Transcript File - Huff Hills Ski Patrol

Chapter 7
Patient Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
7.1 Describe the two parts of the overall
assessment process.
7.2 Describe the importance of scene safety.
7.3 List the two parts of a patient
assessment.
7.4 Describe and demonstrate how to
perform a primary assessment and
manage the ABCDs.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
7.5 Describe and demonstrate how to
perform a secondary assessment.
7.6 Define the following terms:
a.
b.
c.
d.
e.
assessment
chief complaint
DCAP-BTLS
sign
symptom
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
7.7 List and describe the key components of
a patient history.
7.8 Describe how environmental conditions
can affect patient assessment.
7.9 Describe and demonstrate how to obtain
a SAMPLE history.
7.10 Describe and demonstrate how to
assess pain using the OPQRST
mnemonic.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
7.11 Describe and demonstrate how to
assess the eyes (pupils and movement).
7.12 Describe and demonstrate how to
assess a patient’s level of
responsiveness using the following:
a.
b.
AVPU
Glasgow Coma Score
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
7.13 Describe and demonstrate the
procedure for obtaining the following
vital signs:
a.
b.
c.
Respiratory rate
Blood pressure
Heart rate
7.14 Describe and demonstrate how to
reassess a patient.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Scene
Size-up
 Patient Assessment
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
You are called to help a male in his mid-50s who fell
approximately 6 feet to the ground while rock
climbing. He is wearing a helmet and did not lose
consciousness. He is having difficulty breathing and
is complaining of upper left chest pain that he
describes as being “hit with a baseball bat.”
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
Scene Size Up
Copyright J. Selkowitz
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
Case Update
You ask permission to assess and treat the patient.
The patient says, “Yes.” The patient is awake and
speaks to you in two- or three-word sentences. His
airway is open, he is having trouble breathing. His
pulse is 100/rpm. The patient complains of a
persistent pain on the left side of his chest.
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
• Regular and Orthostatic
◦ 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
BRADY
and vitals should be tracked
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You call for backup and perform a physical exam on
the patient. You notice some discoloration on the left
upper portion of the patient’s chest. He has some
tenderness in his lower back, near his spine. Pulses
in both the upper and lower extremities are equal and
strong. The vital signs are normal.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Your
first priority is scene safety.
 Assess the ABCDs first.
 The chief complaint is the patient’s
primary concern.
 Stabilize all potential threats to life
before performing a secondary
assessment.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
A
significant MOI for a patient who
has no signs of physical injury should
raise your suspicions.
 A minor MOI does not mean that the
patient has no serious injury.
 Use SAMPLE, OPQRST, and DCAPBTLS when performing a secondary
assessment.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Know
the normal values of vital signs.
Any abnormalities should raise your
level of concern.
 Reassess the patient frequently.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