5 parts of pt assessment process
- Scene size-up
- Primary survey
- History taking
- Secondary assessment
Ensure scene safety Determine MOI/NOI Take standard precautions Determine # of pts Consider additional/specialized resources
Form general impression through: Responsiveness/LOC, ABCDE, identify cc/life threats, priority of pt care, and transport decision
Investigate cc, hx present illness, and PMH
Repeat primary survey, reassess vital signs and cc, recheck interventions, identify/treat changes in condition
Define blunt trauma
Force of injury occurs over a board are without breaking skin
Define penetrating trauma
for of injury occurs at specific point of contact between skin and object
Signs of airway obstruction in unresponsive pt
Obvious trauma, blood, or other obstruction
Noisy breathing - snoring, bubbling, gurgling, crowing, stridor or other abnormal breath sounds
Extremely shallow or absent breathing
When do you consider use of positive pressure ventilation?
Respirations exceed 28 breaths/min or less than 8 breaths/min with signs of inadequate tidal volume
Signs of respiratory distress
Agitation, anxiety, restlessness Stridor, wheezing Accessory muscle use Tachypnea Mild tachycardia Nasal flaring, seesaw breathing, head bobbing
Signs of respiratory failure
Lethargy, difficulty to rouse Tachypnea w/ periods of bradypnea or agonal respirations Inadequate chest rise/poor excursion Inadequate respiratory rate or effort Bradycardia Diminished muscle tone
Indications for spinal immobilization
Blunt or penetrating trauma w/: MOI indicating potential spinal injury, pain or ttp of neck or spin, c/o neck or back pain, paralysis or neuro complaint, priapism
Blunt trauma w/: AMS, intoxication, difficulty or inability to communicate
Awake : spontaneously opens eyes, awake and aware of you, responsive to surroundings, follows commands, tracks people and objects.
Verbal stimuli : Not awake and alert. Eyes open to verbal stimuli and respond in meaningful way when spoken to.
Painful stimuli : Moves or cries out to painful stimulus.
Unresponsive : No response to verbal or painful stimulus.
What part of memory does Person, Place, Time, and Event test when evaluating orientation? (A&Ox4)
Person : long-term memory
Place : long-term and intermediate memory
Time : intermediate and short- term memory
Event : short-term memory
Deformities Contusions Abrasions Punctures/penetrations Burns Tenderness Lacerations Swelling
Examples of high-priority pts requiring immediate transport
Difficulty breathing Serious MOI Poor general impression AMS Severe chest pain Pale skin or signs of poor perfusion Complicated childbirth Uncontrolled bleeding Responsive but unable to follow commands Severe pain Inability to move any part of body
Significant MOIs - Adults
Ejection from vehicle Death of passenger in same vehicle Fall > 20 feet Vehicle rollover High-speed MVC (40 mph) Vehicle-pedestrian collision Motorcycle crash Unresponsive or AMS following trauma Penetrating trauma to head, chest, or abdomen
Significant MOIs - Peds
Ejection from vehicle
Death of passenger in same vehicle
Fall < 10 feet or 2-3 x the child’s height
Fall of < 10 w/ LOC
Medium-to-high-speed vehicle crash (> 25 mph)
A : alcohol, arrhythmias E : endocrine I : infection O : oxygen U : urine T : trauma, temperature I : insulin (hypo/hyperglycemia) P : poisoning, psych S : stroke, seizure, syncope
When is it appropriate to conduct a full-body exam vs. focused exam during a medical assessment?
Full body exam should be conducted on ALL non-responsive patients.
Focused exam should be conducted on responsive patients based on their complaints.