Highlander Help

EMT NOTES

7/8: Patient Assessment (Chapter 8)



 

  • 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 

  • "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?

 

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