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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
• • • • • • • Patient Assessment VS Communication Documentation The older folks The younger folks Block III written and practical Scene-Size-up – Initial Assessment – Focused history and physical examDetailed Physical ExamOn-Going Assessment- BSI BSI BSI BSI BSI BSI BSI BSI Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment Scene Size-up Initial evaluation of the scene • Continues throughout the scene Part I SCENE SIZE-UP Defined: Begins with dispatch Initial evaluation of the scene Goals: Ensure scene safety To determine if patient is medical or trauma Determine total number of patients • Scene Size-up Begins with Dispatch demographics: residence - Pull to curbside in front of house Always remember, scene safety is a component of Scene Size-up Nature of illness: Number of patients: Considers stabilization of spine Requests additional help if necessary: ALS Personal protection • Always perform your own size-up • Observe as you approach and before getting out of the truck Nature of Illness • Information can be obtained from The patient Family members or bystanders Scene • Mechanism of injury • Number of patients • Call for additional help if needed ALS Collision Scene • Look and listen • Check for power outages • Observe traffic flow • Check for smoke As you approach: • Look for clues to escape hazourdous materials • Look for patients on or near the road • Look for smoke not seen at a distance • Look for broken utility poles and downed lines • Be on the look-out for bystanders • Watch for signals of police officers or other agency personnel Danger Zone • No apparent hazard-at least 50ft in all directons • Fuel spill-at least 100 ft. in all directions uphill and downwind avoid gutter, gullies, ditches do not use flares • Vehicle fire-at least 100 ft. in all directions • Downed wires-area in which contact can be made • Hazardous Materials Emergency Response Guide Book Chemtrec Crimes Scenes and Acts of Violence Signals of violence: • Fighting or loud voices • Visible weapons • Signs of alcohol or other drug use • Unusual silence • Knowledge of prior violence Nature of call • Illness • Injury • • • • • • • • Part II INITIAL ASSESSMENT Defined: Discovering and treating life-threatening conditions Goals: Determine if the patient is ill or injured Triage Components: General Impression • • • • • • • • • Illness or injury Mechanism of injury/Nature of illness Age, sex, race Identify life-threatening problems Mental Status A lert Assess Breathing Assess Breathing Triage V erbal Response P ainful Response U nresponsive • • • • • Part III Focused History and Physical Exam Defined: To identify additional serious or potentially life-threatening injuries or conditions Components, Trauma Reconsider Mechanism of injury • Index of suspicion • Rapid Trauma Assessment • Head to toe physical exam quickly conducted • • • • Base-line Vital Signs Assess S A M P L E history Components Medical History of present illness • • • • • • • • • • O–P–Q–R–S–T SAMPLE Rapid Assessment Base-line Vital Signs Treat IF UNRESPONSIVE: Rapid Assessment Base-line Vital Signs Assess S A M P L E Care Focused History and Physical Exam • Onset? • Provokes? • Quality? • Radiates? • Severity? • Time? • Interventions? S • • • • • • A M P L E history Signs/Symptoms Allergies Medications PMHx. Last oral intake Events leading to the illness/injury General Impression • • • • Illness or injury Mechanism of injury/Nature of illness Age, sex, race Identify life-threatening problems Vital Signs • Pulse Apical • Respirations • Skin color, temp, condition • Pupils • Blood Pressure Auscultation Palpation • Mental Status Communicating with your patient • Position yourself close to the patient • Identify and yourself and reassure • Speak in a normal voice • Learn your patient’s name • Learn your patient’s age • Part IV Detailed Physical Exam • Defined • Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment • Components • Head to Toe exam • Reassess vital signs • Continue care • • • • • • • • • • • • • • Part V On-Going Assessment Defined: To detect any changes in the patient’s condition To detect any missed injuries or conditions To adjust care as needed Goal: The initial assessment is repeated Vital signs are repeated and recorded Focused assessment repeated for additional complaints Components: Repeat Initial Assessment Repeat focused assessment Check interventions Note trends in patient condition On-going Assessment • Repeats initial assessment • Repeats vital signs: • Repeats focused assessment regarding patient complaint or injuries: Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment Responsive • Four parts History of present illness Focused physical exam OPQRST SAMPLE Baseline VS • Prior history • DCAPBTLS Unresponsive • Patient history from family, bystanders etc. • Rapid assessment Abd: distension, firmness, rigidity Pelvis: Incontinence of urine, feces • ID bracelets • Baseline VS • Consider need for ALS • History of present illness and SAMPLE History of present illness and SAMPLE • Patient’s name • What happened what did family/bystander see • Did patient complain of anything prior • Know illness • Medications