InitialAssessment CHAPTER 9. Decisions about assessment and care are typically made within the first...

InitialInitialAssessmentAssessment

CH

AP

TER

9C

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9

Decisions about

assessment and care are

typically made within the

first few seconds of

observing the patient.

Initial Assessment Includes: Initial Assessment Includes:

Form a general impressionForm a general impression

Identify life-threatening injuries; provide immediate interventions as necessaryIdentify life-threatening injuries; provide immediate interventions as necessary

Assess mental statusAssess mental status

Assess the airwayAssess the airway

Assess breathingAssess breathing

Assess circulationAssess circulation

Make an initial transport decisionMake an initial transport decision

General ImpressionGeneral Impressionof the Patientof the PatientGeneral ImpressionGeneral Impressionof the Patientof the Patient

Sick or Not SickSick or Not Sick

General impression:General impression:

The EMS provider’s immediate The EMS provider’s immediate assessment of the environment assessment of the environment and the patient’s chief and the patient’s chief complaint.complaint.

The process of The process of

forming a forming a

general general

impression impression

takes a few takes a few

seconds.seconds.

Determine if the patient Determine if the patient has a has a medical condition...medical condition...

...or an...or an injury. injury.

Nature of illness:Nature of illness:

The patient’s description of the The patient’s description of the chief complaint; or why EMS chief complaint; or why EMS was called.was called.

Mechanism of injury:Mechanism of injury:

The event or forces that caused The event or forces that caused the patient’s injury.the patient’s injury.

If a life-threatening If a life-threatening condition condition is identified…is identified…

……it must it must

be be

corrected corrected

immediatelimmediatel

y!y!

Assessing the Patient’s Assessing the Patient’s Mental StatusMental StatusAssessing the Patient’s Assessing the Patient’s Mental StatusMental Status

AAlertlert

VVerbalerbal

PPainfulainful

UUnresponsivenresponsive

Check response to painful stimuli.

Assessing the Patient’s Assessing the Patient’s Airway StatusAirway StatusAssessing the Patient’s Assessing the Patient’s Airway StatusAirway Status

Responsive PatientUnresponsive PatientResponsive Patient

Unresponsive Patient

Airway - Responsive Patients Airway - Responsive Patients

Talking/cryingTalking/crying Assess breathingAssess breathing

Responsive to painResponsive to pain Assess airwayAssess airway

Airway - Unresponsive Patients Airway - Unresponsive Patients

TraumaTrauma Jaw thrustJaw thrust Chin liftChin lift

MedicalMedical Head-tilt/chin-liftHead-tilt/chin-lift

Airway Management Airway Management Assess airwayAssess airway

Foreign bodyForeign body TeethTeeth BloodBlood VomitusVomitus

Clear airwayClear airway

The The modified jaw thrustmodified jaw thrust can minimize C-spine can minimize C-spine movement.movement.

Head-tilt, Chin-lift Head-tilt, Chin-lift ManeuverManeuver

Done in the absence of spinal Done in the absence of spinal injury.injury.

Assessing the Patient’s Assessing the Patient’s BreathingBreathingAssessing the Patient’s Assessing the Patient’s BreathingBreathing

Look for Look for chestchest rise, rise, listen forlisten for

air movement,air movement, and feel for and feel for

exhaled air.exhaled air.

Assessing the Patient’s Assessing the Patient’s CirculationCirculationAssessing the Patient’s Assessing the Patient’s CirculationCirculation

PulsePulse

Assess the brachial pulse in Assess the brachial pulse in infants.infants.

Compare radial and carotid Compare radial and carotid pulses simultaneously.pulses simultaneously.

Major BleedingMajor BleedingMajor BleedingMajor Bleeding

Major bleeding is one

of the life-threats, and is

an essential part of

assessing the patient’s

circulation.

PerfusionPerfusionPerfusionPerfusion

Check capillary refill in children less than 6 years of age.

Identifying Priority Identifying Priority PatientsPatientsIdentifying Priority Identifying Priority PatientsPatients

TRANSPORTEDTRANSPORTEDIMMEDIATELY!IMMEDIATELY!

If available, request ALS

Priority patients Priority patients should beshould be

Transport Rapidly Transport Rapidly Poor general impressionPoor general impression

Unresponsive with no gag reflex or coughUnresponsive with no gag reflex or cough

Responsive but unable to follow commandsResponsive but unable to follow commands

Difficulty breathingDifficulty breathing

Signs and symptoms of hypoperfusionSigns and symptoms of hypoperfusion

Transport Rapidly continued Transport Rapidly continued Complicated childbirthComplicated childbirth

Chest pain with a BP less thanChest pain with a BP less than100 systolic100 systolic

Uncontrolled bleedingUncontrolled bleeding

Severe painSevere pain

SU

MM

AR

YS

UM

MA

RY General ImpressionGeneral Impression

Assessing the Patient’s Mental Assessing the Patient’s Mental StatusStatus

Assessing the Patient’s Airway Assessing the Patient’s Airway StatusStatus

Assessing the Patient’s Assessing the Patient’s BreathingBreathing

Assessing the Patient’s Assessing the Patient’s CirculationCirculation

Identifying Priority PatientsIdentifying Priority Patients