Transcript Patient Assessment Lecture Notes Page

EMT 100
Patient Assessment
Vital Signs
*SIGNS OF LIFE*
Pulse
Is the heart rate expressed in beats per
minute
Radial Artery Palpation
Carotid Artery Palpation
Normal Pulse Values
Adult – 60-100
 Children – 80-100
 Infants – 100-140

Rapid Weak Pulse May Be A
Sign Of Shock!
Respiration
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Expressed in breaths per minute
 Each breath consists of an inspiration and
an expiration
 Look, Listen, and Feel!
Normal Respiration Rates

Adults = 12-20
 Children = 20-40
 Infants = 30-50
Rapid And Shallow
Respirations May Be A Sign
Of Shock!
Temperature

Normal = 98.6F or 37C
 Warm, dry skin
Cool, Clammy Skin May Be A
Sign Of Shock!
Skin Color

Pale, white ashen appearance, ie Pallor, may
be a sign of shock!
 Bluish, gray skin, ie Cyanosis, shows poor
oxygenation of the blood
 Yellowish-orange skin, ie Jaundice, may be
a sign of liver disease or blood disease
Pupils

Normally are the same size and react
equally to light
Level of Consciousness (LOC)
assessed by asking:
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Who are you? (Orientation to self)
 What were you doing? (Orientation to
situation)
 Where are you ? (Orientation to place)
 What day of the week is it? (Orientation to
time)
LOC continued

Questions must be asked in this order
 May need to assess every few minutes
 As patients become disoriented, they lose
the ability to answer the questions in the
reverse order that they are asked
Psychological Concerns
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Extremely aberrant behavior by the patient
may be a manifestation of illness or injury
Psychological Concerns
(continued)
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Be in control
 Be supportive
 Be honest
Golden Rule
Treat each patient the way you
would want to be treated if you were
the patient!
Patient Assessment
Sequence
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Perform scene size-up.
 Perform primary assessment.
 Obtain SAMPLE History.
 Secondary assessment—head to toe exam.
 Perform on-going re-assessment.
Step I: Scene Size-up

Maintain body substance isolation.
 Maintain scene safety.
 Determine mechanism of injury or
nature of illness.
 Determine need for additional
resources.
Step II:
Perform Primary
Assessment
Look for LifeThreatening Conditions
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Form general impression of patient.
Assess responsiveness.
Check airway.
Check breathing.
Check circulation.
Primary Assessment:
Assess Responsiveness
AVPU Scale
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Alert
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Verbal
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Pain

Unresponsive
Primary Assessment:
Check Patient’s Airway
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Head tilt–chin lift technique
– The tongue is the most common cause of obstruction in an
unconscious person

Jaw-thrust technique
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Inspect mouth

Insert airway if needed
Primary Assessment:
Check Patient’s Breathing

If conscious:
– Check rate and quality.
– Check for any difficulty.
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If unconscious:
– Look, listen, and feel for breathing.
– Start rescue breathing, if needed.
Primary Assessment:
Check Patient’s
Circulation

Check carotid or radial pulse.
 Check for severe bleeding.
 Check skin color and temperature:
– Pale - decreased circulation
– Flushed - excess circulation
– Yellow - liver problems
Step III: Patient’s Medical
History

Signs/Symptoms (Chief Complaint)
 Allergies
 Medications
 Pertinent, past medical history
 Last oral intake
 Events associated with or leading to
the injury or onset of illness
Step IV: Seconday
Assessment - Physical
Examination

Check patient from head to toe
for non-life-threatening conditions.
 Purpose of exam is to locate and begin
initial management of injury or illness.
Physical Exam:
Examine the Patient from Head
to Toe
• Look and feel for signs of injury:
• Deformity
• Open injuries
• Tenderness
• Swelling
• Search all areas of body in a clear,
concise, consistent format.
Examine Patient’s Head and
Eyes
• Examine head:
– Use both hands.
– Do not move patient’s head.
– Remove eyeglasses.
– Remove wigs if necessary.
• Examine eyes:
– Cover one eye for 5 seconds.
– Watch for pupil contraction.
Examine Patient’s Neck and
Chest
• Examine neck:
– Examine each side; check for pain.
–Check neck veins.
–Check for a medical identification tag.
Examine Patient’s Chest
• Examine chest:
– Check for pain on inhalation/exhalation.
– Look for signs of difficult breathing.
– Note injuries, bleeding, or abnormal,
unequal, or painful movement.
– Check for collarbone or rib fractures.
Examine Patient’s Abdomen
• Look for signs of external bleeding,
penetrating injuries, or protruding
parts.
• Check for stomach rigidity or swelling.
• Check for soiled clothing.
• Check genital area for external injuries.
Examine Patient’s Pelvis
• Examine pelvis:
– Check for obvious bruising, bleeding, or
swelling.
– Check for pain if no pain has been
reported.
• Examine back:
– Stabilize head and neck and log-roll
– Check one side of the back at a time.
Examine the Extremities

Observe the extremity.
 Examine for tenderness.
 Check for movement.
 Check for sensation.
 Assess the circulatory status.
Step V: On-going
Reassessment

Monitor patient’s vital signs:
– Every 5 minutes if unstable.
– Every 15 minutes if stable.
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Maintain an open airway.
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Monitor breathing and pulse.
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Monitor skin color and temperature.
It is time for
lab!
Check and record the radial/carotid pulse and the respirations of 5
fellow students
Primary Survey
Looks for life-threatening
conditions!
Determine whether victim is
conscious or unconscious,
then check:

Airway
 Breathing
 Circulation
 Hemorrhage
 Shock
Secondary Survey
Is a head to toe survey that looks for
other injuries/problems
Secondary Survey (cont.)
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Neck
Skull
Face, Nose, and Mouth
Chest and Lungs
Abdomen
Pelvis, Genitals, Incontinence
Extremities
Back and Buttocks
Reassure!
Don’t Overlook:
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Situation
Bystanders, Family or
Friends
Medications and
Medical History
Wallet Cards
Vial of Life
Med-Alert Tags