Chapter 7 - Community Middlebury

Report
Chapter 7
Patient Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Scene Size Up
 Use
all senses to evaluate scene for
potential hazards
 Control the risk – Scene safety
◦ What should you do to ensure that the
rescuers are safe?
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
General Impression
 Chief
◦
◦
◦
◦
complaint
What is the most important symptom?
Traumatic? Medical?
Specific location?
Life threatening?
 MOI
or NOI
◦ What likely caused the injury?
◦ What is the source of the medical
concern?
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
General Impression
 Initial
patient appearance
◦ What do you see when you look at the
patient?
•
•
•
•
Expressions of pain?
Blood?
Deformities?
Skin color?
 May
allow establishment of priorities
for care and transport
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Patient Assessment
 The
formal process in which injuries
and illnesses are identified
 The most important skill in patient
care
 Allows for assessment to be
performed in a systematic, organized
manner each time
 Includes the primary and secondary
assessments
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Primary Assessment
 Identify/Assess
◦
◦
◦
◦
all life threats
Airway
Breathing
Circulation
Disability
• C-Spine
• CSM of extremities
◦ Level of consciousness
• AVPU / Glasgow Coma Scale
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Normal Vital Signs
 Checking
for circulation
 Radial, carotid, brachial
 Table 7-2 on pg. 221
 Adult:
◦ 60-100 bpm; 12-20 rpm
 Child:
◦ 80-100 bpm; 15-30 rpm
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Secondary Assessment
Medical History
SAMPLE
Signs/Symptoms
 Allergies
 Medications
 Past med history
 Last oral intake
 Events leading up
to the incident

BRADY
OPQRST
Onset
 Provocation/Palliation
 Quality
 Radiation
 Severity
 Time

National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Secondary Assessment
Physical Exam
 Systematic
head-to-toe, hands-on
assessment
 Initiate BSI
 Look, then touch
◦
◦
◦
◦
Head (scalp, face, ears, eyes)
Neck (C-Spine)
Trunk (chest, abdomen, back, pelvis)
Extremities
continued
 Expose
BRADY
as appropriate
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Secondary Assessment
Physical Exam
 DCAP
◦
◦
◦
◦
◦
◦
◦
◦
BRADY
– BTLS
Deformity
Contusions
Abrasions/Avulsions
Punctures/Penetrations
Burns / Bleeding / Bruises
Tenderness
Lacerations
Swelling
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Secondary Assessment
Vital Signs
 Vital
Signs
◦ Level of Consciousness
• AVPU scale
◦ Pulse
• Rate and quality
◦ Respirations
• Rate and quality
◦ Blood Pressure
◦ Temperature
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Special Assessment
Considerations
 Unresponsive
patient
◦ Assume C-Spine injury
 Communication
barriers
 Cultural diversity
 Aggressive behavior
 Pediatric patients
 Geriatric patients
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Environmental
Considerations
 Assess
just enough to provide urgent
care and ensure safe transport
◦
◦
◦
◦
BRADY
Temperature
Slope/incline
Bright sun
Wind, dust, rain, dark
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Reassessment
 Patient
condition is dynamic, so
assessment must be ongoing
 Frequency determined by patient
condition
◦ More severe = more frequent checks
 ABCDs
and vitals should be tracked
 Stable patients (10-15 mins) vs.
unstable patients (3-5 mins)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter 7 Skills
Patient Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-1
Patient Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-1 Patient Assessment (a) Perform scene size-up. Initiate
Standard Precautions.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-1 Patient Assessment (b) Perform a primary assessment and
manage ABCDs.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-1 Patient Assessment (c) Perform a secondary assessment and
provide intervention per your local protocols. Reassess the patient based on
the patient's condition.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-2
Patient Assessment –
Trauma Patient
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-2 Patient Assessment—Trauma Patient (a) Perform scene sizeup. Initiate Standard Precautions.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-2 Patient Assessment—Trauma Patient (b) Perform a primary
assessment and provide stabilization to the patient.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-2 Patient Assessment—Trauma Patient (c) Perform a secondary
assessment to detect any serious injuries. Take baseline vital signs. Then
reassess as necessary.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-3
Patient Assessment –
Medical Patient
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-3 Patient Assessment—Medical Patient (a) Patroller is
conducting a scene size-up in this incident involving skier in the lodge.
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-3 Patient Assessment—Medical Patient (b) Patroller performs a
primary assessment. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-3 Patient Assessment—Medical Patient (c) Listening to patient
and examining him based on his chief complaint. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-3 Patient Assessment—Medical Patient (d) Performing a
secondary assessment with a detailed examination. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-3 Patient Assessment—Medical Patient (e) Obtaining a complete
SAMPLE history. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-4
Assessing Pupils
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-4 Assessing Pupils (a) Instruct the patient to stare at your nose
or the center of your forehead. Check that the pupils are equally sized and are
round. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-4 Assessing Pupils (b) Moving laterally to medially, briefly shine
the penlight into the patient's left eye and then do so a second time.
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-4 Assessing Pupils (c) Next shine the light in the patient's right
eye, and then do so a second time.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-5
Assessing Pulse
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-5 Assessing Pulse (a) Locate the radial pulse on an adult.
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-5 Assessing Pulse (b) Locate the carotid pulse on an
unresponsive adult. In each case, note the quality of the pulse. Copyright
Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-5 Assessing Pulse (c)
BRADY
Assess pulse rate and quality.
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-6
Assessing Respiration Rate
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-6 Assessing Respiration Rate (a) Look and feel for the patient's
chest to rise and fall. Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
OEC Skill 7-6 Assessing Respiration Rate (b) Assess the patient's
respirations for rhythm, depth, effort, and noise to determine if the patient is
breathing within normal limits.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skill 7-7
Blood Pressure
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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