Patient Assessment(s)

Question 1

Body Substance Isolation

[ 1 ]

Answer 1

STEP 1: Ensure the donning of proper PPE

— Gloves (always)
— Mask (N95 / HEPA)
— Goggles / Face Shield
— Gown / Apron(s)

Question 2

Scene Size-up

[ 5 ]

Answer 2

STEP 2: Sensorial perception of the scene

1) Safety — Is the scene safe?
2) Patients — How many victims / patients?
3) Additional Help — Do we need backup?
4) Mechanism of Injury / Nature of Illness?
5) Equipment — What do we need to bring?

Question 3

Primary Assessment

[ 3 / GLC ]

Answer 3

STEP 3: Initial findings of the patient

G) General Impression:
      • “Gut Feeling”, and first visuals on scene

L) Level of Consciousness (LOC):
      • AVPU (Alert, Verbal, Pain, Unresponsive)
      • Alert & Oriented (A/Ox3) Medical:
      • Alert & Oriented (A/Ox4) Trauma:

C) Chief Complain / Life Threats:
      • Are there any threats?
      • What are their primary concern(s)

Question 4

Airway

[ ABC’s ]

Answer 4

STEP 4 (a): Assess for the patient’s airway

Airway:

1) Open and assess the airway
2) Insert adjuncts as indicated

Question 5

Transportation Decision

[ TRANSPORT ]

Answer 5

STEP 6:

• You man transport the patient at any time after attempting a complete Primary Assessment
— Code(s)
— Destination (Hospital, Trauma Center, etc.)
— Helicopter

Question 6

History Taking

[ OPQRST - ASPN ]

Answer 6

STEP 8 (a):

• OPQRST:
— Onset (acute/fast or chronic/slow)
— Provocation (what caused the condition)
— Quality of Pain (sharp, numb, hot, stingy)
— Radiation (is the pain anywhere else)
— Severity of Pain (scale from 1 - 10)
— Time (when did condition begin)

• ASPN:
— Associated Symptoms
— Pertinent Negatives

Question 7

History Taking

[ SAMPLE ]

Answer 7

STEP 8 (b):

• SAMPLE:
— Signs/Symptoms
— Allergies (pertinent allergies)
— Medications (known prescriptions)
— Pertinent Past History
— Last Oral Intake (medication, food, etc.)
— Events (leading up into condition)

• Interventions:
— Consult with Medical Control
— State field impression of the patient

• Manage Secondary Injuries / Complaints

Question 8

CSM

Answer 8

Circulation, Sensory, and Motor responses.

Also referred to as PMS; Pulse, Motor, and Sensation(s).

Question 9

LOC

Answer 9

Level of Consciousness.

A term used to describe a person’s awareness and understanding of what is happening in his or her surroundings.

Question 10

DCAP-BTLS

[ 2nd Assessment ]

Answer 10

STEP 7 (b):

— Deformities & Discolorations
— Contusions (bruises)
— Abrasions
— Punctures / Penetrations
— Burns
— Tenderness
— Lacerations
— Swelling

Question 11

Secondary Assessment

[ 2nd Assessment ]

Answer 11

STEP 7 (a):

• Collect patient’s Vital Signs
— Blood Pressure / BP: 120/60
— Pulse: 60-100 beats/min
— Respirations: 12-20 breaths/min
— SPO2: 94-99% O2

• Conduct a Physical Assessment:
— Focused Assessment
— Full Body Scan
— DCAP-BTLS

NOTE:

Focused Assessment:
— An assessment of the chief complaint of the patient.

Full Body Scan:
— A systematic head-to-toe examination used to identify hidden injuries identify causes that may not have been found during the Primary Survey

Question 12

Reassess the Patient

[ Reassessment ]

Answer 12

STEP 9:

• Repeat Primary Survey:
— General Impression
— Level of Consciousness (LOC)
— Chief Complaint / Life Threats
— Maintain Open Airway / Breathing
— Reassess Pulse / Skin Vitals
— External bleeding (new blood)
— Re-evaluate patient’s priority Level

• Reassess Vital Signs:
— Blood Pressure / BP: 120/60
— Pulse: 60-100 beats/min
— Respirations: 12-20 breaths/min

• Repeat Focused Assessment:
— For Non-critical Patients

• Observe Trends:
— Changes over time
— At least 3 assessments must be made

• Check Interventions:
— O2 Delivery
— Artificial Ventilation
— Other (splints, bandages, treatments)

Question 13

Patient Reporting

[ Verbal Report ]

Answer 13

STEP 10:

• Patient Report (En Route):
— ID Yourself (i.e. Med 24)
— Age / Sex
— Chief Complaint
— Findings at the scene
— Physical findings
— Care given to patient
— Code of Transport
— ETA

• Patient Report (At Hospital):
— Patient’s Name
— Age / Sex
— Chief Complaint
— History of patient / situation
— Treatments given
— Response to treatments
— Vital Signs
— Medical information

NOTE: Always ask if they need any other information prior to leaving.

Question 14

Breathing

[ ABC’s ]

Answer 14

STEP 4 (b): Assess for breathing

1) Are they breathing? Y / N
2) Quality of breathing
3) Assist patient with ventilations

Breathing:

— Expose the chest (as needed)
— Assess the breathing (rate and depth)
— Jugular Vein Distention (JVD)
— Subcutaneous Emphysema (Sub-Q/E)
— Open wounds / Chest wall integrity
— Flailing chest (broken ribs in 2 places)
— Accessory muscle use
— Pulse Oximetry (SpO2)
— Lung sounds
— Assure adequate ventilation
— Manage any airway injuries

MNEMONIC:

“Expose the Chest, Assess the Breaths”
“JVD, Sub-Q/E”
“Open Wounds, Chest Wall too”
“Flailing chest, Accessories next (muscles)”
“Pulse Ox out, with Lung Sounds”
“Adequately Ventilate”
“Manage Injured Airways”

Question 15

Circulation

[ ABC’s ]

Answer 15

STEP 4 (c): Assess for adequate circulation

Circulation:

— Assess and control bleeding
— Pulse (estimated)
— Perfusion (skin vitals / capillary refill)
— Shock treatment / Positioning

MNEMONIC:

“Make the Bleeding Stop”
“Then We Treat for Shock”
“Get a Patient’s Pulse”
“Skin Vitals”

Shock Treatment:

1) Provide High Flow O2 to patient
2) Position patient for shock:
3) Keep patient warm
4) Rapid Transportation

Question 16

Perform a Rapid Scan

[ NAKED ]

Answer 16

STEP 5: Assess for any injuries or traumas

Perform a Rapid Scan:

— 60-90 seconds
— Top-Bottom, Left-Right, Front-Back
— Check for any Life Threats to Patient

NOTE: Expose the patient as needed and search for Gross Abnormalities.