General Medical.pdf

General Patient ASSESSMENT/Initial Medical Care (IMC) Assessments and initial interventions shall be performed on all pts at the point of contact unless it is unsafe, as circumstances allow, and the pt. consents. Monitoring & intervention equipment/devices for EMS personnel to function to their le...

General Patient ASSESSMENT/Initial Medical Care (IMC) Assessments and initial interventions shall be performed on all pts at the point of contact unless it is unsafe, as circumstances allow, and the pt. consents. Monitoring & intervention equipment/devices for EMS personnel to function to their level of licensure, in accordance with the level of service at which the EMS vehicle is operating must be brought to the pt. so complete information is obtained that will allow treatment at the appropriate level of care without delay. Perform resuscitative interventions during the primary assessment as impairments are found. Care should progress from BLS to ALS as required by pt. condition, practitioner scope of practice, level of service, and local policy/procedure. 1. SCENE SIZE UP: Situational awareness; dynamic risk assessment –Assess/intervene as needed: Scene safety; control and correct hazards; remove patient/crew from unsafe environment ASAP; if potential crime scene, make efforts to preserve integrity of possible evidence Nature of illness; scan environment for clues; DNR/POLST orders Universal blood/body secretion & sharps precautions; use appropriate personal protective equipment prn Number of patients; triage / request additional resources if needed. Weigh risk of waiting for resources against benefit of rapid transport to definitive care. Consider if a medium or large scale MPI declaration is needed. 2. PRIMARY ASSESSMENT: establish rapport with patient/significant others General impression: age, gender, general appearance, position, purposeful movements Determine if immediate life threat exists and resuscitate as found Level of consciousness using AVPU or GCS; chief complaint S&S If unconscious, apneic or gasping, & pulseless START QUALITY CPR – see appendix AIRWAY: snoring, gurgling, stridor, silence; consider possible spine injury - Open/maintain using position, suction, and appropriate adjuncts - If Obstructed: Go to AIRWAY OBSTRUCTION SOP - Loosen tight clothing; vomiting and seizure precautions as indicated BREATHING/gas exchange/adequacy of ventilations: Assess for hypoxia or hypercarbic ventilatory failure - Spontaneous ventilations; general rate (fast or slow); depth, effort (work of breathing); - Position, adequacy of air movement, symmetry of chest expansion; accessory muscle use; retractions - Lung sounds now if in ventilatory distress - SpO2 if possible hypoxia, CR or neurological compromise. Note before & after O2 if able. S&S hypoxemia: Dyspnea, irritability; confusion, somnolence: tachycardia, arrhythmia; tachypnea; cyanosis (late) - EtCO2 number & waveform if possible ventilatory/perfusion/metabolic compromise S&S hypercarbia: Headache; change of behavior; AMS/coma; warm extremities *Correct hypoxia/assure adequate ventilations: Target SpO2: 94%-98% (88%-92% COPD) unless hyperoxia contraindicated* - O2 1-6 L/NC: Adequate rate/depth; minimal distress; SpO2 92%-93% (88%-91% COPD) - O2 12-15 L/NRM: Adequate rate/depth: mod/severe distress; SpO2 < 92%; (