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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Patient Assessment Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline • Scene Size-Up • Patient History • Initial Assessment • Ongoing Assessment • Physical Examination • Hand-Off Report Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Assessment • Determining the problems a patient is experiencing • Goal is to identify and treat critical problems Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Scene Size-Up • First step of patient assessment – Personal safety – Safety of scene – Assessment of Mechanism of Injury (MOI) or Nature of Illness (NOI) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Size up this scene Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Personal Safety • First concern is PPE – BSI – Protective clothing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Size up this scene Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common hazards • Unstable vehicles • Undeployed airbags • Leaking fluids • Traffic • Agitated or violent patient or bystanders Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hazardous Materials • Tractor-trailer crashes, train derailments, industrial sites, farm incidents • Notify HAZMAT team • Do not approach scene until directed Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Crimes Scenes and Environment • Crime Scenes – Violent crime – Domestic violence • Environment – Slopes, ice, water, etc. – Weather conditions Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bystanders • Often not aware of hazards and may put themselves at risk • May also put others at risk – Smoking in presence of oxygen or spilled fuel Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Safety First • If the scene is not safe, and you cannot make it safe, do not enter STOP! • Wait for specially trained rescue personnel to make scene safe or bring patient to you Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MOI • An evaluation of forces that caused an injury • May help anticipate injuries • Systematically survey scene and question bystanders Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What would you ask or look for? Mosby items and derived items © 2007, 2004 by Mosby, Inc., anMosby affiliate of Elsevier Inc. items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. items and derived Determine • If patient assaulted (shot, beaten, stabbed) • Weapon used • Height of fall • Surface patient landed on • Position patient landed Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nature of Illness • What are some clues to illness? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nature of Illness • Why did patient call for help? • What is the patient’s complaint? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived © All 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Copyright © 2004 Elsevieritems (USA). Rights Reserved Clues to Illness • Patient confined to bed • Patient uses walker or cane • Patient lacks adequate food/shelter • Patient takes medications • Other clues? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Number of Patients • Incident may involve more than 1 patient • Must be determined before patient care • Call for additional resources if needed • If more than 1 patient, perform triage Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The initial assessment is performed to identify any immediate threats to the patient’s life Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Initial Assessment • GILT – General impression / life threatening • Level of responsiveness • Checking ABCDEs Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. GILT • Gather information about patient and patient’s environment – What is the patient’s position? – What is the patient’s appearance? – Any sights/sounds/smells? – Does it appear to be medical or trauma? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. LOC • Evaluate level of consciousness using the AVPU – Alert – Verbal – Pain – Unconscious Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Caution! If trauma, begin by stabilizing patient’s cervical spine Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Unconscious Patient • Speak to patient • If no response – Shake patient’s shoulder – Pinch earlobe or shoulder Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Infants & Children • AVPU not a good scale • Note if interaction with parents and actions normal for age Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A - Airway • Responsive Patient – Can patient speak without difficulty? • Unresponsive Patient – Perform head-tilt chin-lift/jaw-thrust – Inspect airway – Clear airway as needed Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat If patient’s airway is not open …. OPEN IT! Before moving on to B - Breathing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. B - Breathing • Responsive Patient – Ability to speak without stopping to catch breath – Noisy breathing – Patient position – Use of accessory muscles – Rate and depth of ventilations Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. B - Breathing Unresponsive patient • Look • Listen • Feel Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat If breathing is absent, too fast, too slow, too shallow, Immediately begin ventilations before moving to C - Circulation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. C - Circulation • Evaluation of circulation of patient’s blood – Look for major blood loss – Assess pulse – Assess skin Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Check for Blood Loss • Major external bleeding – Actively bleeding? – Pool of blood anywhere? – Collection of blood in patient clothes/hair? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat Control major bleeding Often times this goes hand-in-hand with A - Airway Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse - Where? • Responsive adult – Radial pulse • Unresponsive adult – Carotid pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse - Where? • Responsive child – Radial or brachial pulse • Unresponsive child – Carotid or femoral pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse - Where? • Infant – Brachial pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Pulse Determine • Presence or absence • Rate • Strength • Regularity Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess & Treat If no pulse, Immediately begin chest compressions before moving to D - Disability Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assess Skin • Color • Temperature • Moisture • Inadequate circulation causes pale, cool, clammy skin Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. D - Disability • Assessment of brain function • Use Glasgow Coma Scale (GCS) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Glasgow Coma Scale Eye Opening Spontaneous To Voice To Pain None 4 3 2 1 Verbal Response Oriented Confused Inappropriate Words Incomprehensible Words None 5 4 3 2 1 Motor Response Obeys Command Localizes Pain Withdraw (pain) Flexion (pain) Extension (pain) None 6 5 4 3 2 1 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. E – Expose / Environment • Expose the patient’s body as needed or appropriate to assess for injury or illness • Consider the environment and keep the patient warm Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Make a decision! • Is the patient critical? • Is the patient non-critical? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is critical? • Any life-threatening problems identified in the ABCDEs! Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Communicate and Ask Questions • Helps determine – Patient’s age and sex – Chief complaint – Level of responsiveness – Status of airway and breathing – Status of circulation and disability Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vital Signs • Respiratory Rate – Note depth, regularity, and effort • Heart Rate – Note location, regularity, and strength • Blood Pressure – Auscultated vs. palpated Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination (PE) • Begins once life-threatening problems addressed • Purpose is locating and beginning management for signs and symptoms of injury and illness Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Take Note! • May not perform detailed PE if life-saving care still required • Not all patients will require all steps of a detailed PE Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination • Inspection – Look for signs of illness or injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination • Palpation – Feel for signs of illness or injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Systematic and Orderly • Often done “head to toe” • Assess all body areas for DOTS – D = Deformities – O = Open injuries – T = Tenderness – S = Swelling Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. • Listen to lung sounds Physical Examination Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. • Look for medical alert tags Patient History • Take patient history either before, after, or during physical examination – Depends on situation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. • Begin with patient • If patient can’t answer Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. – Ask family members – Ask bystanders SAMPLE History S – Signs and symptoms – May also ask S – Social drugs A – Allergies M – Medications P – Past history (medical / surgical) L – Last oral intake E – Events leading to injury or illness Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Signs and Symptoms A sign is a finding you can hear, see, feel or measure A symptom is something a patient describes Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ask Questions … • Can you describe the problem? • What kind of symptoms? • What makes the symptoms better/worse? • When did the symptoms start? • How long have you had problem? • Anything like this happen before? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A - Allergies • Medications • Foods • Substances in environment • Any medical alert tags? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. M - Medications • Prescription medications • Over-the-counter medications • Another person’s medications • Has patient recently stopped taking any medications Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. P – Past History • Are you seeing physician for anything? • Ever been hospitalized? • Any medical problems? • Any pertinent surgeries? • Any significant injuries? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. L – Last Oral Intake • When did you last eat or drink? • What was it? • How much? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. E – Events leading up to injury or illness • What were you doing when the problem started? • Were there any other symptoms at that time? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ongoing Assessment • Assessment doesn’t end after physical examination and patient history • Continue to reassess patient until additional help arrives – Frequency depends on patient’s condition Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What do I Reassess? • • • • Airway Breathing Circulation Disability (mental status) – GCS • Reassure the patient while waiting for help Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. When EMS Unit Arrives Provide: • Patient age and sex • Chief complaint • Assessment and history findings • Summary of care provided Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary • Initial assessment provides a general impression of the patient’s condition – Correct life-threats during the initial assessment • Other assessment activities help provide clues to the nature of illness or injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.