presenting signs and symptoms of
patient
Chief Complaint Most serious problem voiced by the patient May
not be the most significant problem present Most serious problem
voiced by the patient May not be the most significant problem
present
Slide 19
Assessing Mental Status Responsiveness How the patient responds
to external stimuli Orientation Mental status and thinking ability
Responsiveness How the patient responds to external stimuli
Orientation Mental status and thinking ability
Slide 20
Testing Responsiveness AAlert VResponsive to Verbal stimulus
PResponsive to Pain UUnresponsive AAlert VResponsive to Verbal
stimulus PResponsive to Pain UUnresponsive
Slide 21
Testing Orientation Person Place Time Event Person Place Time
Event
Slide 22
Caring for Abnormal Mental Status Complete initial assessment.
Provide high-flow oxygen. Consider spinal immobilization. Initiate
transport. Support ABCs. Reassess. Complete initial assessment.
Provide high-flow oxygen. Consider spinal immobilization. Initiate
transport. Support ABCs. Reassess.
Slide 23
Assessing the Airway Look for signs of airway compromise: Two-
to three-word dyspnea Use of accessory muscles Nasal flaring and
use of accessory muscles in children Labored breathing Look for
signs of airway compromise: Two- to three-word dyspnea Use of
accessory muscles Nasal flaring and use of accessory muscles in
children Labored breathing
Slide 24
Signs of Airway Obstruction in the Unconscious Patient Obvious
trauma, blood, or other obstruction Noisy breathing such as
bubbling, gurgling, crowing, or other abnormal sounds Extremely
shallow or absent breathing Obvious trauma, blood, or other
obstruction Noisy breathing such as bubbling, gurgling, crowing, or
other abnormal sounds Extremely shallow or absent breathing
Slide 25
Assessing Breathing Choking Rate Depth Cyanosis Lung sounds Air
movement Choking Rate Depth Cyanosis Lung sounds Air movement
Slide 26
High-Flow Oxygen Administration Breathing faster than 20
breaths/min Breathing slower than 12 breaths/min Breathing too
shallow Decreased level of consciousness Respiratory distress Poor
skin color Breathing faster than 20 breaths/min Breathing slower
than 12 breaths/min Breathing too shallow Decreased level of
consciousness Respiratory distress Poor skin color
Slide 27
Positioning the Patient Position of comfort Sitting up with
feet dangling High Fowlers position Spinal precautions if possible
spinal injury Position of comfort Sitting up with feet dangling
High Fowlers position Spinal precautions if possible spinal
injury
Normal Pulse Rates in Infants and Children AgeRange (beats/min)
Infant: 1 month to 1 year100 to 160 Toddler: 1 to 3 years90 to 150
Preschool-age: 3 to 6 years80 to 140 School-age: 6 to 12 years70 to
120 Adolescent: 12 to 18 years60 to 100
Slide 30
Assessing and Controlling External Bleeding Assess after
clearing the airway and stabilizing breathing. Look for blood flow
or blood on floor/clothes. Controlling bleeding Direct pressure
Elevation Pressure points Assess after clearing the airway and
stabilizing breathing. Look for blood flow or blood on
floor/clothes. Controlling bleeding Direct pressure Elevation
Pressure points
Slide 31
Assessing Perfusion Color Temperature Skin condition Capillary
refill Color Temperature Skin condition Capillary refill
Slide 32
Priority Patients Difficulty breathing Poor general impression
Unresponsive with no gag reflex Severe chest pain Signs of poor
perfusion Complicated childbirth Uncontrolled bleeding Responsive
but unable to follow commands Severe pain Inability to move any
part of the body Difficulty breathing Poor general impression
Unresponsive with no gag reflex Severe chest pain Signs of poor
perfusion Complicated childbirth Uncontrolled bleeding Responsive
but unable to follow commands Severe pain Inability to move any
part of the body
Slide 33
Transport Decision Patient condition Availability of advanced
care Distance to transport Local protocols Patient condition
Availability of advanced care Distance to transport Local
protocols
Slide 34
Patient Assessment Process
Slide 35
Focused History and Physical Exam Understand the circumstances
surrounding the chief complaint. Obtain objective measurements.
