Emergency Care and Transportation: Patient Assessment

Overview

• Focus: Understanding the scope and sequence of patient assessment for medical and trauma patients.
• Five Main Sections:
  1. Scene Size-Up
  2. Primary Assessment
  3. History Taking
  4. Secondary Assessment
  5. Reassessment

Introduction to Patient Assessment

• Importance: Critical for patient care, divided into five key parts.
• Steps may change order based on patient condition and environment.
• Symptom vs Sign:
  • Symptom: Subjective, patient-reported.
  • Sign: Objective, observable or measurable.

Scene Size-Up

• Purpose: Evaluate conditions for safety and operation.
• Situational Awareness: Vital throughout the call.
• Key Considerations:
  • Scene safety (self and team)
  • Traffic and environmental conditions
  • Hazards: Environmental, physical, chemical, etc.
  • Potential for violence
  • Determine Mechanism of Injury (MOI) or Nature of Illness

Standard Precautions

• Use PPE adapted to task.
• Assume all bodily fluids present infection risk.
• Minimum PPE: Gloves, possibly masks and eye protection.

Scene Size-Up Actions

• Determine number of patients and need for additional resources.
• Triage: Sort patients by severity.
• Consider additional emergency services (e.g., police, fire department).

Primary Assessment

• Goal: Identify and begin treating life threats.
• Steps:
  • Form general impression.
  • Level of Consciousness (AVPU): Alert, Verbal, Pain, Unresponsive.
  • Identify and treat life threats (ABC/CAB).
  • Assess breathing and circulation.
  • Rapid scan for life threats (60-90 seconds).
  • Determine patient priority and transport decisions (Golden Hour).

History Taking

• Determine chief complaint and gather patient history.
• Investigate Chief Complaint: Use OPQRST mnemonic.
  • OPQRST: Onset, Provocation, Quality, Region/Radiation, Severity, Timing.
• Gather SAMPLE History: Signs, Allergies, Medications, Past history, Last oral intake, Events leading to illness/injury.

Critical Thinking

• Essential in patient assessment for scene management and decision making.
• Sensitive Topics: Alcohol, drug use, abuse, violence, sexual history.
• Special Challenges: Silence, anxiety, intoxication, depression, limited cognitive ability, cultural and language barriers, hearing and visual impairments.

Secondary Assessment

• Performed on stable patients or during transport.
• Methods: Inspect, palpate, auscultate (look, listen, feel).
• DCAP-BTLS: Deformities, Contusions, Abrasions, Penetrations, Burns, Tenderness, Lacerations, Swelling.

Systematic Focused Exam

• Respiratory System: Assess rate, rhythm, quality, depth.
• Cardiovascular System: Check pulse, rhythm, blood pressure.
• Neurologic System: Level of consciousness, pupils, motor function.
• Trauma Assessment: Head, neck, chest, abdomen, pelvis, extremities, back.

Vital Signs and Monitoring

• Use appropriate devices (pulse oximetry, capnography, blood glucose levels, non-invasive blood pressure measurement).

Reassessment

• Continuous reassessment for changes in patient's condition.
• Elements:
  • Repeat primary assessment.
  • Reassess vital signs and compare trends.
  • Reassess chief complaint and interventions.
  • Unstable patients: Reassess every 5 minutes.

Conclusion

• Review questions and scenarios to reinforce learning.

Key Review Questions

1. Determine elements during scene size-up (except pediatric/adult ratio).
2. Actions on encountering unsafe scenes.
3. Initial steps in dealing with life threats.
4. Identification of patient's condition through primary assessment.
5. Usage of AVPU and GCS in assessing patient consciousness.
6. Importance of reassessment and identifying trends in patient condition.