PATIENT ASSESSMENT

EMERGENCY MEDICAL TECHNICIAN - BASIC

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INTRODUCTION
What is Patient Assessment? Why is Patient Assessment important?

Temple College EMS Program

INTRODUCTION
What are the phases of patient assessment?
Review of Dispatch Information Scene Survey Initial Assessment Focused History and Physical Exam Detailed Physical Exam Ongoing Assessment Communication Temple College EMS Documentation Program

INTRODUCTION
Why is the order of Patient Assessment important? Why is it necessary to develop a method of assessment and use that method on all patients?

Temple College EMS Program

PATIENT ASSESSMENT
SCENE SIZEUP

Medical Patient

INITIAL ASSESSMENT

Trauma Patient

FOCUSED HISTORY & PHYSICAL EXAM DETAILED PHYSICAL EXAM

FOCUSED HISTORY & PHYSICAL EXAM DETAILED PHYSICAL EXAM

ON-GOING ASSESSMENT

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Begin with receipt of call
Location Incident Injured/Injuries

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Continue En Route
Further info from dispatcher Observe
Smoke? Fire? High line wires? Railroads? Water? Industry? Other Public Safety units?
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Upon Arrival
Observe
Overall scene Location of victim(s) Possible Mechanisms of Injury

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Upon Arrival
Observe
Hazards
Crowds HazMat Electricity Gas Fire Glass Jagged metal Stability of environment Traffic Environment

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Ensure Safety
Yourself Partner Other rescuers/Bystanders Patient

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Call for assistance
Other EMS Units Law Enforcement Fire Department HazMat Negotiating Team etc.

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Scene Safety & Personal Protection

Body Substance Isolation
Hand washing Gloves & eye protection Mask & gown

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Scene Safety & Personal Protection

Protective Clothing
Cold weather clothing
Dress in layers

Turnout gear
Provides head-to-toe protection

Gloves
Use proper gloves for job being performed

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Scene Safety & Personal Protection

Protective Clothing (Cont.)
Helmets
Must be worn in any fall zone

Boots
Should protect your feet, fit well, be flexible

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Scene Safety & Personal Protection

Protective Clothing (Cont.)
Eye & ear protection
Should be used on rescue operations

Sin protection
Use sun block when working outdoors

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Scene Safety & Personal Protection

Violent Situation
Civil disturbances Domestic disputes Crime scenes Large gatherings

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Scene Safety & Personal Protection

Behavioral Emergencies
Determinants of violence
Past History Posture Vocal Activity Physical activity

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Scene Safety & Personal Protection

Immunizations
Tetanus-Diphtheria Measles vaccine Rubella Vaccine Mumps Vaccine Flu vaccine Hepatitis vaccine
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Scene Safety & Personal Protection

Your personal safety is of the almost importance. You must understand the risks of each environment you enter!

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Initial Assessment
Purpose
To rapidly identify & correct life threats To identify those patients who need rapid evacuation
Minimum Time on scene - Maximum Care En Route

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Initial Assessment
General Impression
Using the facts gathered to this point, what is your first impression of the patients condition?

Chief Complaint

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Initial Assessment
Mental Status (Level of Consciousness)

A - Alert V - Verbal P - Painful U - Unresponsive

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Initial Assessment
Identify Life Threats

Airway
Control C-spine (If trauma suspected) Open-Clear-Maintain

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Initial Assessment
Breathing
Look Listen Feel Bare chest if respiratory distress apparent

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Initial Assessment
Circulation
Major Bleeding Pulse (Rapid/Slow : Weak/Bounding)
Radial >80 systolic Femoral >70 systolic Carotid >60 systolic

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Initial Assessment
Circulation (cont.)
Capillary Refill Skin Color
Pale Ashen Cyanotic Mottled Red

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Initial Assessment
Circulation (cont.)
Skin Temperature
Hot (warm) Cool

Skin Condition
Moist Dry Skin Turgor

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Initial Assessment
Disability Expose
Head/Neck Chest Abdomen

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Initial Assessment
Rapid Evacuation
Consider ALS intercept If, during the Initial Assessment, you encounter a life-threatening condition that your intervention cannot alleviate, you should rapidly evacuate to someone who can.

