- signs
- objective
- can be seen
- symptoms
- subjective
- cannot be seen
Remember: You can see a patients’ signs, just like you can see road signs!
Scene Size-up
- ensure scene safety
- look for possible dangers
- wear safety vest if working on road
- determine reason for 911 call
- assess patient
- talk with patient, family, bystanders
- determine MOI (Mechanism of Injury) for traumatic events
- blunt vs. penetrating trauma
- consider C-Spine immobilization for head, neck or back injury
- determine NOI (Nature of Illness) for medical events
- # of patients
Primary Assessment
- Introduce self
- Form general impression
- name, age, sex
- Assess level of consciousness
- AVPU scale
- Awake and Alert
- Responsive to Verbal stimuli
- Responsive to Pain
- Unresponsive
- Glasgow Coma Scale also used to assess consciousness and mental status
- AVPU scale
- “Alert and oriented”-patient knows the following:
- Person
- Place
- Time
- Event
- Pain responsiveness- test by pinching earlobe, pressing on bone above eye, or pinching muscles of neck.
- “ABC’s” of Primary Assessment:
- Airway
- Breathing
- Circulation (pulse)
- Assess Breathing:
- Rate
- Rhythm
- Quality
- Depth
- Breath sounds
- wheezing-high pitched whistling sound, especially on exhalation. Suggests obstruction of lower airways.
- rales-moist crackling noise, sounds like rubbing your hair together near your ear. Indicates cardias failure.
- rhonchi- congested breath sounds suggesting mucus in lungs.
- Positions indicating respiratory distress
- tripod position-hands on knees
- sniffing position-commonly seen in children. Head and chin thrust forward, patient appears to be sniffing.
- Assess Circulation:
- Pulse rate
- Pulse quality
- Pulse rhythm
- Skin color, temperature, and moisture
- Capillary refill
- diaphoretic-wet skin
- Rapid Scan
- scan body to identify injuries that must be managed or protected immediately
- takes 60-90 seconds to perform
- given to patients with any kind of altered mental status or severe MOI
- Determine priority of patient care and transport
- patient condition
- availability of advanced care
- distance of transport
- local protocols
Golden Period
time from injury to definitive care during which treatment of shock and traumatic injuries should occur for best chances of survival.
Rapid Scan
- DCAP-BTLS
- Deformities
- Contusions
- Abrasions
- Punctures/penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
- Look for medic alert tags
- Check extremities for Pulse, Motor, and Sensory Control (PMS)
History Taking
- SAMPLE History
- Signs and Symptoms
- Allergies
- “NKA”=”No Known Allergies”
- Medications
- remember to ask about medications that they are prescribed but not taking
- remember to ask about herbal remedies/supplements, which can have significant interactions with treatment
- Pertinent Past medical history
- ask about any recent injury/illness and family history
- Last oral intake
- when did patient last eat/drink?
- what was consumed?
- any recent alcohol/drug consumption?
- Events leading up to the injury/illness
- OPQRST Pain Assessment
- Onset (time and causative factors)
- when did problem begin and what caused it?
- Provocation or Palliation
- does anything cause the pain to become better or worse?
- Quality
- sharp/dull?
- Region/Radiation
- where does it hurt?
- Severity
- how bad is pain from scale of 0-10?
- Timing
- is the pain constant or comes and goes?
- Onset (time and causative factors)