Assessment of the Patient

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Assessment of the Patient
Unit 3 Patient Assessment
CHAPTER 7
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Assessment of the Patient

• Scene Size-up
• Initial Assessment
• Focused History and Physical Exam
• Vital Signs
• SAMPLE History / OPQRSTI
• Hand-off to EMTs

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Patient Assessment
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Patient Assessment
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• HISTORY S.A.M.P.L.E.
• Signs and symptoms
• Allergies
• Medications
• Pertinent past medical history
• Last oral intake
• Events leading to the illness or injury

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• HISTORY O.P.Q.R.S.T.I.
• Onset what were you doing when started?
• Provokes anything makes worse/better?
• Quality Type of pain/discomfort?
• Radiation (Pain) radiates other places?
• Severity (pain) scale of 1-10
• Time when started (how long ago)?
• Interventions What if anything has patient
  done/taken for condition?

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Scene Size-up

• Every patient assessment begins with scene
  size-up, which includes
• Taking BSI precautions
• Determining if the scene is safe
• Identifying the MOI or nature of illness
• Determining the number of patients
• Identifying any additional resources needed

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Scene Size-up

• BSI Precautions
• Body substance isolation (BSI) precautions must
  be taken on every call.

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Scene Size-up

• BSI Precautions

Rescuer wears protective eyewear.
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Scene Size-up

• BSI Precautions

Rescuer dons gloves.
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Scene Size-up

• BSI Precautions

Rescuer wears a gown.
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Scene Size-up

• BSI Precautions

Rescuer wears a simple surgical mask.
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Scene Size-up

• BSI Precautions

Rescuer wears a HEPA mask.
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Scene Size-up

• Scene Safety

An assessment of the scene and surroundings will
provide valuable information to the First
Responder and will ensure the well-being of the
First Responder.
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Scene Size-up

• Scene Safety
• Personal protection
• Protection of the patient
• Protection of bystanders

If the scene is unsafe, make it safe. Otherwise,
DO NOT ENTER.
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Scene Size-up

• Unstable Situation

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Scene Size-up

• HazMat Situation

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Scene Size-up

• Violent Situation

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Scene Size-up

• Identify Mechanism of Injury
• In trauma situations
• An evaluation of the forces that caused an injury
• May be beneficial in determining the presence of
  internal injuries
• Determined from the patient, family, or
  bystanders, and inspection of the scene

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Scene Size-up

• Identify Mechanism of Injury

Trauma patient
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Scene Size-up

• Identify Mechanism of Injury

Impact 1
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Scene Size-up

• Identify Mechanism of Injury

Impact 2
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Scene Size-up

• Identify Mechanism of Injury

Impact 3
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Scene Size-up

• Identify Nature of Illness
• In medical situations
• Determined from the patient, family, or
  bystanders
• Why was EMS called?

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Scene Size-up

• Identify Nature of Illness

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Scene Size-up

• Determine the number of patients and additional
  resources needed
• It is important to account for all patients
  involved.
• Request additional resources if needed
• Fire department
• Police
• ALS crews
• Rescue
• Utilities
• Call for resources early.

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Initial Assessment

• Form a general impression of the patient.
• Assess the patients mental status.
• Assess the patients airway.
• Assess the patients breathing.
• Assess the patients circulation.
• Make a decision on the priority the patient.

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Initial Assessment
The initial assessment is completed to assist the
First Responder in identifying Immediate Threats
to Life.
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Initial Assessment

• Form a General Impression of the Patient

Based on the First Responders immediate
assessment of the environment and the patients
chief complaint.
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Initial Assessment

• Form a General Impression of the Patient

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Initial Assessment

• Assess the Patients Mental Status
• Classify the patients mental status into one of
  the following categories
• Alert ( Orientated x 1, 2, 3, 4 person, place,
  time, events)
• Verbal
• Painful
• Unresponsive

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Initial Assessment

• Assess the Patients Mental Status

Assessing the apparently unresponsive patient
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Initial Assessment

• Assess the Patients Mental Status

Assessing the apparently responsive patient
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Initial Assessment

• Assess the Patients Airway

Head-Tilt, Chin Lift
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Initial Assessment

• Assess the Patients Airway

Jaw-Thrust Maneuver
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Initial Assessment

• Assess the Patients Breathing
• Look at the effort of breathing.
• Look, listen, and feel for presence of
  ventilations.
• Ventilate as needed.