Perform physical exam. Understand the circumstances surrounding the
chief complaint. Obtain objective measurements. Perform physical
exam.
Slide 36
Components of Focused History and Physical Exam Medical history
Baseline vital signs Physical exam Medical history Baseline vital
signs Physical exam
Slide 37
Rapid Physical Exam 60-90 second head-to-toe exam Performed on:
Significant trauma patients Unresponsive medical patients
Identifies undiscovered conditions 60-90 second head-to-toe exam
Performed on: Significant trauma patients Unresponsive medical
patients Identifies undiscovered conditions
Slide 38
DCAP-BTLS D Deformities C Contusions A Abrasions P Punctures/
Penetrations B Burns T Tenderness L Lacerations S Swelling D
Deformities C Contusions A Abrasions P Punctures/ Penetrations B
Burns T Tenderness L Lacerations S Swelling
Slide 39
Components of a Rapid Physical Exam
Slide 40
Maintain spinal immobilization while checking patients ABCs.
Assess the head. Assess the neck. Apply a cervical spine
immobilization collar. Maintain spinal immobilization while
checking patients ABCs. Assess the head. Assess the neck. Apply a
cervical spine immobilization collar.
Slide 41
Assess the chest. Include presence of lung sounds Assess the
abdomen. Assess the pelvis. Assess the chest. Include presence of
lung sounds Assess the abdomen. Assess the pelvis.
Slide 42
Assess all four extremities. Include: P- Pulse M- Motor S-
Sensation Roll the patient with spinal precautions. Assess all four
extremities. Include: P- Pulse M- Motor S- Sensation Roll the
patient with spinal precautions.
Slide 43
Focused Physical Exam Used to evaluate patients chief complaint
Performed on: Trauma patients without significant MOI Responsive
medical patients Used to evaluate patients chief complaint
Performed on: Trauma patients without significant MOI Responsive
medical patients
Slide 44
Head, Neck, and Cervical Spine Feel head and neck for
deformity, tenderness, or crepitation. Check for bleeding. Ask
about pain or tenderness Feel head and neck for deformity,
tenderness, or crepitation. Check for bleeding. Ask about pain or
tenderness
Slide 45
Chest Watch chest rise and fall with breathing. Feel for
grating bones as patient breathes. Listen to breath sounds. Watch
chest rise and fall with breathing. Feel for grating bones as
patient breathes. Listen to breath sounds.
Slide 46
Abdomen Look for obvious injury, bruises, or bleeding. Evaluate
for tenderness and any bleeding. Do not palpate too hard. Look for
obvious injury, bruises, or bleeding. Evaluate for tenderness and
any bleeding. Do not palpate too hard.
Slide 47
Pelvis Look for any signs of obvious injury, bleeding, or
deformity. Press gently inward and downward on pelvic bones. Look
for any signs of obvious injury, bleeding, or deformity. Press
gently inward and downward on pelvic bones.
Slide 48
Extremities Look for obvious injuries. Feel for deformities.
Assess Pulse Motor function Sensory function Look for obvious
injuries. Feel for deformities. Assess Pulse Motor function Sensory
function
Slide 49
Posterior Body Feel for tenderness, deformity, and open wounds.
Carefully palpate from neck to pelvis. Look for obvious injuries.
Feel for tenderness, deformity, and open wounds. Carefully palpate
from neck to pelvis. Look for obvious injuries.
