Patient Assessment Chapter 10

Patient Assessment Process

• Five key components: Scene size-up, Primary assessment, History taking, Secondary assessment, Reassessment.
• Scene size-up includes assessing the safety and mechanism of injury before patient care begins.

Scene Size-Up and Awareness

• Scene size-up helps determine safety and injury/illness nature.
• Situational awareness refers to understanding surroundings and potential safety risks for the EMS team.

Incident Command System (ICS)

• ICS is a structured approach for managing disasters and mass-casualty incidents with section chiefs reporting to an incident commander.

Triage and Emergency Assessments

• Triage involves medical screening to prioritize patient needs and treatment locations.
• Primary survey checks for life-threatening emergencies focusing on airway, breathing, and circulation.

Breathing and Respiratory Assessment

• Spontaneous respirations occur without assistance.
• Inspections during breathing assessments include respiratory rate (RR), depth, rhythm, and distress indicators.

Positions and Signs Indicating Breathing Difficulties

• Tripod position indicates difficulty breathing; patient leans forward on arms.
• Sniffing position helps keep the airway open; patient’s head is slightly forward.

Respiratory Failure and Distress

• Respiratory failure occurs when blood oxygenation is inadequate for body needs.
• Signs of inadequacy in pediatric patients include nasal flaring and seesaw breathing.

Assessing Breathing and Perfusion

• During breath assessments, seek information on respiratory rate, quality, distress level, and accessory muscle use.
• Perfusion evaluation involves checking skin tone, capillary refill, temperature, and moisture.

Skin Assessment Indicators

• Cyanosis signals oxygen deficiency leading to bluish skin; jaundice indicates liver issues with yellowing skin.
• Normal skin temperature averages 98.6°F; assess color, temperature, and moisture during skin evaluations.

Mental Status Evaluation

• Orientation checks mental status through memory and cognition by assessing person, place, time, and event.
• The AVPU scale measures responsiveness: Alert, Verbal, Pain, Unresponsive.

Secondary and Focused Assessment

• Secondary assessment includes obtaining vital signs and performing a systematic physical exam.
• Focused assessments evaluate specific complaints like chest pain or abdominal pain, checking vital signs and trauma presence.

Breathing Sounds and Indicators

• Abnormal breath sounds include wheezing (lower airway obstruction), crackles (CHF indication), and stridor (upper airway obstruction).
• Rhonchi suggests mucus in lungs; pleural friction rub indicates irritation of lung surfaces.

Vital Signs and Monitoring

• Normal blood glucose is between 80-120 mg/dL; diabetic or altered patients should have glucose assessed.
• Blood pressure gauges arterial pressure during heart contractions (systolic) and between (diastolic).

Neurological and Abdominal Assessment

• Neurological exams are critical when there's a change in mental status or head injury.
• Guarding reflex indicates peritonitis; rebound tenderness suggests abdominal irritation or inflammation.

Reassessment Steps

• Reassessment should repeat primary assessments and vital signs while reevaluating the chief complaint and any interventions applied.
• The Golden Hour emphasizes urgency for treating trauma and shock, while Platinum 10 Minutes sets optimal on-scene time goals for patient care.