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Initial Assessment

• Assess the Patients Breathing

Look at the effort of breathing.
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Initial Assessment

• Assess the Patients Breathing

Assess breathing look, listen, feel.
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Initial Assessment

• Assess the Patients Breathing

Mouth-to-Mask Ventilations
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Initial Assessment

• Assess the Patients Circulation
• Check for a pulse.
• Check for serious bleeding.
• Check skin color.

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Initial Assessment

• Assess the Patients Circulation

Check for a pulse.
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Initial Assessment

• Assess the Patients Circulation

Check for a pulse in infants.
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Initial Assessment

• Assess the Patients Circulation

Check for serious bleeding.
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Initial Assessment

• Assess the Patients Circulation

Controlling hemorrhage
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Initial Assessment

• Assess the Patients Circulation

Check for skin color.
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Initial Assessment

• Make a Decision on the Priority the Patient
• A high-priority patient
• Poor general impression
• P or U on AVPU Responsiveness Scale
• Breathing difficulties
• Severe bleeding or shock
• Complicated childbirth
• Chest pain
• Severe pain

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Initial Assessment

• Make a Decision on the Priority the Patient

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Initial Assessment

• Alert Dispatch

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Focused History and Physical Exam
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Focused History and Physical Exam

• Trauma PatientSignificant MOI
• Significant mechanisms of injury include
• Ejection from a vehicle
• Death of another passengers in a MVC
• Falls greater than 15 feet
• Rollover vehicle collision
• High-speed vehicle collision
• Vehicle-pedestrian collision
• Motorcycle crash
• Unresponsiveness or altered mental status
• Penetrations of the head, chest, or abdomen

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Focused History and Physical Exam

• Trauma PatientSignificant MOI
• Significant mechanisms of injury in a child
  include
• Falls greater than 10 feet
• Bicycle collision
• Medium-speed vehicle collision

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Focused History and Physical Exam

• Trauma PatientSignificant MOI
• Steps of assessment include
• Life Saving Interventions FIRST (ABCs)
• Perform a rapid trauma assessment.
• Take vital signs.
• Gather SAMPLE history.

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Focused History and Physical Exam

• Physical Exams or Assessments
• Deformities
• Contusions
• Abrasions
• Punctures and Penetrations
• Burns
• Tenderness
• Lacerations
• Swelling

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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

EXPOSE (Remove clothing) Stabilize the head and
neck, and check the head.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check the neck and apply a cervical collar.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check the chest.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check each quadrant of the abdomen.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check the pelvis, pressing gently down and inward.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check the back and buttocks.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check the extremities, legs, and then arms.
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Focused History and Physical Exam

• Trauma PatientRapid Trauma Assessment

Check for distal pulse, motor function, and
sensation in each extremity.
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Focused History and Physical Exam

• Trauma PatientNo Significant MOI
• Steps of assessment include
• Perform a focused trauma assessment.
• Take vital signs.
• Gather SAMPLE history.

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Focused History and Physical Exam

• Trauma PatientFocused Trauma Assessment

Examine the area that is injured.
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Focused History and Physical Exam

• Trauma PatientFocused Trauma Assessment

Take vital signs.
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Focused History and Physical Exam

• Trauma PatientFocused Trauma Assessment

Provide appropriate care.
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Focused History and Physical Exam

• Trauma Patient
• SAMPLE History
• Signs and symptoms
• Allergies
• Medications
• Pertinent past medical history
• Last oral intake
• Events leading to the illness or injury

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Focused History and Physical Exam

• Medical PatientUnresponsive
• Steps of assessment include
• Life Saving Interventions FIRST (ABCs)
• Perform a rapid physical exam (head-to-toe).
• Take vital signs.
• Gather SAMPLE history.

