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TRANSCRIPT
9/12/2012
1
Chapter 12
Patient Assessment
Chapter Goal
Integrate principles of history taking & techniques of physical examination to perform patient assessment on emergency patient
Learning Objectives
Describe, recognize, & differentiate common hazards found at scene of trauma patient from those found at scene of medical patient
Differentiate safe from unsafe scenes
Describe methods for making an unsafe scene safe
Discuss common mechanisms of injury
Predict patterns of injury on basis of MOI
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9/12/2012
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Learning Objectives Discuss reasons for identifying total number of
patients at scene
Explain reasons for identifying need for additional help or assistance
Summarize reasons for forming general impression of patient
Review methods of assessing mental status & level of consciousness in adult, child, & infant
Learning Objectives
Discuss methods of assessing airway in adult, child, & infant
State reasons for management of cervical spine once patient is declared trauma patient
Analyze scene to determine if spinal precautions are required
Describe methods used for assessing patient breathing
Learning Objectives Differentiate between patient with adequate breathing &
one with inadequate breathing (minute ventilation)
Distinguish between methods of assessing breathing in adult, child, & infant
Compare methods of providing airway care to adult, child, & infant
Describe methods used to locate & assess pulse
Differentiate between locating & assessing pulse in adult, child, & infant
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9/12/2012
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Learning Objectives
Discuss need for assessing patient for external bleeding
Describe normal & abnormal findings when assessing skin color
Describe normal & abnormal findings when assessing skin temperature
Describe normal & abnormal findings when assessing skin condition
Learning Objectives Explain reasons for prioritizing patient for care &
transport
Identify patients who require expeditious transport
Describe evaluation of patient’s perfusion status based on findings in initial assessment
Describe orthostatic vital signs & evaluate their usefulness in assessing patient in shock
Apply techniques of physical examination to medical patient
Learning Objectives Differentiate between assessment done for patient who
is unresponsive or has altered mental status & assessment done for other medical patients
Discuss reasons for reconsidering MOI
State reasons for doing rapid trauma assessment
Recite examples & explain why patients should receive rapid trauma assessment
Apply techniques of physical examination to trauma patient
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9/12/2012
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Learning Objectives Describe areas included in rapid trauma assessment &
discuss what should be evaluated
Identify cases where rapid assessment may be altered to provide patient care
Discuss reasons for doing focused history & physical examination
Describe when & why detailed physical examination is necessary
Discuss components of detailed physical examination in relation to techniques of examination
Learning Objectives State areas of body evaluated during detailed exam
Explain what additional care should be provided while doing detailed physical examination
Distinguish between detailed physical examination performed on trauma patient & one performed on medical patient
Differentiate between patients who require detailed physical examination & those who do not
Discuss reasons for repeating initial assessment as part of ongoing assessment
Learning Objectives
Describe components of ongoing assessment
Describe trending of assessment components
Discuss medical identification devices, systems
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9/12/2012
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Introduction
Patient assessment Structured
Looking for & recognizing• Symptoms
• Signs
Continues throughout time spent with patient
6 phases
Introduction
Scene Size-Up
General approach: Potential scene hazards Ensure safe environment Anticipate potentially
hazardous situations Call for appropriate
resources
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9/12/2012
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Scene Size-Up
General approach Before care given—rapid
assessment based on: • Dispatch information
• Previous knowledge
• On-scene observations
Scene Size-Up
BSI precautions Formerly called universal
precautions
CDC recommendations—guidelines are law
Scene Size-Up
BSI precautions
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Scene Size-Up
Ensuring scene safety Main purpose
Consider environment
Situation hostile
Special equipment
Ensure your personal protection
Scene Size-Up
Determine MOI & NOI
Initial Assessment
Rapid, organized, systematic evaluation
General impression
Life-threatening problems, injuries
Mental status—AVPU
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Initial Assessment
Airway status Trauma patient
• Stabilize C-spine
• Perform jaw-thrust maneuver
Initial Assessment
Assess airway status
Initial Assessment
Assess patient’s breathing
Palpate chest for equal expansion
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9/12/2012
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Initial Assessment
Assess patient’s circulation Patient unresponsive— check
carotid pulse first
Pulse present—estimate BP• Carotid—60 mm Hg systolic
• Femoral—70 mm Hg systolic
• Radial—80 mm Hg systolic
Initial Assessment
Check for major bleeding Assess skin—determine
perfusion status
Places where color assessed
Abnormal skin colors: • Red
• Pale
• Yellow
• Mottled red or pale
• Cyanosis
Initial Assessment
Capillary refill—subject of controversy
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Initial Assessment
Identify “priority” patients Require more advanced-level care
Availability of care
Lights & siren
Guidelines for identifying “priority” patients
Initial AssessmentResuscitation
Focused History & Physical Exam
Trauma patient
Medical patient
Mechanism of injury, transport decision help identify “priority” patients
Infants & small children
Rapid trauma assessment—DCAP-BTLS
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9/12/2012
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Focused History & Physical Exam
Hidden injuries
Rapid medical assessment
Focused history & physical exam Trauma patient
Medical patient—OPQRST
Detailed Physical Examination
Organized
Specific
“Priority” patients
Detailed Physical Examination
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9/12/2012
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Ongoing Assessment
Stable patient
Unstable patient
Parameters
Definitive field management
Transportation Specialty centers Helicopter transport The “3 Rs”
Contacting medical direction
Summary
Patient assessment—structured method of evaluating patient’s physical condition
During scene size-up, evaluate “whole picture” of call
The initial assessment—organized approach
Focused history & physical exam—evaluate patient on basis of suspected condition
Summary
Following rapid trauma assessment—obtain baseline vital signs
Detailed assessment—more detailed exam that is patient & injury specific
Patient assessment is ongoing process
Many conditions cannot be completely managed in field
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