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

Introduction

• Importance of patient assessment is crucial.
• Process divided into five main parts:
  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

• Evaluate operating conditions and ensure safety.
• Combine dispatch information and scene observations.
• Ensure Scene Safety:
  • Identify hazards such as environmental, physical, chemical, electrical, etc.
  • Be aware of potential violence.
• Determine Mechanism of Injury (MOI) or Nature of Illness:
  • Differentiate between trauma and medical patients.
  • Engage with patient, family, or bystanders for information.
• Standard Precautions:
  • Use PPE (gloves, masks, etc.).
  • Assume all bodily fluids pose infection risk.
• Identify Number of Patients and Triage:
  • Use incident command system if multiple patients.
  • Consider additional resources if necessary.

Primary Assessment

• Goal: Identify and treat immediate life threats.
• Form General Impression:
  • Note age, sex, race, distress level, etc.
  • Communicate with patient and assess consciousness.
• Assess Level of Consciousness (AVPU):
  • Alert, Verbal, Pain, Unresponsive.
  • Use orientation questions (person, place, time, event).
• Identify and Treat Life Threats:
  • Address airway, breathing, and circulation (ABCs).
  • Assess and manage airway patency and breathing.
• Circulation Assessment:
  • Check pulse, skin condition, and capillary refill.
  • Manage external bleeding.
• Determine Patient Priority:
  • High priority for unresponsive, severe symptoms, etc.

History Taking

• Gather details on chief complaint and symptoms.
• Investigate Chief Complaint:
  • Use OPQRST mnemonic (Onset, Provocation, Quality, Region/Radiation, Severity, Timing).
• Obtain SAMPLE History:
  • Signs and Symptoms, Allergies, Medications, Past history, Last oral intake, Events leading up.
• Critical Thinking in Assessment:
  • Synthesize gathered information for clinical decision making.
• Handling Sensitive Topics:
  • Approach with professionalism and sensitivity.

Secondary Assessment

• Perform systematic physical exam.
• Focus Assessment on Affected Area/System:
  • For respiratory issues: check airway obstruction, breath sounds, chest symmetry.
  • Cardiovascular issues: check trauma to chest, pulse, blood pressure.
  • Neurological issues: assess consciousness, pupil response.
  • Perform hands-on assessment for sensory and motor response.
• DCAP-BTLS for Trauma:
  • Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.

Vital Signs

• Assess using monitoring devices.
• Tools include pulse oximetry, capnography, blood glucose meter.

Reassessment

• Regularly reassess patient condition.
• Repeat primary assessment and compare vital signs.
• Recheck interventions and document changes.
• Continuous reassessment for unstable patients.

Review Questions

• Scene size-up involves determining scene safety, number of patients, but not patient ratios.
• Respond to unsafe scenes by retreating until secured.
• Primary assessment identifies immediate life threats.

Conclusion

• Chapter emphasizes structured patient assessment and prioritization of life-threatening conditions.
• Follow the defined sequence tailored to patient condition and scene environment.
• Regular reassessment is crucial for monitoring patient status and intervention efficacy.