9/12/2012. Chapter Goal. Learning Objectives. Chapter 12. Patient Assessment

Transcription

1 Chapter 12 Patient Assessment Chapter Goal Integrate principles of history taking & techniques of physical examination to perform patient assessment on emergency patient Describe, recognize, & differentiate common hazards found at scene of trauma patient from those found at scene of medical patient Differentiate safe from unsafe scenes Describe methods for making an unsafe scene safe Discuss common mechanisms of injury Predict patterns of injury on basis of MOI 1

2 Discuss reasons for identifying total number of patients at scene Explain reasons for identifying need for additional help or assistance Summarize reasons for forming general impression of patient Review methods of assessing mental status & level of consciousness in adult, child, & infant Discuss methods of assessing airway in adult, child, & infant State reasons for management of cervical spine once patient is declared trauma patient Analyze scene to determine if spinal precautions are required Describe methods used for assessing patient breathing Differentiate between patient with adequate breathing & one with inadequate breathing (minute ventilation) Distinguish between methods of assessing breathing in adult, child, & infant Compare methods of providing airway care to adult, child, & infant Describe methods used to locate & assess pulse Differentiate between locating & assessing pulse in adult, child, & infant 2

3 Discuss need for assessing patient for external bleeding Describe normal & abnormal findings when assessing skin color Describe normal & abnormal findings when assessing skin temperature Describe normal & abnormal findings when assessing skin condition Explain reasons for prioritizing patient for care & transport Identify patients who require expeditious transport Describe evaluation of patient s perfusion status based on findings in initial assessment Describe orthostatic vital signs & evaluate their usefulness in assessing patient in shock Apply techniques of physical examination to medical patient Differentiate between assessment done for patient who is unresponsive or has altered mental status & assessment done for other medical patients Discuss reasons for reconsidering MOI State reasons for doing rapid trauma assessment Recite examples & explain why patients should receive rapid trauma assessment Apply techniques of physical examination to trauma patient 3

4 Describe areas included in rapid trauma assessment & discuss what should be evaluated Identify cases where rapid assessment may be altered to provide patient care Discuss reasons for doing focused history & physical examination Describe when & why detailed physical examination is necessary Discuss components of detailed physical examination in relation to techniques of examination State areas of body evaluated during detailed exam Explain what additional care should be provided while doing detailed physical examination Distinguish between detailed physical examination performed on trauma patient & one performed on medical patient Differentiate between patients who require detailed physical examination & those who do not Discuss reasons for repeating initial assessment as part of ongoing assessment Describe components of ongoing assessment Describe trending of assessment components Discuss medical identification devices, systems 4

5 Introduction Patient assessment Structured Looking for & recognizing Symptoms Signs Continues throughout time spent with patient 6 phases Introduction Scene Size-Up General approach: Potential scene hazards Ensure safe environment Anticipate potentially hazardous situations Call for appropriate resources 5

6 Scene Size-Up General approach Before care given rapid assessment based on: Dispatch information Previous knowledge On-scene observations Scene Size-Up BSI precautions Formerly called universal precautions CDC recommendations guidelines are law Scene Size-Up BSI precautions 6

7 Scene Size-Up Ensuring scene safety Main purpose Consider environment Situation hostile Special equipment Ensure your personal protection Scene Size-Up Determine MOI & NOI Rapid, organized, systematic evaluation General impression Life-threatening problems, injuries Mental status AVPU 7

8 Airway status Trauma patient Stabilize C-spine Perform jaw-thrust maneuver Assess airway status Assess patient s breathing Palpate chest for equal expansion 8

9 Assess patient s circulation Patient unresponsive check carotid pulse first Pulse present estimate BP Carotid 60 mm Hg systolic Femoral 70 mm Hg systolic Radial 80 mm Hg systolic Check for major bleeding Assess skin determine perfusion status Places where color assessed Abnormal skin colors: Red Pale Yellow Mottled red or pale Cyanosis Capillary refill subject of controversy 9

10 Identify priority patients Require more advanced-level care Availability of care Lights & siren Guidelines for identifying priority patients Resuscitation Focused History & Physical Exam Trauma patient Medical patient Mechanism of injury, transport decision help identify priority patients Infants & small children Rapid trauma assessment DCAP-BTLS 10

11 Focused History & Physical Exam Hidden injuries Rapid medical assessment Focused history & physical exam Trauma patient Medical patient OPQRST Detailed Physical Examination Organized Specific Priority patients Detailed Physical Examination 11

12 Ongoing Assessment Stable patient Unstable patient Parameters Definitive field management Transportation Specialty centers Helicopter transport The 3 Rs Contacting medical direction Summary Patient assessment structured method of evaluating patient s physical condition During scene size-up, evaluate whole picture of call The initial assessment organized approach Focused history & physical exam evaluate patient on basis of suspected condition Summary Following rapid trauma assessment obtain baseline vital signs Detailed assessment more detailed exam that is patient & injury specific Patient assessment is ongoing process Many conditions cannot be completely managed in field 12

13 Questions? 13