Initial Patient Assessment. Lesson Goal. Lesson Objectives 9/10/2012

Transcription

1 Initial Patient Assessment Lesson Goal Perform initial patient assessment, form a general impression, and determine transport priority of medical or trauma patient Lesson Objectives Discuss importance of forming general impressions of patient Discuss ways to assess patient with altered mental status Discuss differences in assessing altered mental status of adult, child, and infant patients 1

2 Lesson Objectives Discuss methods of assessing airway Discuss importance of managing spine of trauma patient Describe methods used for assessing whether patient is breathing Lesson Objectives State care that should be provided to patient with adequate breathing State care that should be provided to patient without adequate breathing Discuss difference between patient with adequate breathing and one with inadequate breathing Lesson Objectives Describe methods used to obtain a pulse Discuss need for assessing patient for external bleeding Describe normal & abnormal findings when assessing skin color, temperature & condition 2

3 Lesson Objectives Explain reason for prioritizing patient for care & transport Introduction Patient assessment Systematic evaluation of patient for injuries & illness Focus Initially find & treat life threats Then move on to finding less serious problems Introduction 3

4 General Impression Combine elements of scene size-up & preliminary observations to form general impression General Impression Includes: NOI for medical patients MOI for trauma patients Determine need for cervical spine stabilization Both medical problem & injury possible Age Gender Race (ethnicity) General Impression During initial assessment, any life threats identified are treated as found, before assessment is continued 4

5 General Impression Know when to act quickly Re-evaluate after interventions Plan ahead for next action Be able to adapt to unique demands of each situation & patient General Impression Once general impression formed, focus on Mental status Airway Breathing Circulation Assessing Mental Status Level of awareness & ability to respond Alert Orientation Person Place Time Event Verbal Painful Unresponsive 5

6 Mental Status The lower the level of responsiveness, the more critical the patient s condition Glasgow Coma Scale sophisticated method of assessing mental status Airway Without an open airway patient cannot breathe or receive oxygen Awake and talking = open airway Unresponsive patient Perform manual maneuver Breathing = open airway Not breathing ventilate Airway Noisy breathing partially obstructed airway Position Suctioning Once airway is open, monitor continually 6

7 Assessing Breathing Adequate? Not breathing Begin rescue breathing immediately Inadequate breathing (<8 or >24/min) O 2 Bag-mask Assessing Circulation Check pulse Check for & control major bleeding Check adequacy of perfusion Assessing Circulation Pulse Check adequacy <60 or >100 bpm early interventions & transport No pulse Start CPR 7

8 Circulation Bleeding Significant bleeding leads to shock & death Assess for & control significant external bleeding Internal bleeding cannot be controlled in prehospital setting Circulation Adequacy of perfusion Skin signs Mental status Pulse Blood pressure Skill 9-1: Unresponsive Patient 1. Evaluate general impression; assess degree of unresponsiveness 2. Assess airway & breathing 8

9 Skill 9-1: Unresponsive Patient 3. Assess for a pulse 4. Assess for major bleeding Skill 9-1: Unresponsive Patient 5. Assess skin 6. Determine disability; assess priority Skill 9-2: Responsive Patient 1. Evaluate general impression 2. Assess responsiveness, airway & breathing 9

10 Skill 9-2: Responsive Patient 3. Assess circulation 4. Determine disability; assess priority Prioritizing Patients Goal of initial assessment Determine whether patient has life threats or is stable Life threats Intervene in life-threatening problems & transport Stable Move on to focused history & physical examination Summary Initial assessment General impression Mental status ABCs Immediately intervene if life threats present Determine priority for treatment & transport 10