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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