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Focused History and Physical Exam

• Medical PatientResponsive
• Steps of assessment include
• Gather SAMPLE history.
• Take vital signs.
• Perform a focused physical exam.
• Area of chief complaint

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Focused History and Physical Exam

• Medical PatientFocused Physical Exam

Gather a SAMPLE history.
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Focused History and Physical Exam

• Medical PatientFocused Physical Exam

Take vital signs.
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Focused History and Physical Exam

• Medical PatientFocused Physical Exam

Perform a focused physical exam on the patients
problem areas.
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Medical Identification Devices
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Vital Signs

• Pulse
• Assess for three characteristics
• Rate
• Strength
• Rhythm
• Carotid pulse in the neck
• Radial pulse in the lateral portion of the
  forearm, on the thumb side of the wrist

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Vital Signs

• Pulse
• To measure a radial pulse rate
• Use the three middle fingers.
• Do not use your thumb.
• Find the radial artery.
• Apply moderate pressure.
• Count the beats for 30 seconds.
• Multiply your 30-second count by 2.

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Vital Signs

• Pulse

Check a radial or carotid pulse.
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Vital Signs

• Pulse

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Vital Signs

• Pulse
• The normal pulse rate for adults is 60100 bpm.
• Rate gt 100 Tachycardia
• Rate lt 60 Bradycardia
• Newborn infants 120 to 160 bpm
• Up to 5 years old 80 to 140 bpm
• 5 to 12 years of age 70 to 110 bpm

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Vital Signs

• Respirations
• Assess for two characteristics
• Rate
• Slow
• Normal
• Rapid

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Vital Signs

• Respirations
• Assess for two characteristics
• Character
• Rhythm(Regular or Irregular)
• Depth(Normal, Shallow, or Deep)
• Sound(Abnormal Sounds)
• Ease(Labored, Difficult, or Painful)

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Vital Signs

• Respirations
• To measure respirations
• After pulse count, leave your hand on the wrist.
• Observe the rise and fall of the chest.
• Listen for sounds.
• Count the number of breaths in 30 seconds.
• Multiply your 30-second count by 2.
• Note rhythm, depth, sound, and ease of breathing.

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Vital Signs

• Respirations

Measuring and assessing respirations
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Vital Signs

• Respirations

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Vital Signs

• Respirations
• The normal respiratory rate for adults is 1220
  breaths per minute.
• gt 28 or lt 8 are considered serious.
• Newborn infants 2550 breaths per min.
• Up to 5 years old 2030 breaths per min.
• 5 to 12 years of age 1530 breaths per min.

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Vital Signs

• Skin Color, Temperature, and Moisture

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Vital Signs

• Skin Color, Temperature, and Moisture

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Vital Signs

• Skin Color, Temperature, and Moisture

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Vital Signs

• Pupils

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Ongoing Assessment
While awaiting the additional EMS resources, the
First Responder should continue to assess the
patient.
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Ongoing Assessment
Repeat every 15 minutes for a stable patient.
Repeat every 5 minutes for an unstable patient.
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Ongoing Assessment

• Repeat initial assessment.
• Repeat exams as needed.
• Repeat vital signs.
• Check interventions.
• Calm and reassure.

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Hand-Off to EMTs

• Verbal Report
• Age and sex
• Patients mental status
• Chief complaint
• Airway, breathing, and circulatory status
• Physical findings
• SAMPLE history
• Interventions applied
• Patients response to interventions
• Accurate Documentation if Required

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Hand-Off to EMTs
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Summary

• Scene Size-up
• Initial Assessment
• Focused History and Physical Exam
• Vital Signs
• Hand-off to EMTs