Patient Assessment Chart - PowerPoint by yru91928

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									Patient Assessment
     Chris Morse
       10/3/04
          The Patient Assessment Flow-Chart

                                                  Scene Size-Up



                                                Initial Assessment



Unresponsive Pts.              Responsive Trauma Pts.                Responsive Medical Pts.



            Rapid Hx. And Physical Exam     Focused Hx. And Physical Exam          Focused Hx and Physical Exam



                                                              Detailed Physical Exam               Detailed Physical Exam




                                    Ongoing Assessment!!!
                      Assessment Goals
•   Detect and care for life threatening
    emergencies
•   Determine other problems
•   Evaluate and facilitate transport
    decisions
•   Perform a complete assessment
    and note all significant findings
•   Cause no further harm!
             Scene Size-Up

• BSI!!
• Scene Safety
• Determine # of
  patients
• Request additional
  assistance
• Determine MOI/NOI
• C-Spine
  Immobilization??
             A quick word on MOI/NOI
             (Verticality and Velocity!!)
• Significant                 • Significant Nature of
  Mechanism of Injury           Illness
  –   Falls from height         –   Unresponsive pt.
  –   MVAs                      –   Stroke
  –   High speed collisions     –   Resp./Cardiac Arrest
  –   Gunshot/stab wounds       –   Chest Pain
  –   Pedestrian/MVA            –   Abnormal PR/RR
  –   Motorcycle accidents      –   Near-drowning
                                –   Severe Allergic
                                    Reaction
                    Initial Assessment

• General Impression (think
  index of suspicion!)
• Assess responsiveness
    – AVPU!
•   Assess ABC(DE)
•   Stabilize ABCs
•   Identify Priority Pts.
•   Initiate Transport
    Decision
Unresponsive Patients


       Rapid Body Survey


       Baseline Vitals

       Sample History


     Rapid Transportation
         Principles of the Patient Exam

• Pt. exams are an interactive process conducted
  by one rescuer to find all possible injuries
• Head-to-toe: look, listen, feel, and ask.
• For a responsive pt. explain what you are doing
  and ask about any elicited pain (OPQRST)
• Avoid unnecessary movement.
• Inspection, comparison, palpation, auscultation,
  circulation, sensation, motion.
                  DCAP-BTLS
•   Deformity
•   Contusions
•   Abrasions
•   Punctures, Penetrations
•   Burns, Bleeds
•   Tenderness
•   Lacerations
•   Swelling
         Responsive Trauma Patient
               Always reconsider the MOI

• Significant MOI            • No significant MOI
  – Rapid Trauma                 – Focused Physical
    Assessment                     Exam based on CC
  – Baseline                     – Baseline
    Vitals/SAMPLE                  Vitals/SAMPLE
  – Rapid Transport              – Reevaluate Transport
                                   Decisions
         Responsive Medical Patients

•   History of Illness (OPQRST)
•   SAMPLE History
•   Focused Physical Exam based on CC
•   Baseline Vitals
•   Reevaluate Transport
Detailed Physical Exam (in-da’ hut)
• To further investigate problems found in focused
  physical exam and to possibly determine cause.
• The detailed physical exam should NEVER
  delay transportation!
  –   Head-to-toe steps
  –   Systematic Exam using DCAB-BTLS (assess CSMs)
  –   Vitals!
  –   Inspection, comparison, palpation, auscultation,
      circulation, sensation, motion.
         Ongoing assessment

• Repeat the Initial Assessment
• Reassess Vitals
• Repeat Focused Assessment (in
  responsive pts.)
• Check Interventions
          The Patient Assessment Flow-Chart

                                                  Scene Size-Up



                                                Initial Assessment



Unresponsive Pts.              Responsive Trauma Pts.                Responsive Medical Pts.



            Rapid Hx. And Physical Exam     Focused Hx. And Physical Exam          Focused Hx and Physical Exam



                                                              Detailed Physical Exam               Detailed Physical Exam




                                    Ongoing Assessment!!!

								
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