EMT 100

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EMT 100

• Patient Assessment

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Vital Signs

• SIGNS OF LIFE

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Pulse

• Is the heart rate expressed in beats per minute

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Radial Artery Palpation
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Carotid Artery Palpation
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Normal Pulse Values

• Adult 60-100
• Children 80-100
• Infants 100-140

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Rapid Weak Pulse May Be A Sign Of Shock!
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Respiration

• Expressed in breaths per minute
• Each breath consists of an inspiration and an
  expiration
• Look, Listen, and Feel!

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Normal Respiration Rates

• Adults 12-20
• Children 20-40
• Infants 30-50

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Rapid And Shallow Respirations May Be A Sign Of
Shock!
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Temperature

• Normal 98.6F or 37C
• Warm, dry skin

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Cool, Clammy Skin May Be A Sign Of Shock!
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Skin Color

• Pale, white ashen appearance, ie Pallor, may be a
  sign of shock!
• Bluish, gray skin, ie Cyanosis, shows poor
  oxygenation of the blood
• Yellowish-orange skin, ie Jaundice, may be a sign
  of liver disease or blood disease

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Pupils

• Normally are the same size and react equally to
  light

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Level of Consciousness (LOC)assessed by asking

• Who are you? (Orientation to self)
• What were you doing? (Orientation to situation)
• Where are you ? (Orientation to place)
• What day of the week is it? (Orientation to time)

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LOC continued

• Questions must be asked in this order
• May need to assess every few minutes
• As patients become disoriented, they lose the
  ability to answer the questions in the reverse
  order that they are asked

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Psychological Concerns

• Extremely aberrant behavior by the patient may be
  a manifestation of illness or injury

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Psychological Concerns (continued)

• Be in control
• Be supportive
• Be honest

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Golden Rule

• Treat each patient the way you would want to be
  treated if you were the patient!

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Patient Assessment Sequence

• Perform scene size-up.
• Perform primary assessment.
• Obtain SAMPLE History.
• Secondary assessmenthead to toe exam.
• Perform on-going re-assessment.

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Step I Scene Size-up

• Maintain body substance isolation.
• Maintain scene safety.
• Determine mechanism of injury or nature of
  illness.
• Determine need for additional resources.

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Step II Perform Primary AssessmentLook for
Life-Threatening Conditions

• Form general impression of patient.
• Assess responsiveness.
• Check airway.
• Check breathing.
• Check circulation.

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Primary AssessmentAssess Responsiveness

• AVPU Scale
• Alert
• Verbal
• Pain
• Unresponsive

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Primary Assessment Check Patients Airway

• Head tiltchin lift technique
• The tongue is the most common cause of
  obstruction in an unconscious person
• Jaw-thrust technique
• Inspect mouth
• Insert airway if needed

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Primary Assessment Check Patients Breathing

• If conscious
• Check rate and quality.
• Check for any difficulty.
• If unconscious
• Look, listen, and feel for breathing.
• Start rescue breathing, if needed.

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Primary AssessmentCheck Patients Circulation

• Check carotid or radial pulse.
• Check for severe bleeding.
• Check skin color and temperature
• Pale - decreased circulation
• Flushed - excess circulation
• Yellow - liver problems

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Step III Patients Medical History

• Signs/Symptoms (Chief Complaint)
• Allergies
• Medications
• Pertinent, past medical history
• Last oral intake
• Events associated with or leading to the injury
  or onset of illness

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Step IV Seconday Assessment - Physical
Examination

• Check patient from head to toe
• for non-life-threatening conditions.
• Purpose of exam is to locate and begin initial
  management of injury or illness.

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Physical Exam Examine the Patient from Head to
Toe

• Look and feel for signs of injury
• Deformity
• Open injuries
• Tenderness
• Swelling
• Search all areas of body in a clear, concise,
  consistent format.

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Examine Patients Head and Eyes

• Examine head
• Use both hands.
• Do not move patients head.
• Remove eyeglasses.
• Remove wigs if necessary.
• Examine eyes
• Cover one eye for 5 seconds.
• Watch for pupil contraction.

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Examine Patients Neck and Chest

• Examine neck
• Examine each side check for pain.
• Check neck veins.
• Check for a medical identification tag.

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Examine Patients Chest

• Examine chest
• Check for pain on inhalation/exhalation.
• Look for signs of difficult breathing.
• Note injuries, bleeding, or abnormal, unequal,
  or painful movement.
• Check for collarbone or rib fractures.

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Examine Patients Abdomen

• Look for signs of external bleeding,
  penetrating injuries, or protruding parts.
• Check for stomach rigidity or swelling.
• Check for soiled clothing.
• Check genital area for external injuries.

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Examine Patients Pelvis

• Examine pelvis
• Check for obvious bruising, bleeding, or
  swelling.
• Check for pain if no pain has been reported.
• Examine back
• Stabilize head and neck and log-roll
• Check one side of the back at a time.

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Examine the Extremities

• Observe the extremity.
• Examine for tenderness.
• Check for movement.
• Check for sensation.
• Assess the circulatory status.

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Step V On-going Reassessment

• Monitor patients vital signs
• Every 5 minutes if unstable.
• Every 15 minutes if stable.
• Maintain an open airway.
• Monitor breathing and pulse.
• Monitor skin color and temperature.

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It is time for lab!
Check and record the radial/carotid pulse and the
respirations of 5 fellow students
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Primary Survey

• Looks for life-threatening conditions!

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Determine whether victim is conscious or
unconscious, then check

• Airway
• Breathing
• Circulation
• Hemorrhage
• Shock

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Secondary Survey

• Is a head to toe survey that looks for other
  injuries/problems

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Secondary Survey (cont.)

• Neck
• Skull
• Face, Nose, and Mouth
• Chest and Lungs
• Abdomen
• Pelvis, Genitals, Incontinence
• Extremities
• Back and Buttocks
• Reassure!

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Dont Overlook

• Situation
• Bystanders, Family or Friends
• Medications and Medical History
• Wallet Cards
• Vial of Life
• Med-Alert Tags