Transcript Paramedic Care: Principles & Practice Volume 5 Special

Paramedic Care: Principles
& Practice
Volume 5
Special Considerations /
Operations
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 7
Assessment-Based
Management
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Effective Assessment
The Right Equipment
General Approach to the Patient
Presenting the Patient
Review of Common Complaints
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
Sequence of
assessment
Inverted pyramid
reasoning
– Critical thinking,
problem solving, or
clinical decision
making
Differential diagnosis
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Effective Assessment
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Effective Assessment
Assessment forms the foundation for patient
care
You must gather, evaluate, and synthesize
information
The ability to reason and to reach a field
diagnosis is critical to paramedic practice
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Importance of Accurate
Information
The History
– A patient’s history
is a crucial part of
the medical record
– It is important for
you to question
the patient, family
members, and
bystanders
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Importance of Accurate
Information
The Physical Exam
– Never forget, or minimize, the importance of a
thorough physical exam
You may have to move the patient into the ambulance
or some other controlled environment
– Significant mechanism of injury
Head-to-toe
– Medical patient or minor isolated trauma
Focused exam
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Importance of Accurate
Information
Pattern Recognition
– Remain alert to patterns
– Compare information to what is in your
knowledge base about various diseases
– The ability to recognize patterns increases with
experience
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Importance of Accurate
Information
Assessment/Field Diagnosis
– Based on a combination of pattern recognition
and intuition
A product of experience
– Formulate a plan of action, based on the
patient’s condition and the environment
BLS/ALS Protocols
– Use of protocols
– Know when to apply appropriately
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Factors Affecting Assessment
and Decision Making
Personal attitudes
– Be as
nonjudgmental as
possible
– Seek to identify any
preconceived
notions that you
may have about a
group
© Craig Jackson/In the Dark Photography
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Factors Affecting Assessment
and Decision Making
Uncooperative patients
– Patients are perceived as being “high,” either on
alcohol or drugs
– Consider medical causes
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Factors Affecting Assessment
and Decision Making
Patient compliance
– Cultural and ethnic barriers and prior negative
experiences
Distracting injuries
– You must resist the temptation to form a field
diagnosis too early
May lead to snap judgments
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Factors Affecting Assessment
and Decision Making
Environmental
and personal
considerations
– Include scene
chaos, violent or
dangerous
situations, high
noise levels, or
crowds of
bystanders
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment/Management
Choreography
Role of the team leader
– Usually the person who will accompany the
patient through to definitive care
– During multiple-casualty situations, the team
leader acts as the initial EMS commander
– Must maintain overall patient perspective and
provide leadership to the team
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment/Management
Choreography
Role of the Patient Care Provider
– The patient care provider should ensure “scene
cover”
– Performs any skills or interventions requested
by the team leader
– Acts as the triage group leader during mass
casualty
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Right Equipment
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Right Equipment
Having the right equipment at the patient’s
side is essential
Assessment and management must usually
be done simultaneously
– You must be prepared to manage many
conditions and injuries or changes in the
patient’s condition
Essential equipment
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Approach
to the Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Approach
to the Patient
Scene size-up
Initial assessment
– Resuscitative
approach
– Contemplative
approach
– Immediate evacuation
Focused history and
physical exam
Ongoing assessment
and detailed physical
exam
© Glen Jackson
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Identify Life-Threatening
Problems
Rapidly determine the chief complaint
– Assess the distress in a systematic manner
Keep in mind the mechanism of injury and
the nature of the illness
Your role as paramedic is to rapidly and
accurately assess the patient and then to
treat for the worst case scenario
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Presenting the Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Presenting the Patient
The ability to communicate effectively is the
key to transferring patient information
A skill that will be used on every single
patient is that of effective presentation
– Radio, telephone, face-to-face, and writing
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Trust and
Credibility
Effective
presentation and
communication
skills help establish
a paramedic’s
credibility
© Ken Kerr
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Developing Effective
Presentation Skills
Last less than one
minute
Are very concise and
clear
Avoid extensive use
of medical jargon
Follow a basic format,
usually the SOAP
format or some
variation
Include both
pertinent findings
and pertinent
negatives
Conclude with
specific actions,
requests, or
questions related to
the plan
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Elements of an
Effective Presentation
Patient identification, age, sex, and degree
of distress
Chief complaint
Present illness/injury
– Pertinent details about the present problem
– Pertinent negatives
Past medical history
– Allergies
– Medications
– Pertinent medical history
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Elements of an
Effective Presentation
Physical signs
– Vital signs
– Pertinent positive findings
– Pertinent negative findings
Assessment
– Paramedic impression
Plan
– What has been done
– Orders requested
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Review of Common Complaints
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Review of Common Complaints
Practice Sessions
– Goal is to choreograph the roles and actions of
the EMS response team
Laboratory-based Simulations
– Requires you to assess a preprogrammed
patient or mannequin
Self-motivation
– Take advantage of every opportunity to practice
your new skills
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Effective Assessment
The Right Equipment
General Approach to the Patient
Presenting the Patient
Review of Common Complaints
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