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InitialInitialAssessmentAssessment
CH
AP
TER
9C
HA
PTER
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