Patient Assessment in Emergency Response

Patient Assessment

• Scene size-up ensures safety and decides whether trauma systems should be activated, considering the need for backup.
• The decision to immobilize a patient depends on local protocols and high-risk mechanisms of injury.

High-Risk Mechanisms of Injury

• High-velocity crashes (>40 mph) with severe vehicle damage
• Unrestrained occupant in moderate to high-speed motor vehicle crash
• Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space
• Fall of an adult (>20 ft) or a child (>10 ft) or height 2-3 times their child's height
• Penetrating trauma near the spine
• Ejection from a moving vehicle or a motorcycle crash (>20 mph)
• Other high-impact injuries like auto-pedestrian or auto-bicycle crash (>20 mph)

Mechanisms of Uncertain Risk for Spinal Injury

• Moderate to low-velocity motor vehicle crashes
• Isolated injury without positive assessment findings
• Syncopal events in which the patient was already seated or supine
• Syncopal events in which the patient was assisted by a bystander to a supine position

Primary Survey

• Keep manual stabilization in line position
• Identify the patient's level of responsiveness
• Conduct the primary survey while continuing manual stabilization
• Focus on identifying and managing life-threatening concerns
• Use the X ABCDE method to evaluate and monitor the level of consciousness

Airway Management

• Clear the mouth and suction if necessary
• Use the jaw thrust maneuver to open the airway
• Do not insert an NPA if spinal injury is indicated or if there is a basil or skull fracture
• Continue monitoring the airway closely and have suctioning unit available

Breathing and Oxygenation

• Evaluate and ensure adequate oxygenation and ventilation
• Administer 100% oxygen via non-rebreather if the patient is breathing adequately
• Ventilate the patient to maintain an end-tidal CO2 > 25

Circulation and Hemorrhage Control

• Control external bleeding with direct pressure or pressure dressings
• Initiate CPR if necessary
• Assess for signs and symptoms of shock and treat appropriately

History Taking

• Investigate the chief complaint
• Obtain a medical history and be alert for injury-specific signs and symptoms
• Perform OPQRST and SAMPLE
• Obtain history from friends, family members, or medical identification jewelry and cards if the patient is not responsive

Secondary Assessment

• Obtain vital signs and perform a physical exam with the patient in a neutral position
• Apply manual stabilization while asking the patient not to move unless specifically asked to do so
• Focus on the site of injury depending on the chief complaint
• Monitor for any changes in level of consciousness and estimate the severity of increase in ICP

Traumatic Brain Injury (TBI)

• Establish an adequate airway, control bleeding, and provide adequate circulation to maintain cerebral perfusion
• Treat according to local protocols and medical direction
• Assess and treat other injuries
• Dress and bandage any open wounds and splint fractures

Spinal Immobilization

• Stabilize the head and trunk to prevent further damage
• Use a cervical collar to provide preliminary partial support
• Avoid moving the cervical spine during patient transfers
• Use a rigid cervical collar that is the correct size for the patient

Helmet Removal

• Check the patient's ABCs
• Assess whether the helmet fits well and prevents the patient's head from moving
• Remove the helmet if it is a full-face helmet or if it makes assessing or managing airway problems difficult
• Consult with medical direction before moving a helmet
• Use a two-person log roll method to remove the helmet, ideally

Low Back Pain

• Most common physical ailments of non-traumatic spinal conditions
• Upright posture places a substantial amount of weight on the lumbar spine
• Most causes of low back pain are idiopathic
• Pay attention to the patient's medications
• Older patients, especially women with a history of osteoporosis, are at high risk for spontaneous compression fractures
• Tumors in the spine can cause pathologic spine fractures and degenerative disk disease
• Prehospital management of low back pain in the absence of trauma is primarily palliative

Patient Assessment

• Scene size-up determines safety and the need for trauma system activation and backup
• Immobilization is decided based on local protocols and high-risk mechanisms of injury

High-Risk Mechanisms of Injury

• Crashes with high velocity (>40 mph) and severe vehicle damage
• Unrestrained occupants in moderate to high-speed motor vehicle crashes
• Vehicle damage with compartmental intrusion (>12 in) into the patient's seating space
• Falls from a height (>20 ft for adults, >10 ft or 2-3 times their height for children)
• Penetrating trauma near the spine
• Ejection from a moving vehicle or a motorcycle crash (>20 mph)
• High-impact injuries involving auto-pedestrian or auto-bicycle crashes (>20 mph)

Mechanisms of Uncertain Risk for Spinal Injury

• Moderate to low-velocity motor vehicle crashes
• Isolated injuries without positive assessment findings
• Syncopal events where the patient was already seated or supine
• Syncopal events where the patient was assisted to a supine position by a bystander

Primary Survey

• Perform manual stabilization in line position
• Assess the patient's level of responsiveness
• Focus on identifying and managing life-threatening concerns
• Use the X ABCDE method to evaluate and monitor consciousness

Airway Management

• Clear the mouth and suction if necessary
• Use the jaw thrust maneuver to open the airway
• Avoid inserting an NPA if spinal injury is indicated or if there's a basil or skull fracture
• Continuously monitor the airway and have suctioning unit available

Breathing and Oxygenation

• Ensure adequate oxygenation and ventilation
• Administer 100% oxygen via non-rebreather if the patient is breathing adequately
• Ventilate to maintain an end-tidal CO2 > 25

Circulation and Hemorrhage Control

• Control external bleeding with direct pressure or pressure dressings
• Initiate CPR if necessary
• Assess for signs and symptoms of shock and treat appropriately

History Taking

• Investigate the chief complaint
• Obtain a medical history and be alert for injury-specific signs and symptoms
• Perform OPQRST and SAMPLE
• Obtain history from friends, family, or medical identification jewelry/cards if the patient is non-responsive

Secondary Assessment

• Obtain vital signs and perform a physical exam in a neutral position
• Apply manual stabilization while asking the patient not to move
• Focus on the site of injury depending on the chief complaint
• Monitor for changes in level of consciousness and estimate ICP severity

Traumatic Brain Injury (TBI)

• Establish an adequate airway, control bleeding, and provide circulation to maintain cerebral perfusion
• Treat according to local protocols and medical direction
• Assess and treat other injuries
• Dress and bandage open wounds and splint fractures

Spinal Immobilization

• Stabilize the head and trunk to prevent further damage
• Use a cervical collar for preliminary partial support
• Avoid moving the cervical spine during patient transfers
• Use a rigid cervical collar that is the correct size for the patient

Helmet Removal

• Check the patient's ABCs
• Assess whether the helmet fits well and prevents head movement
• Remove the helmet if it's a full-face helmet or if it makes assessing/ managing airway problems difficult
• Consult medical direction before moving a helmet
• Use a two-person log roll method to remove the helmet ideally

Low Back Pain

• Most common physical ailment of non-traumatic spinal conditions
• Upright posture puts substantial weight on the lumbar spine
• Most causes of low back pain are idiopathic
• Pay attention to the patient's medications
• Older patients, especially women with osteoporosis, are at high risk for spontaneous compression fractures
• Tumors in the spine can cause pathologic spine fractures and degenerative disk disease
• Prehospital management of low back pain in the absence of trauma is primarily palliative

This quiz covers the process of patient assessment in emergency response, including scene size-up and deciding whether to immobilize a patient. It also discusses high-risk mechanisms of injury that may require trauma system activation.