Primary Assessment

DR. SAMAH MOHAMMED 2014 – 2015

EMS 351 LECTURE (3)

Out lines

1. List component of primary assessment.

2. Explain Initial general impression.

3. List Level of consciousness.

4. Discuss ABCs ( Airway – Breathing – Circulation).

5. Identify Perform rapid scan.

6. Determine priority of patient care and transport.

Introduction

• One of the most important skills you will develop is

the ability to assess a patient.

1. Identify your patient’s problem(s).

2. Set your care priorities.

3. Develop a patient care plan.

4. Implement your plan.

Primary AssessmentPrimary assessment for all patient situations

1. Initial general impression.

2. Level of consciousness.

3. ABCs ( Airway – Breathing – Circulation).

4. Perform rapid scan.

5. Determine priority of patient care and transport.

Begin interventions needed to preserve life.Integration of treatment/procedures needed to

preserve life

Initial general impression

1. Determines priorities of care. Based on:

Assessment of environment.

Patient's chief complaint.2. Determine if medical or trauma problem

If injured, identify mechanism of injury. If ill, identify nature of illness.

3. Patient’s age, gender, and race.

4. Observe level of consciousness.

1. Initial general impression

2. Assess Level of consciousness

• The APUV scale is a rapid method of assessing the patients level consciousness using one of the following:-

1. A: Alert to person, place, and day.

2. V: Verbal response.

3. P: Pain response.

4. U: Unresponsive.

Methods of patients response to painful stimuli:-

A. Gently pinch the patient earlobe.

B. Press down on the bone above the eye.

C. Pinch the muscles of the neck.

2. Assess Level of consciousness

3. Assess the Airway1. Is airway open or obstructed?• Assess ability:

o Can patient speak?o Signs of airway obstruction or respiratory insufficiency

(stridor)o Oral cavity for foreign objects

2. For all unresponsive patients:

a) Establish responsiveness.

b)Assess breathing.

a) If ineffective or absent, open the airway.

b) Mechanical means requires an airway devices.

3. Assess the Airway1. Contributing factors:-

i. Tongue, loose teeth, other foreign objects

ii. Epiglottitis

iii. Facial and oral bleeding

iv. Vomits

v. Soft tissue trauma to face and neck

vi. Facial fractures

2. Management:-

i. Manually or with devices equipment.

ii. If trauma suspected, take spinal precautions.

3. Assess Breathing1. Evaluate breathing Rate:

Normal breathing: 12- 20 breaths/min Too fast: greater than 24 breaths/min

Too slow: 8–20 breaths/min

2. Evaluate breathing Rhythm: (regular – irregular)

3. Evaluate breathing quality: ( listen to breath sound on each side of patient chest).

4. Evaluate breathing Depth: ( tidal volume): the amount of air that is moved into or out of the lungs.

5. Assess for chest rise and fall.

3. Breathing management

1. If respirations are absent:

1. Positive pressure ventilation

• Mask-Bag-valve.

• End tracheal intubation.

2. Supplement with oxygen therapy.

a) If respirations ineffective, ventilator assistance

b) to maintain adequate oxygenation

3. Consider spinal precautions

3. Assess Circulation1. Palpate the pulse:

Count the number of beats in 15 seconds.

A. Normal pulse rate for adults: is 60–100 beats/min.

B. Bradycardia: rate less than 60 beats/min.

C. Tachycardia: rate higher than 100 beats/min.

2. Force: pulse feels weak or normal.

3. Rhythm: is regular or irregular.

4. Inspect signs of bleeding.

5. Evaluate skin color, moisture, temperature.

3. Assess Circulation

6. Capillary refill: evaluates

ability to restore blood.

– To test:

A. Place thumb on patient’s

finger and compress.

B. Remove pressure.

C. Adequate perfusion: color

restored within two seconds.

Signs of Inadequate Circulation

1. Altered level of consciousness.

2. Swollen neck veins.

3. Pale, cool, diaphoretic skin ( moist).

4. Disturbance heart sounds.

5. Restlessness.

6. Thirst.

Circulation Management

1. If a patient has inadequate circulation:

o improve circulation. IV fluids or Other medications

o Improve oxygen delivery to the tissues.

o Provide rapid transportation to appropriate medical facility.

2. If you cannot feel a pulse, begin CPR until.

o Follow standard precautions.

o Evaluate cardiac rhythm of any patient in cardiac arrest.

o Oxygen delivery is improved through the administration of

100% supplemental oxygen.

Assess and Control External Bleeding

1. Perform a rapid exam to identify any external

bleeding.

a) Venous Bleeding: dark red slow blood

flow.

b) Arterial Bleeding: bright red blood flow.

2. Control severe bleeding with direct pressure,

elevation, use of pressure points.

Identify and Treat Life Threats

1. Poor general

impression.

2. Decreased level of

consciousness.

3. Unresponsive.

4. Difficulty breathing.

5. Shock (hypo perfusion)

6. Complicated childbirth.

7. Chest pain with

hypotension.

8. Uncontrolled bleeding.

9. Severe pain.

10. Multiple injuries.

4.Perform a Rapid Exam

• you will need to take 60 -90 second and perform

rapid scan of the patient body to identify injuries that

be managed immediately. Not physical examination,

but fast examination to save life of patient.

• Assess head, neck, chest, abdomen, pelvis,

extremities back and buttock.

Perform a Rapid Exam

• Guidelines:

1. Inspect.

2. Palpate.

3. Auscultation.

4. Precaution

• DCAP-BTLS:

1. Deformities

2. Contusions

3. Abrasions

4. Punctures/penetration/

5. Burns

6. Tenderness

7. Lacerations

8. Swelling

Assess the Patient for Disability

• Perform a neurologic evaluation.–Have the patient move all extremities.•Assess for motor strength and weakness.•Assess for loss of sensation.

Priority Patients1. Hypo perfusion or shock.

2. Complicated childbirth.

3. Chest pain w/systolic BP < 100 mm Hg.

4. Uncontrolled bleeding.

5. Severe pain anywhere.

6. Multiple injuries.

7. Poor general impression.

8. Unresponsive patients.

9. Responsive but does not follow commands.

10. Difficulty breathing.