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Criteria for Rapid Evacuation

Poor General Impression Unresponsive - no gag or cough reflex Responsive - unable to follow commands Cannot establish / maintain patent airway Difficulty breathing / Resp. distress

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Criteria for Rapid Evacuation

Poor perfusion Uncontrolled bleeding Severe pain in any part of the body Severe chest pain Inability to move any part of body

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Criteria for Rapid Evacuation

Complicated childbirth High body temp (above 104 F) Signs of generalized hypothermia Severe allergic reaction (anaphylaxsis) Poisoning or overdose of unknown nature

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Focused History & Physical Exam - Trauma

Purpose
Obtain Chief Complaint
What happened to the patient?

Evaluate Chief Complaint

What circumstances surround this incident? Is the Mechanism of Injury a high risk for injury?

Conduct Physical Exam Obtain Baseline Vital Signs

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Focused History & Physical Exam - Trauma

Re-evaluate Mechanism of Injury (MOI)
Significant MOI? Yes/No Is patient unresponsive or disoriented?
Can they participate in examination?

Is the patient under the influence of drugs or alcohol?

Can they participate in examination?

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Patients with Significant MOI

RAPID TRAUMA ASSESSMENT
Head-to-Toe Physical Exam Palpation Auscultation Other Senses

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Patients with Significant MOI

` RAPID TRAUMA ASSESSMENT
DCAP-BTLS
D - Deformities C - Confusions A - Abrasions P - Punctures/Penetrations B - Burns T - Tenderness L - Lacerations S - Swelling
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Patients with Significant MOI

Baseline Vital Signs
More than one set Look for trending

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Patients with Significant MOI

History

S-A-M-P-L-E

S - Signs & Symptoms A - Allergies

Medications Foods Environment

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Patients with Significant MOI

M - Medications
Are you taking any? When did you last take your medication? What are they? What are they for? May I see them? May we take them with us?

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Patients with Significant MOI

P - Previous Medical History
Pertinent Related to this complaint Complicating factor

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Patients with Significant MOI

L - Last Oral Intake
Food and/or Drink? What? When?

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Patients with Significant MOI

E - Events leading up to the incident
What happened? When?

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Patients with NO Significant MOI

Assess Chief Complaint Focused Assessment Baseline Vitals

SAMPLE History

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Focused History & Physical Exam - Medical

Patient Responsive? Yes/No

AVPU A - Alert V - Verbal P - Painful U -Unresponsive

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Responsive Patients - Medical

Assess Chief Complaint Signs & Symptoms

O - Onset
When & How did the symptom begin?

P - Provokes
What makes the symptom worse?

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Responsive Patients - Medical

Signs & Symptoms (cont.)

Q - Quality
How would describe the pain?/What does the pain feel like? DO NOT lead the patient

R - Region/Radiation
Where is the pain? Does the pain travel anywhere else?
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Responsive Patients - Medical

Signs & Symptoms (cont.)

S - Severity
How bad is the pain?

T - Time
How long have you had the symptom?

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Responsive Patients - Medical

SAMPLE History
Focused Medical Assessment Baseline Vital Signs Transport Decision Detailed Physical Exam Ongoing Assessment
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Unresponsive Patients - Medical

Rapid Medical Assessment Baseline Vital Signs

SAMPLE History
Family, co-workers, bystanders

Transport Ongoing assessment

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Detailed Physical Exam

More detailed Head-to-Toe examination Time sensitive
Usually performed en-route

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Detailed Physical Exam

Required for any unresponsive patient
If the patient cannot communicate what is wrong, you must seek out the problem(s)

Required for any multi-trauma patient

Victims of multiple trauma must be assessed for less obvious or masked injuries

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Detailed Physical Exam

Required for any Patient with significant mechanism of injury
If the mechanism of injury could have caused serious injuries, the EMT must actively assess for additional injuries

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On-Going Assessment
Purpose Determine if there are any changes in the patients condition Identify any missed injuries or conditions Assess the effectiveness of treatment given and adjust if necessary

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On-Going Assessment
Performed on both the trauma or medical patient Procedure
Repeat Initial Assessment Reassess Vital Signs Repeat Focused Assessment Check Interventions
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