Slide 50
Specific Chief Complaints Chest pain Shortness of breath Pain
associated with bones or joints Abdominal pain Dizziness Chest pain
Shortness of breath Pain associated with bones or joints Abdominal
pain Dizziness
Slide 51
Significant Mechanism of Injury Ejection from vehicle Death in
passenger compartment Fall greater than 15'-20' Vehicle rollover
High-speed collision Vehicle-pedestrian collision Motorcycle crash
Unresponsiveness or altered mental status Penetrating trauma to the
head, chest, or abdomen Ejection from vehicle Death in passenger
compartment Fall greater than 15'-20' Vehicle rollover High-speed
collision Vehicle-pedestrian collision Motorcycle crash
Unresponsiveness or altered mental status Penetrating trauma to the
head, chest, or abdomen
Slide 52
Assessment Steps for Significant MOI Rapid trauma assessment
Baseline vital signs SAMPLE history Reevaluate transport decision
Rapid trauma assessment Baseline vital signs SAMPLE history
Reevaluate transport decision
Slide 53
Assessment Steps for Trauma Patients Without Significant MOI
Focused assessment Baseline vital signs SAMPLE history Reevaluate
transport decision Focused assessment Baseline vital signs SAMPLE
history Reevaluate transport decision
Slide 54
Responsive Medical Patients History of illness SAMPLE history
Focused assessment Vital signs Reevaluate transport decision
History of illness SAMPLE history Focused assessment Vital signs
Reevaluate transport decision
Slide 55
Unresponsive Medical Patients Rapid medical assessment Baseline
vital signs SAMPLE history Reevaluate transport decision Rapid
medical assessment Baseline vital signs SAMPLE history Reevaluate
transport decision
Slide 56
Patient Assessment Process
Slide 57
Detailed Physical Exam More in-depth exam based on focused
physical exam Should only be performed if time and patients
condition allows Usually performed en route to the hospital More
in-depth exam based on focused physical exam Should only be
performed if time and patients condition allows Usually performed
en route to the hospital
Slide 58
Performing the Detailed Physical Exam
Slide 59
Visualize and palpate using DCAP-BTLS. Look at the face.
Inspect the area around the eyes and eyelids. Examine the eyes.
Visualize and palpate using DCAP-BTLS. Look at the face. Inspect
the area around the eyes and eyelids. Examine the eyes.
Slide 60
Pull the patients ear forward to assess for bruising. Use the
penlight to look for drainage or blood in the ears. Pull the
patients ear forward to assess for bruising. Use the penlight to
look for drainage or blood in the ears.
Slide 61
Look for bruising and lacerations about the head. Palpate the
zygomas. Look for bruising and lacerations about the head. Palpate
the zygomas.
Slide 62
Palpate the maxillae. Palpate the mandible Palpate the
maxillae. Palpate the mandible
Slide 63
Assess the mouth and nose for obstructions and cyanosis. Check
for unusual odors. Assess the mouth and nose for obstructions and
cyanosis. Check for unusual odors.
Slide 64
Look at the neck. Palpate the front and the back of the neck.
Look for distended jugular veins. Look at the neck. Palpate the
front and the back of the neck. Look for distended jugular
veins.
Slide 65
Look at the chest. Gently palpate over the ribs Look at the
chest. Gently palpate over the ribs
Slide 66
Listen for breath sounds. Listen also at the bases and apices
of the lungs. Listen for breath sounds. Listen also at the bases
and apices of the lungs.
Slide 67
Look at the abdomen and pelvis. Gently palpate the abdomen.
Gently compress the pelvis. Look at the abdomen and pelvis. Gently
palpate the abdomen. Gently compress the pelvis.
Slide 68
Gently press the iliac crests. Inspect all four extremities.
Assess the back for tenderness or deformities Gently press the
iliac crests. Inspect all four extremities. Assess the back for
tenderness or deformities
Slide 69
Patient Assessment Process
Slide 70
Ongoing Assessment Is treatment improving the patients
condition? Has an already identified problem gotten better? Worse?
What is the nature of any newly identified problems? Is treatment
improving the patients condition? Has an already identified problem
gotten better? Worse? What is the nature of any newly identified
problems?
Slide 71
Steps of the Ongoing Assessment Repeat the initial assessment.
Reassess and record vital signs. Repeat focused assessment. Check
interventions Repeat the initial assessment. Reassess and record
vital signs. Repeat focused assessment. Check interventions