Patient Assessment PDF

EHS205 Medical Emergencies Patient Assessment 1/13/2025 PATIENT ASSESSMENT 1 Learning Objectives By the end of this lesson you will be able to: Explain the importance of the scene size-up; Outline the steps for the scene size-up;...

EHS205 Medical Emergencies Patient Assessment 1/13/2025 PATIENT ASSESSMENT 1 Learning Objectives By the end of this lesson you will be able to: Explain the importance of the scene size-up; Outline the steps for the scene size-up; Describe possible hazards experienced on scene; Explain ways to protect yourself and your collegueas; Explain the importance of determining the number of patients on scene; Describe the possible assistance that can be called; Describe the importance of deterining the mechanism of injury; Explain the purpose of the primary survey; Describe the general impression; Explain how to use AVPU to determine level of consciousness; Outline the primary survey. 1/13/2025 PATIENT ASSESSMENT 2  Introduction Patient assessment is the most important tasks of the “Job” Combines execution of a number of steps Aim is to make a field diagnosis which will guide the prehospital management plan, type of transportation, and the type of capabilities of the receiving facility required 1/13/2025 PATIENT ASSESSMENT 3  Scene Size-up Safety Takes appropriate PPE precautions – gloves, gown, goggles, vest, helmet, mask, Hazmat suit Hazards – chemical, thermal, atmospheric, electrical, weapons, riots, traffic, violent/ hostile patient (Drug user), patient prone to sudden behavior change Environment – bystanders, ambient temperature, adequate space, day/night Number of patients and location 1/13/2025 PATIENT ASSESSMENT 4  Scene Size-up Clues/evidence at the scene Medication bottles, chemical containers, syringes, illicit drug paraphernalia, blood etc Additional resources Hazmat, heavy rescue, law enforcement (UAE Drug abuse policies- How they will also affect your handover?), bystanders, historians, air medical Nature of illness/ Mechanism of injury Determines reason for call 1/13/2025 PATIENT ASSESSMENT 5  Scene Size-up Clues/evidence at the scene Medication bottles, chemical containers, syringes, illicit drug paraphernalia, blood, dead snakes/ scorpions/ jelly fish etc Additional resources Hazmat, heavy rescue, law enforcement (UAE Drug abuse policies- How they will also affect your handover?), bystanders, historians, air medical, veterinarian/ snake handlers, beekeepers Nature of illness/ Mechanism of injury Determines reason for call 1/13/2025 PATIENT ASSESSMENT 6  Primary survey General impression Patient appearance- Posture, position, obvious distress, incontinence, vomiting, odors, pain Age, gender and weight of patient LOC- AVPU CAB if unconscious/ ABC if conscious 1/13/2025 PATIENT ASSESSMENT 7  Primary survey Airway Assess patency, position, obstructions, clarity of speech/ voice CAB if unconscious/ ABC if conscious Airway management- airway adjunct/ airway maneuvers/ pharmacological interventions (Epi/ RSI) Breathing Auscultation of lung sounds – presence, clarity, abnormal sounds Minute volume – rate, rhythm, tidal volume and equal chest rise and fall VQ Mismatch→ Hypoxia →Hypoxemia →Acidosis →Respiratory fatigue → Respiratory arrest 1/13/2025 Supplementary O2/ Ventilatory support as needed PATIENT ASSESSMENT 8  Primary survey Circulation Pulse - Presence, rate, rhythm, quality Skin- Color, moisture, temperature, turgor, edema, capillary refill Disability GCS Pupil- reactivity to light, size, equality Chief complaint 1/13/2025 PATIENT ASSESSMENT 9  Primary survey Transport decision- Type of transportation (HEMS/ Road) * Distance??? Type of facility required for patient(determined by the type of resources the facility has e.g., CT scans, psych ward, available bed space at the time of call) And also, the facility HCP complement/ specialization e.g., does the facility have specialists/ G.P/ psychiatrist, can they handle the patient or will transfer the patient to another facility?) Lastly does the local authority pathway allow? Does dispatcher allow? Is it approved by protocol/ clinical governance structures 1/13/2025 PATIENT ASSESSMENT 10  Vital signs BP HGT Pulse Respiratory rate Capillary refill ETCo2 SPo2 ECG analysis 1/13/2025 PATIENT ASSESSMENT 11 Secondary assessment History OPQRSTI SAMPLE Focused history Head and Neck assessment Eyes, mouth, JVD, membrane color and moisture, skin color, ears, nose, white powder on nostrils 1/13/2025 PATIENT ASSESSMENT 12 Secondary assessment Chest and CVS Inspects – rate, rhythm, depth, symmetry, effort of breathing, color, scars, lumps Palpates – tenderness, lumps Auscultates – vesicular, bronchial, bronchovesicular breath sounds in proper locations anteriorly and posteriorly, notes abnormal breath sounds Percussion – symmetry of sounds Oxygenation/ventilation – adjust oxygen flow, change adjuncts, accordingly, administers appropriate respiratory/ cardiovascular medications/ monitor trends Cardiac management – monitor/ conduct12-lead ECG, medications 1/13/2025 PATIENT ASSESSMENT 13 Secondary assessment Abdomen and pelvis Interviews patient – location, type of pain, duration, events leading up to current complaint, food or products ingested, did patient self-medicate/ intervene after ingestion/ drug admin Inspects – scars, distention, needle tread marks, pulsations, color, including flanks and posterior Auscultation – bowel sounds Palpation – guarding, tenderness with cough or increasing pressure, pulsations, rigidity 1/13/2025 PATIENT ASSESSMENT 14 Secondary assessment Extremities Arms and legs– pulses, edema, capillary refill, grip strength, drift, observe if any tread marks are present (especially in the anatomical positions of superficial veins e.g. ACF) 1/13/2025 PATIENT ASSESSMENT 15 Secondary assessment Mental status examination Appearance – dress, eye contact, posture, depression, violence, facial grimaces, actions, mannerisms Speech – spontaneous, slow/fast, volume, clarity, appropriate Mood – depressed, euphoric, manic, anxious, angry, agitated, fearful, guilty Thoughts – racing, hallucinations, delusions, suicidal, unconnected, disturbed, homicidal 1/13/2025 PATIENT ASSESSMENT 16 Secondary assessment Neurological Interviews patient – pain, paralysis; location, duration, events leading up to, changes over time, past medical history, medications Motor system – posturing, involuntary movements, strength, coordination, flaccid, seizures, gait Stroke scale- Cincinatti/ LAPSS and Severity Scales for Large Vessel Occlusion 1/13/2025 PATIENT ASSESSMENT 17 Reassessment and management (Discussion) Importance of creating and observing vital sign trends and how does current technology assist on the field (12 Lead transport ECGs with record keeping abilities) Adapting to changes in management based on trends- Did your management improve the condition of the patient or did it make the patient worse (Improvement VS Deterioration)???? Should you just transport the patient as is and cross your fingers enroute- How does this affect prognosis??? 1/13/2025 PATIENT ASSESSMENT 18 1/13/2025 PATIENT ASSESSMENT 19 References Andrew Pollak (2018). Nancy Caroline’s Emergency Care in the Streets, Eighth Edition. Jones & Bartlett Learning. Vanden Hoek, T. L., Morrison, L. J., Shuster, M., Donnino, M., Sinz, E., Lavonas, E. J.,... & Gabrielli, A. (2010). Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(18_suppl_3), S829-S861. 1/13/2025 PATIENT ASSESSMENT 20