Chapter 8 The Initial Assessment DOT Directory
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1 Chapter 8 The Initial Assessment
2 U.S. Objectives U.S. Objectives are covered and/or supported by the PowerPoint Slide Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 8 correlation below. *KNOWLEDGE AND ATTITUDE Summarize the reasons for forming a general impression of the patient. Slides Discuss methods of assessing altered mental status. Slides Differentiate between assessing the altered mental status in the adult, child, and infant patient Discuss methods of assessing the airway in the adult, child, and infant patient. Slides State reasons for management of the cervical spine once the patient has been determined to be a trauma patient. Slides Describe methods used for assessing if a patient is breathing. Slides State what care should be provided to the adult, child, and infant patient with adequate breathing. (cont.)
3 U.S. Objectives *KNOWLEDGE AND ATTITUDE State what care should be provided to the adult, child, and infant patient without adequate breathing Differentiate between a patient with adequate and inadequate breathing Distinguish between methods of assessing breathing in the adult, child, and infant patient Compare the methods of providing airway care to the adult, child, and infant patient. Slides Describe the methods used to obtain a pulse. Slides Differentiate between obtaining a pulse in an adult, child, and infant patient. Slides Discuss the need for assessing the patient for external bleeding. Slide Describe normal and abnormal findings when assessing skin color. Slide 26 (cont.)
4 U.S. Objectives *KNOWLEDGE AND ATTITUDE Describe normal and abnormal findings when assessing skin temperature. Slides Describe normal and abnormal findings when assessing skin condition. Slide Describe normal and abnormal findings when assessing skin capillary refill in the infant and child patient. Slide Explain the reason for prioritizing a patient for care and transport. Slides Explain the importance of forming a general impression of the patient. Slides Explain the value of performing an initial assessment. Slide 7 (cont.)
5 U.S. Objectives *SKILLS Demonstrate the techniques for assessing mental status Demonstrate the techniques for assessing the airway Demonstrate the techniques for assessing if the patient is breathing Demonstrate the techniques for assessing if the patient has a pulse Demonstrate the techniques for assessing the patient for external bleeding Demonstrate the techniques for assessing the patient s skin color, temperature, condition, and capillary refill (infants and children only) Demonstrate the ability to prioritize patients.
6 Components of Initial Assessment
7 Components of Initial Assessment Form a general impression. Assess mental status. Assess airway. Assess breathing. Assess circulation. Identify priority patients.
8 Form a General Impression
9 Form a General Impression Environment/scene clues Chief complaint Age Sex Look/listen/smell Obvious life threats? (cont.)
10 Form a General Impression
11 Assess Mental Status Alert Verbal stimulus Painful stimulus Unresponsive
12 Mental Status: Alert Patients who are oriented to person, place, time, and day, or date are considered alert and oriented. A few EMS systems include additional questions to determine orientation.
13 Mental Status: Verbal Stimulus
14 Mental Status: Painful Stimulus
15 Mental Status: Unresponsive
16 Assess the Airway
17 Assess the Airway (cont.)
18 Assess the Airway Is patient able to maintain his own airway? If unable to, is patient a medical or trauma patient?
19 Open and Maintain Airway Medical patients Use head-tilt, chin-lift. Suction and insert oral or nasal airway as necessary. (cont.)
20 Open and Maintain Airway Trauma patients Immobilize the head manually. Use jaw thrust as necessary. Suction and insert oral or nasal airway as necessary.
21 Assess Breathing
22 Assess Breathing
23 Assess Pulse In adults and children, check radial pulse first. If no radial pulse, check carotid pulse. If no carotid pulse, start CPR and use AED as appropriate.
24 Circulation: Pulse, Bleeding, Skin
25 Infants: Check Brachial Pulse
26 Assess Skin Check skin at the same time you are checking pulse; determine: Color Temperature Condition (cont.)
27 Assess Skin
28 Look for Any Life-Threatening Injury
29 Infants/Children: Check Capillary Refill
30 Identify Priority Patients
31 Identify Priority Patients Poor general impression Unresponsive patients Responsive, but not following commands (cont.)
32 Identify Priority Patients Difficulty breathing Shock (hypoperfusion) Complicated childbirth (cont.)
33 Identify Priority Patients Chest pain with systolic BP lower than 100 Uncontrolled bleeding Severe pain anywhere
34 Determine Next Assessment Step
35 Determine Next Assessment Step Focused history and physical exam (Medical) or Focused history and physical exam (Trauma)
36 Review Questions 1. List factors you will take into account in forming a general impression of a patient. 2. Explain how to assess a patient s mental status with regard to the AVPU levels of responsiveness. (cont.)
37 Review Questions 3. Explain how to assess airway, breathing, and circulation during the initial assessment. Explain the interventions you will take for possible problems with airway, breathing, and circulation. 4. Explain what is meant by the term priority decision. (cont.)
38 Review Questions 5. Explain what special interventions are required. If a patient has suffered trauma If a patient is unresponsive
39 Street Scenes What should be done immediately upon contact with an unconscious patient who has fallen? What are some considerations when opening the airway of an unconscious patient? (cont.)
40 Street Scenes Using the AVPU scale, what is the level of responsiveness of a patient who responds to you calling out his name? (cont.)
41 Street Scenes Would knowing the cause of Joey s seizures change how you perform his initial assessment? (cont.)
42 Street Scenes For Joey, what is the best position to prevent airway problems from occurring? How did Joey s priority change during this call? (cont.)
43 Street Scenes What is the value of following a systematic method of assessment for threats to life? How much more assessment is appropriate before you transport this patient?
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