Chapter 10: Patient Assessment - Emergency Care and Transportation of the Sick and Injured

Introduction

• The importance of patient assessment cannot be overemphasized.
• Divided into five sections:
  1. Scene Size-Up
  2. Primary Assessment
  3. History Taking
  4. Secondary Assessment
  5. Reassessment
• Order of steps may change based on patient condition and environment.

Scene Size-Up

• Purpose: Evaluate operating conditions and ensure safety.
• Key Points:
  • Situational awareness is critical.
  • Ensure scene safety; may involve calling additional resources.
  • Consider traffic, environmental conditions, and potential violence.
  • Determine mechanism of injury (MOI) or nature of illness.
  • Standard precautions and personal protective equipment are necessary.
  • Identify the number of patients and begin triage.
• Hazards: Environmental, physical, chemical, electrical, water, fire, explosions, violence.

Primary Assessment

• Goal: Identify and begin treatment of immediate or imminent life threats.
• Steps:
  • Form general impression of the patient.
  • Assess level of consciousness (AVPU method - Alert, Verbal, Pain, Unresponsive).
  • Identify life threats in ABC order (Airway, Breathing, Circulation).
  • Determine patient priority for transport (ABCD - airway, breathing, circulation, determine transport priority).
  • Scan for uncontrolled external bleeding.
  • Use CAB sequence (Circulation, Airway, Breathing) if necessary.
• Conditions: Airway obstruction, respiratory failure/arrest, shock, severe bleeding.

History Taking

• Purpose: Provide details about patient’s chief complaint and history.
• Information to Document:
  • Date of incident, patient's age, gender, race, medical history, current health status.
• OPQRST Mnemonic:
  • Onset, Provocation, Quality, Region/Radiation, Severity, Timing.
• SAMPLE Mnemonic:
  • Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to illness/injury.
• Critical Thinking & Sensitive Topics:
  • Gather facts, evaluate information, synthesize a plan.
  • Handle sensitive topics professionally (e.g., alcohol, drugs, abuse).

Secondary Assessment

• Purpose: Perform a systematic physical exam.
• When & Where: Stable patients at scene; unstable patients during transport.
• Assessment Techniques:
  • Inspection (Look), Palpation (Feel), Auscultation (Listen).
• Focused Assessment:
  • Based on chief complaint, focus on affected body part/system.
• DCAP-BTLS Mnemonic:
  • Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.

Vital Signs

• Monitoring Devices:
  • Pulse oximetry, capnography, blood glucose measurement, non-invasive blood pressure.
• Reassessment:
  • Monitor changes in patient condition over time.

Reassessment

• Purpose: Identify and treat changes in patient condition.
• Components:
  • Repeat primary assessment, reassess vital signs, reassess chief complaint, recheck interventions.
• Intervals:
  • Every 5 minutes for unstable patients, every 15 minutes for stable patients.

Conclusion

• Patient assessment is a critical skill in emergency care.
• Ensure thoroughness in each of the five main parts of assessment.
• Be flexible and adapt to the situation and patient needs.