sick/not sick rapid assessment of a patient with traumatic injury

Sick/Not SickSick/Not Sick

Rapid Assessment Rapid Assessment

of a Patient with Traumatic Injury of a Patient with Traumatic Injury

Truama Sick/Not SickTruama Sick/Not Sick 22


The Concept of Sick/Not SickThe Concept of Sick/Not Sick

This concept has been around for years and is This concept has been around for years and is based off similar principles used during Mass based off similar principles used during Mass Casualty Incidents Casualty Incidents

It’s a method of rapid patient assessment that It’s a method of rapid patient assessment that allows you to make good treatment decisions allows you to make good treatment decisions based on proven clinical indicatorsbased on proven clinical indicators

Facilitates good coordination and communication Facilitates good coordination and communication in the field and results in better patient carein the field and results in better patient care


Purpose of Sick/Not SickPurpose of Sick/Not Sick

To help you quickly and accurately decide To help you quickly and accurately decide who is critically injured and who is notwho is critically injured and who is not

Assure a rapid initial assessment and Assure a rapid initial assessment and transport to appropriate facilitytransport to appropriate facility

Prevent delays in patient carePrevent delays in patient care


ObjectivesObjectives

Understanding TermsUnderstanding TermsThe clinical pictureThe clinical pictureWho is “Sick”Who is “Sick”Who is “Not Sick”Who is “Not Sick”Making a decisionMaking a decisionTreatmentTreatmentTransport Transport


Terms While In RouteTerms While In Route

Index of SuspicionIndex of Suspicion – The anticipation – The anticipation that certain types of accidents will result in that certain types of accidents will result in certain types of injuriescertain types of injuries

Mechanism of InjuryMechanism of Injury – The forces of – The forces of injury and how they were applied to the injury and how they were applied to the bodybody


Terms Involving Exam Terms Involving Exam

PerfusionPerfusion – The flow of blood through the – The flow of blood through the organs and tissue of the bodyorgans and tissue of the body

RPMRPM – An acronym that stands for – An acronym that stands for respirations, pulse and mentationrespirations, pulse and mentation

Skin SignsSkin Signs – Observable indications of – Observable indications of circulation including skin color, circulation including skin color, temperature and moisturetemperature and moisture


Terms of DecisionTerms of Decision

SickSick – Someone who appears – Someone who appears physiologically unstable as indicated by physiologically unstable as indicated by clinical indicatorsclinical indicators

Critical / Urgent / UnstableCritical / Urgent / Unstable

Not SickNot Sick – Someone who appears – Someone who appears physiologically as indicated by adequate physiologically as indicated by adequate respiration, pulse, mental status, skin color respiration, pulse, mental status, skin color and an appropriate body positionand an appropriate body position

Non-critical / Non-urgent / Stable Non-critical / Non-urgent / Stable


The “Sick” PatientThe “Sick” Patient

Appears to be unstable as indicated by clinical Appears to be unstable as indicated by clinical signssigns

Has life-threatening injuries that need to be Has life-threatening injuries that need to be treated aggressively by both BLS and ALS treated aggressively by both BLS and ALS crewscrews

This patient can die quickly unless you initiate This patient can die quickly unless you initiate immediate treatment and rapid transport to an immediate treatment and rapid transport to an appropriate facilityappropriate facility


Recognizing the Sick PatientRecognizing the Sick Patient

It may only take one of these to convince you!It may only take one of these to convince you!

Index of SuspicionIndex of Suspicion Mechanism of InjuryMechanism of Injury RespirationsRespirations PulsePulse Mental StatusMental Status Skin SignsSkin Signs Body PositionBody Position


The “Not Sick” PatientThe “Not Sick” Patient

Appears to be stable as indicated by clinical Appears to be stable as indicated by clinical signssigns

This patient still has injuries at this time the This patient still has injuries at this time the condition is not life threateningcondition is not life threatening

Even though this patient has no life threatening Even though this patient has no life threatening injuries they still need and deserve treatment injuries they still need and deserve treatment and transport to the appropriate facilityand transport to the appropriate facility


Gathering The Information Gathering The Information Pre Plan While In RoutePre Plan While In Route

Index of suspicion/Mechanism of injuryIndex of suspicion/Mechanism of injury Differential Diagnosis X 3Differential Diagnosis X 3

View the Clinical Picture Upon ArrivalView the Clinical Picture Upon Arrival Chief complaintChief complaint RespirationsRespirations PulsePulse Mental statusMental status Skin color/signsSkin color/signs Body positionBody position


Making The DecisionMaking The Decision What does the clinical picture tell you?What does the clinical picture tell you?

