Skill Sheet Dyspnea Assessment

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					McGraw Hill – The Paramedic                                                       Procedure/Skill Evaluation
Student:________________________________ Level: □ EMT-I □ EMT-P       Date:___________________
                                          Time
Evaluator:_______________________________ Start:________ End:________ Total:________Pass/Fail ___


Skill Sheet 35: Dyspnea Assessment

 Conditions                 The candidate should perform this skill on a simulated patient in a sitting
                            position under existing indoor, ambulance, or outdoor lighting, temperature and
                            weather conditions.
 Indications                A patient complaining of shortness of breath or experiencing respiratory
                            distress
 Red Flags                  The patient’s complaint may be secondary to another body system not
                            described here. Be vigilant for other causes.

 Don appropriate standard precautions
 Conduct a primary survey (initial assessment)
 Manage problems associated with the patient’s airway, breathing and circulation as they are found
 Establish a chief complaint of shortness of breath or dyspnea
     If perfusion is adequate, assist supine patient to sitting position with legs dependent
     Provide supplemental oxygen if patient is in respiratory distress
     Assist ventilations with bag mask if patient’s ventilatory effort is insufficient
 Perform a secondary survey (focused history and physical exam)
     Perform tasks simultaneously if assistance is available
 Elicit the patient’s history of the current event, using the OPQRST mnemonic
 Obtain baseline vital signs
     Pulse, respiratory rate, blood pressure, temperature
     Pulse oximetry reading
     Capnography reading
 Acquire electrocardiogram
     Limb lead ECG is required
     12 lead ECG for patients with suspected cardiac ischemia
 Elicit patient’s past medical history, using the SAMPLE mnemonic
 Examine patient, checking for the following physical findings:
      HEENT - jugular venous distention, accessory muscle use, tracheal tugging, medical
               alert pendant, sputum production, audible stridor
     Chest - Inspect for normal chest dimensions, symmetry, discoloration, pacemaker,
               sternal notch and supraclavicular retraction
               - Auscultate anterior, posterior and lateral chest wall for lung sounds and heart tones
               - Palpate for chest wall tenderness
     Abdomen - Inspect for discoloration, distention
                    - Palpate for tenderness, masses
                    - Use of abdominal muscles to assist with ventilation
     Extremities - Inspect for carpopedal spasms
                    - Palpate for equal radial and femoral pulses
 Consider possible underlying causes for patient’s presentation and treat if necessary
     Begin treatment when enough information is elicited to treat symptomatically; suspect several
     possible causes and weigh risk versus benefit for each possible intervention
 Decide if early transport is critical to patient care
 Perform an ongoing assessment
     Frequently assess the patient’s airway patency, breathing effort and circulatory status
     Reassess vital signs and ECG after each intervention and/or every few minutes

Critical Criteria:
__      Uses appropriate standard precautions
__      Perform primary survey first
__      Manage problems found in the primary survey first
__      Begin treatment when enough information is elicited
McGraw Hill – The Paramedic                                           Procedure/Skill Evaluation
Student:________________________________ Level: □ EMT-I □ EMT-P       Date:___________________
                                          Time
Evaluator:_______________________________ Start:________ End:________ Total:________Pass/Fail ___
__

				
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posted:12/5/2011
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