Transcript V2ch03b - SchultzMedic

 The
circulation assessment consists of
evaluating the pulse and skin and controlling
hemorrhage
 Capillary


refill
May provide information regarding the patient’s
cardiovascular status.
Refill time greater than 2 seconds is caused by
shunting and capillary closure to peripheral
capillary beds and suggests inadequate circulation
and impaired cardiovascular function.
 Treat
for and anticipate shock
Elevate lower extremities
 Keep patient warm
 Follow local protocols regarding use of PASG
 Fluid replacement

 Once
the initial assessment is completed,
determine the patient’s priority.
 If serious injury or illness is indicated by the
initial assessment, conduct rapid head-totoe assessment for other potential lifethreats and initiate transport.
 Poor
general
impression
 Unresponsive
 Conscious but
cannot follow
commands
 Difficulty
breathing
 Hypoperfusion
 Complicated
childbirth
 Chest pain and BP
below 100 systolic
 Uncontrolled
bleeding
 Severe pain
 Multiple injuries
© Glen Jackson
 Trauma
patient with significant mechanism
of injury
 Trauma patient with isolated injury
 Responsive medical patient
 Unresponsive medical patient
 Sustained
significant injury
 Exhibits altered mental status from the
incident
© Robert J. Bennett
 Ejection
from
 High-speed
motor
vehicle
vehicle collision
 Death in same
 Vehicle-passenger
passenger
collision
compartment
 Motorcycle crash
 Fall from higher  Penetration of the
than 20 feet
head, chest, or
 Rollover of vehicle abdomen



Fall from higher than ten feet
Bicycle collision
Medium-speed vehicle collision
with resulting severe vehicle
deformity
Courtesy of Edward T. Dickinson, MD
 Not
a detailed physical exam
 Fast, systematic assessment for
other life-threatening injuries
 Findings may influence transport decision
 Deformity
 Burns
 Contusion
 Tenderness
 Abrasion
 Lacerations
 Penetration
 Swelling
 Inspect
the anterior
neck
 Tracheal deviation
 Jugular venous
distension
 Subcutaneous
emphysema
 Inspect


Accessory muscle use
Flail chest
 Palpate

Stability
 Auscultate

Equal and adequate air movement
 Inspect


Exaggerated abdominal motion
Bruising or discoloration


Cullen’s sign
Grey-Turner’s sign
 Palpate


Rigidity
Tenderness
 Assess
all four extremities
 Stability
 Circulation
 Sensation
 Motor function
 No
significant mechanism of injury
 Shows no signs of systemic
involvement
 Does not require an extensive history
 Does not require a comprehensive
physical exam
 History
takes
priority when
assessing the
medical patient.
 Initiate treatments
as you are
assessing.
 Chief
complaint
 History of the present illness
 Past history
 Current health status
 The
pain, discomfort, or
dysfunction causing patient to
call for help
 “What seems to be the problem?”
 Onset
 Associated
 Provocation
Symptoms
 Pertinent
Negatives
or
Palliation
 Quality
 Region/Radiation
 Severity
 Time
 Symptoms
 Allergies
 Medications
 Past
medical history
 Last oral intake
 Events preceding the incident
 General
state of health
 Childhood and adult diseases
 Psychiatric illnesses
 Accidents and injuries
 Surgeries and hospitalizations
 Current
 Sleep
patterns
medications
 Exercise and
 Allergies
leisure activities
 Tobacco use
 Environmental
hazards
 Alcohol and
substance abuse  Use of safety
measures
 Diet
 Screening exams  Family history
 Social history
 Immunizations
 Use
exam techniques relative to your
patients situation or complaint.
 Common presentations:
Cardiac chest pain/respiratory distress
 Altered mental status
 Acute abdomen

 Blood
pressure
 Pulse
 Respiration
 Temperature
 Pupils
 Orthostatic
vitals
(if possibly hypovolemic)
 Pulse
oximetry
 Capnography
 Cardiac monitoring
 Blood glucose determination
 Initial
assessment
 Rapid medical assessment

Similar to the rapid trauma assessment except
you will look for signs of illness rather than injury
 Brief
history
 Mental
status and speech
 Cranial nerves
 Motor system
 Reflexes
 Sensory system
 Biceps
 Triceps
 Brachioradialis
 Quadriceps
 Achilles
 Abdominal
plantar
 Pain
 Light
touch
 Temperature
 Position
 Vibration
 Discriminative
 Pulse
rate and quality
 Blood pressure
 Respiration rate and quality
 Skin condition
 Temperature
 Detects
trends
 Determines changes
 Assesses intervention’s effects
 Mental
status
 Airway patency
 Breathing rate
and quality
 Pulse rate and
quality
 Skin condition
 Transport
priorities
 Vital signs
 Focused
assessment
 Effects of
interventions
 Management
plans
 The
Scene Size-Up
 The Initial Assessment
 The Focused History and Physical Exam
 The Detailed Physical Exam
 Ongoing Assessment