Chief ComplaintChief Complaint – Focus on injury – Focus on injury Mechanism of Injury (MOI) – Mechanism of Injury (MOI) – How significant was the How significant was the

mechanism and is there obvious traumamechanism and is there obvious trauma RespirationsRespirations – What is the rate or character – What is the rate or character Pulse Pulse – Can it be palpated and what is its rate and character– Can it be palpated and what is its rate and character Mental StatusMental Status – Is the patient anxious, combative, drowsy, – Is the patient anxious, combative, drowsy,

lethargic or unconscious lethargic or unconscious Skin SignsSkin Signs – What is the color, temperature and moister – What is the color, temperature and moister Body PositionBody Position – meeting you at the door, tripod to breath, – meeting you at the door, tripod to breath,

unable to support weight unable to support weight

Is the patient likely to survive without immediate and Is the patient likely to survive without immediate and aggressive action?aggressive action?


The Decision MadeThe Decision Made

The clinical picture has been formedThe clinical picture has been formed All information has been gathered quicklyAll information has been gathered quickly

Sick/Not SickSick/Not Sick

Having a planHaving a plan Taking action based on the decisionTaking action based on the decision

Sick – ALS & rapid transportSick – ALS & rapid transport Not Sick – Thorough on-scene exam with appropriate Not Sick – Thorough on-scene exam with appropriate

treatment treatment


Changing The DecisionChanging The Decision

It’s OK to switch from Not Sick to the Sick It’s OK to switch from Not Sick to the Sick decisiondecision Things may change in the patients statusThings may change in the patients status You may discover more information during a thorough You may discover more information during a thorough

examexam You may have a “Gut Feeling”You may have a “Gut Feeling”

Don’t get caughtDon’t get caught Failing to respond to new informationFailing to respond to new information Having tunnel visionHaving tunnel vision Not having a clear well thought out planNot having a clear well thought out plan


Treatment/TransportTreatment/Transport

Formulate a plan based on the clinical decisionFormulate a plan based on the clinical decision

Make a decision early in the call Make a decision early in the call

Take action quickly, add additional recourses Take action quickly, add additional recourses early and treat the patient aggressivelyearly and treat the patient aggressively

Transport the patient to an appropriate Transport the patient to an appropriate destination and inform them that you are comingdestination and inform them that you are coming


SummarySummary

Speed up the delivery of care to critical patients Speed up the delivery of care to critical patients by determining Sick/Not Sick earlyby determining Sick/Not Sick early

Create a plan while en-route based on Create a plan while en-route based on information from dispatch and other units on-information from dispatch and other units on-scenescene

Treat Sick patients aggressively with both BLS Treat Sick patients aggressively with both BLS and ALS crewsand ALS crews

Understand the clinical signs and how they are Understand the clinical signs and how they are used to determine if a patient is Sick or Not Sickused to determine if a patient is Sick or Not Sick


SummarySummary

RespirationsRespirations PulsePulse Mental StatusMental Status Skin SignsSkin Signs Body Position Body Position Evidence of Significant Mechanism of InjuryEvidence of Significant Mechanism of Injury

The sick patient appears unstable as indicated The sick patient appears unstable as indicated by inadequacies in:by inadequacies in:


Questions?Questions?

sick/not sick rapid assessment of a patient with traumatic injury

Documents

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bodytruama sicknot sickterms

clinical signsthis patient

patient anxious

als crewsthis patient

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sick patientit

forces of injury