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

Overview

• The chapter covers the scope and sequence of patient assessment for medical and trauma patients.
• Key Sections: Scene Size-Up, Primary Assessment, History Taking, Secondary Assessment, and Reassessment.

Importance of Patient Assessment

• Divided into 5 main parts:
  • Scene Size-Up
  • Primary Assessment
  • History Taking
  • Secondary Assessment
  • Reassessment
• The order of steps may vary depending on the patient's condition and environment.
• Symptoms (subjective) vs. Signs (objective).

Scene Size-Up

• Evaluation of conditions for safe operation.
• Key Elements:
  • Situational Awareness
  • Scene Safety
  • Mechanism of Injury (MOI) or Nature of Illness (NOI)
  • Standard Precautions
  • Number of Patients
  • Need for Additional Resources

Scene Safety

• Ensure the scene is safe before entering.
• Consider environmental and safety hazards.
• Identify potential violence or hazards.

Mechanism of Injury or Nature of Illness

• Traumatic injuries vs. Medical conditions.
• Determine MOI for trauma or NOI for medical patients.
• Importance in preparing for patient care.

Standard Precautions

• Protective measures and PPE for communicable diseases.
• Assume risk with blood, body fluids, etc.

Determine Number of Patients

• Use Incident Command System for multiple patients.
• Triage based on severity.
• Consider additional resources (ambulance, police, fire rescue).

Primary Assessment

• Goal: Identify and treat immediate life threats.
• Steps:
  • Form General Impression
  • Assess Level of Consciousness (LOC)
  • Airway, Breathing, Circulation (ABCs)
  • Scan for Uncontrolled Bleeding
  • Determine Priority of Care

Level of Consciousness

• Use AVPU scale (Alert, Verbal, Pain, Unresponsive).
• Assess orientation (Person, Place, Time, Event).

Airway and Breathing

• Ensure patent airway.
• Check for breathing adequacy and signs of distress.
• Positive pressure ventilation if needed.

Circulation

• Assess pulse and skin condition.
• Control external bleeding.

History Taking

• Provides details on chief complaint and signs/symptoms.
• Components:
  • OPQRST for present illness (Onset, Provocation, Quality, Region/Radiation, Severity, Timing)
  • SAMPLE history (Signs/Symptoms, Allergies, Medications, Past History, Last Oral Intake, Events)

Secondary Assessment

• Systematic physical exam, focused on specific areas.
• Focus Areas:
  • Respiratory System
  • Cardiovascular System
  • Neurological System

Respiratory System

• Check for obstructions, trauma, symmetry, breath sounds.

Cardiovascular System

• Pulse, respiratory rate, blood pressure.

Neurological System

• LOC, orientation, pupils (PEARRL).

Vital Signs

• Use appropriate monitoring devices (e.g., pulse oximetry, capnography).

Reassessment

• Regular intervals to check for changes in condition.
• Repeat primary assessment, reassess vital signs, recheck interventions.

Reassessment Frequency

• Unstable patients: Every 5 minutes.
• Stable patients: Every 15 minutes.

Summary

• Chapter emphasizes the structured approach to patient assessment to identify life threats and provide necessary care.

Review Questions

• Importance of scene safety, identifying life threats, and prioritizing patient care.