health assessment chapter 27 emergency

8/8/2019 Health Assessment Chapter 27 Emergency

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Slide 1

CHAPTER 27

EMERGENCY ORLIFE-THREATENING SITUATIONS


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Slide 2

THE ABCS OF PRIMARYASSESSMENT


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Slide 4

Emergencies

Recommended approach for treatment

Rapid primary assessment

Secondary assessment

Definitive care

The ABCs of Primary Assessment


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Slide 5

Primary Assessment

A = Airway is maintained and cervical spine

control is performed.

B = Breathing is assessed.

C = Circulation is assessed and hemorrhage

controlled.

D = Disability is assessed with patients degree

of responsiveness.

E = Exposure: Undress patient to identify all

injuries.



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Slide 6

Secondary Assessment (1)

General

Vital signs

Head-to-toe survey

Glasgow coma scale



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Slide 7


Abbreviated history (AMPLE)

A = Allergies

M = Medications currently taken

P = Past illnesses

L = Last meal

E = Events preceding the incident



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Slide 8


Head and neck

Chest

Abdomen Back

Extremities

Rectum and perineum

Neurologic examination

Reevaluation Urgent or emergent

threat



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Slide 9

INJURY ASSESSMENT


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Slide 10

Injury Assessment

Trauma

Blunt

Penetrating

Burns

Injury Assessment


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Slide 11

Infants and Children

Secondary assessment in children

Weight

Approximated systolic blood pressure

Patent airway in crying child

Capillary refill time

Responsiveness

Injury Assessment


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Slide 12

Infants and Children

Intervention

Establish rapport.

Obtain history (AMPLE) with additional questions about

mothers pregnancy and delivery.

Get as much history as possible from child.

Evaluate with deliberate speed.

Injury Assessment


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Slide 13

RECORDS AND LEGALCONSIDERATIONS


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Slide 14

Records

Meticulous record keeping is essential.

Memory unreliable

Recording of observations, evaluations, orders, and

what was and was not done

Thorough, concise, clear, and accurate

Chronologic order of events

Legibility

Records and Legal Considerations


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Slide 15

Consent for Treatment

Life threatening: Treat first, get consent later.

Forensic trauma: Preserve evidence.



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Slide 16

Advance Directives

Advance directives

Living wills

Durable power of attorney for health care



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Slide 17

Summary (1)

Evaluation and care are divided into four phases:

Primary assessment: assessment of ABCs

Airway assessment and management when C-spine control is

performed. Breathing is assessed and ventilation is assisted as needed.

Circulation is assessed, with hemorrhage control or shock

management.

Disability: neurologic function is briefly evaluated.

Exposure: completely undress the patient whenever possible

but keep the patient warm, particularly an infant or child.


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Slide 18

Summary (2)

Resuscitation

The management of life-threatening problems

identified in the primary survey is continued.

Mechanical monitoring is implemented.


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Slide 19

Summary (3)

Secondary assessment

Take vital signs.

Develop the history, guided by the mnemonic AMPLE.

Total evaluation of the patient is performed in the following

areas: head and skull, neck, chest, abdomen, rectum and

perineum, and extremities (for fractures).


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Slide 20

Summary (4)

Secondary assessment - continued

Complete neurologic examination is performed, along

with appropriate x-ray examinations, laboratory tests,

and special studies.

Tubes and fingers are in every orifice.


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Slide 21

Summary (4)

Definitive care

Diagnosis and treatment specific to the condition

can begin after:

Identifying and ascertaining patients injuries

Managing life-threatening problems

Obtaining special studies


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Slide 22

Summary (5)

Definitive care - continued

The following factors must return to comfortable levels

before you can relax:

Heart rate Respiratory rate

Level of consciousness

Capillary refill time

Assessment of central versus distal pulses


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Slide 23

Summary (6)

Definitive care - continued

Positive assessments of the following issues are essential

until the clinical situation stabilizes:

100% oxygen

Cervical immobilization

Maintenance of core temperature


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Thank You for a Great Semester

health assessment chapter 27 emergency

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