Overview
This lecture covers the step-by-step process of patient assessment in emergency care, focusing on scene safety, initial evaluation, secondary assessment, and reassessment to identify and manage life threats.
Patient Assessment Principles
- Patient assessment identifies illness/injury and directs emergency care.
- Follow a structured approach: scene size-up, primary assessment, secondary assessment, and reassessment.
- Safety is always the first priority for responders, patients, and bystanders.
Scene Size-up
- Take Body Substance Isolation (BSI) precautions.
- Ensure scene safety and assess for hazards (chemical, electrical, violence, etc.).
- Identify mechanism of injury (MOI) for trauma or nature of illness (NOI) for medical calls.
- Determine the number of patients and need for additional resources.
- Consider spinal precautions for trauma patients.
Primary Assessment
- Form a general impression of the patient (age, sex, distress).
- Assess mental status using the AVPU scale: Alert, Verbal, Painful, Unresponsive.
- Check airway, breathing, and circulation (ABCs), and control life-threatening bleeding.
- Identify high-priority patients (unresponsive, severe bleeding, breathing difficulties).
Secondary Assessment
- Perform only after life threats are managed.
- For trauma: choose rapid (head-to-toe) or focused assessment based on MOI.
- For medical patients: focus on chief complaint and obtain SAMPLE history (Signs/Symptoms, Allergies, Medications, Past history, Last intake, Events).
- Take and compare baseline vital signs (pulse, respirations, skin signs, pupils).
Physical Exam
- Use BP-DOC (Bleeding, Pain, Deformities, Open wounds, Crepitus) and DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling) tools.
- Follow systematic head-to-toe approach: head, neck, chest, abdomen, pelvis, extremities, back.
- For medical patients, use OPQRST (Onset, Provocation, Quality, Region/Radiate, Severity, Time) for pain assessment.
Special Populations
- Infants/children: check brachial pulse, use capillary refill, adjust airway techniques.
- Elderly: be aware of lower injury thresholds and communication challenges.
Reassessment
- Repeat primary assessment and vital signs; check interventions.
- Reassess every 5 minutes for unstable patients, every 15 for stable.
- Communicate findings and changes to arriving EMS teams.
Key Terms & Definitions
- Scene Size-up — evaluating scene for safety, hazards, MOI/NOI, number of patients, resources.
- Primary Assessment — quick check of ABCs and life threats.
- Secondary Assessment — detailed exam after primary, includes history and vital signs.
- Reassessment — repeated checks for changes; trending patient status.
- AVPU Scale — Alert, Verbal, Painful, Unresponsive mental status scale.
- ABCs — Airway, Breathing, Circulation.
- SAMPLE — Signs/Symptoms, Allergies, Medications, Past Medical History, Last Intake, Events.
- BP-DOC — Bleeding, Pain, Deformities, Open wounds, Crepitus.
- DCAP-BTLS — Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.
- OPQRST — Onset, Provocation, Quality, Region/Radiate, Severity, Time.
Action Items / Next Steps
- Practice patient assessment skills with classmate scenarios.
- Review chapter summary, quiz, and run review questions.
- Memorize key assessment tools and acronyms: AVPU, SAMPLE, BP-DOC, DCAP-BTLS, OPQRST.