Chapter 17The Ongoing Assessment

2

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Ongoing Assessment Components of the Ongoing Assessment

3

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Ongoing Assessment

Once the patient has been thoroughly assessed, vital signs measured, and transport decision made, the next step is to begin ongoing assessment

The purpose is to identify any significant changes in the patient’s condition that need immediate attention

4

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Watch this video clip about ongoing assessment

Ongoing Assessment

5

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

The initial assessment repeated The patient’s condition dictates whether

this step will take more than a moment Carefully reassess the seriously

injured patient

6

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

The initial assessment repeated– Mental status

• Use AVPU• Mental status changes may occur very gradually but may

have devastating consequences if not recognized and quickly acted on

– Airway • Maintain constant vigil over the airway, making sure that

it remains open and clear

7

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

The initial assessment repeated– Breathing: Evaluate effectiveness of oxygen delivery

• Did the oxygen relieve the patient’s pain or make her feel better? If not, why not?

• Check for equipment malfunctions and kinked oxygen tubing• Check to make sure you did not run out of oxygen!• Changes in patient condition may necessitate switching

from non-rebreather mask to assisted bag valve mask ventilations

• Pulse oximetry may be helpful in confirming the EMT’s findings; never should the pulse oximeter replace the EMT’s assessment of respiratory effort

Components of the Ongoing Assessment

8

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

9

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

The initial assessment repeated– Circulation

• Ensure that all bleeding has been addressed and remains controlled

• Reassess any external bleeding that was discovered and initially managed on scene

• Internal bleeding requires evaluation of the mechanism of injury and indicators of perfusion such as skin temperature, color, and distal pulse

10

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

11

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

The initial assessment repeated– Reevaluate patient priority

• A low-priority patient’s condition may change, prompting notification of the hospital and arranging an ALS intercept if the patient’s condition deteriorates

• Destination facility may need to change based on the patient’s condition– Follow local protocols for this

12

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

Reassess vital signs– First set of vitals is the baseline– Subsequent vitals are compared to the baseline– Ensure at a minimum two sets of vital signs are

obtained and recorded

13

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

Repeat history– Patients may have been confused or distracted on

scene; history taking may be more accurate in the back of the ambulance

– Reaffirming a patient’s history improves its reliability

– Treatments may need to be adjusted due to historical findings

14

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

Repeat physical examination—focused or detailed– Some findings may take time to develop– Reassess using DCAP-BTLS– Compare findings with on scene findings

15

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

Check ABCs and interventions– Check all treatments in progress– Ask, Is it working?– Check splints– Check dressings and bandages used for

wound control– If EMT assisted with meds, are they working?

16

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

17

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

Note changes– All changes in the patient’s condition from on the

scene and while en route must be noted– Changes may represent a pattern– Patterns reflect the patient’s trending—either

positive or negative; this should be reported and recorded

18

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Components of the Ongoing Assessment

How often?– Determined by the priority of the patient– Reassess every 5 minutes if a high-priority patient– Reassess every 10–15 minutes if a low-priority

patient– Remember these are just guidelines; a patient’s

priority level may change rapidly, and reassessment intervals are not arbitrary

19

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Stop and Review

Why do we do an ongoing assessment? Is the ongoing assessment done only one

time? At a minimum, how often should a high-

priority patient be reassessed? At a minimum, how often should a low-priority

patient be reassessed?