Lecture Two: Patient Assessment Definitions


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In this presentation students will have the opportunity to learn all definitions and acronyms related to patient assessment. We have links to YouTube videos to further demonstrate various assessments.

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Lecture Two: Patient Assessment Definitions

  1. 1. Patient Assessment Definitions Patient Assessment Definitions  for Pharmacistsfor Pharmacistsfor Pharmacistsfor Pharmacists Anas Bahnassi PhD
  2. 2. Anas Bahnassi PhD CDM CDE 2
  3. 3. Basic Definitions:Basic Definitions: Scene Size‐up :p Steps taken by first aid providers  hen approaching the emergencwhen approaching the emergency  scene. Determinee scene safety Take BSI precautions, noting the  mechanism of injury or patient’s  nature of illness Determine the number of patients,  and deciding what, if any additional  resources are needed including  BSI stands for body substance  isolation. It means the gloves,  gowns, masks an other objects weg Advanced Life Support. gowns, masks an other objects we  use to protect ourselves from our  patients blood, vomit, feces, saliva  and other substances 3Anas Bahnassi PhD CDM CDE
  4. 4. Basic Definitions:Basic Definitions: Initial Assessment: The process used to identify and treat life‐p y threatening problems, concentrating on  Level of Consciousness, Cervical Spinal  Stabilization Airway Breathing andStabilization, Airway, Breathing, and  Circulation.  You will also be forming a General  Impression of the patient to determineImpression of the patient to determine  the priority of care based on your  immediate assessment and determining if  h i i di l ithe patient is a medical or trauma patient.  The components of the initial assessment  may be altered based on the patient  Anas Bahnassi PhD CDM CDE 4 presentation.
  5. 5. Basic Definitions:Basic Definitions: Golden Hour May be defined as the period during which all efforts are made to  save a life before irreversible pathological changes can occur p g g thereby reducing or preventing death in the second and third phase. The first platinum 10 minutes becomes  important to make this golden hour  effective and should be distributed aseffective and should be distributed as  follows to make it fruitful: Assessment of the victim and primary survey 1 minAssessment of the victim and primary survey 1 min Resuscitation and stabilization 5 min Immobilization and transport to nearby hospital 4 min Anas Bahnassi PhD CDM CDE 5
  6. 6. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam: In this step you will:p y Reconsider the mechanism of injury Determine if the  Rapid Trauma Assessment or  a Focused Assessment is neededa Focused Assessment is needed Assess the patient’s chief complaint Assess medical patients complaints and signs  and symptomsand symptoms  Obtain a baseline set of vital signs, and  perform a SAMPLE history.  Th t f thi t b lt dThe components of this step may be altered  based on the patient’s presentation. Anas Bahnassi PhD CDM CDE 6
  7. 7. Basic Definitions:Basic Definitions: Anas Bahnassi PhD CDM CDE 7
  8. 8. Anas Bahnassi PhD CDM CDE 8
  9. 9. OPQRST HISTORYOPQRST HISTORY • Branch of SAMPLE History • Focuses on Signs and SymptomsFocuses on Signs and Symptoms  • Gives a clearer picture of patient’s  li i l d i iclinical case and its severity  9Anas Bahnassi PhD CDM CDE
  10. 10. OPQRST Historiy Onset O O t• O = Onset • When the complaint first  startedstarted. • The patient’s activities at the  time of onset/immediatelytime of onset/immediately  before • “What were you doing when this  started” • Chest pain patient – mowing lawn • Anaphylaxis patient – stung by beep y p g y • Diabetic patient – Working in hot day  without food 10Anas Bahnassi PhD CDM CDE
  11. 11. OPQRST History Provocation • P = Provocation  • What actions make the  symptoms better/worse • “Is there anything thatIs there anything that  makes it better? Anything  that makes it worse?” • Chest pains – Worse with  activity Better with rest • SOB – Better when sitting• SOB – Better when sitting  Worse when lying flat • Etc… 11Anas Bahnassi PhD CDM CDE
  12. 12. OPQRST History Crushing Quality • Q = QualityQ   Quality  • Subjective  description ofdescription of  complaint in pt  own words Stabbing own words • “Would you please  describe the paindescribe the pain.  What does it feel  like” Burning • Chest pains – Crushing, vice‐like,  elephantelephant 12Anas Bahnassi PhD CDM CDE
  13. 13. OPQRST History Radiation • Is the pain local or does it  travel to another part of the  bodybody • “Is the pain in one place or  does it spread to other partsdoes it spread to other parts  of your body?” • Chest pains  • L shoulder, arm, jaw,  neck ,back 13Anas Bahnassi PhD CDM CDE
  14. 14. OPQRST History Severity • Severity• Severity • 1‐10 scale gauging pain • “On a scale of 1‐10, 1 , being the least pain  you’ve felt and 10 being  the worst pain you’ve  ever felt can you rate the  pain?” 14Anas Bahnassi PhD CDM CDE
  15. 15. OPQRST Hx Time • T = Time • Duration of the clinical case and associated  complaints • “How long has this been going on?”How long has this been going on?   • Chest pains – Woke pt from sleep that night • Allergic rxn‐ 15‐20 min 15Anas Bahnassi PhD CDM CDE
  16. 16. Basic Definitions:Basic Definitions: Rapid Trauma Assessment: This is performed on patients with  significant mechanism of injury to  determine potential life threateningdetermine potential life threatening  injuries.  In the conscious patient, symptoms should  b ht b f d d i th R idbe sought before and during the Rapid  Trauma assessment.  You will estimate the severity of the  injuries, re‐consider your transport  decision, reconsider Advanced Life  Support, consider the platinum 10 minutes  and the Golden Hour, rapidly assess the  patient from head to toe.  Obtain a baseline set of vital signs, and Anas Bahnassi PhD CDM CDE 16 Obtain a baseline set of vital signs, and  perform a SAMPLE history.
  17. 17. Rapid Trauma AssessmentRapid Trauma Assessment http://www.youtube.com/watch?v=nmgYYCxOrJo Anas Bahnassi PhD CDM CDE 17
  18. 18. Basic Definitions:Basic Definitions: Rapid Medical Assessment: This is performed on medical patientsThis is performed on medical patients  who are unconscious, confused, or unable  to adequately relate their chief complaint.  This assessment is used toThis assessment is used to quickly identify existing or potentially life‐ threatening conditions. You will f h d idperform a head to toe rapid assessment.  obtain a baseline set of vital signs, and  perform a SAMPLE history. Anas Bahnassi PhD CDM CDE 18
  19. 19. Rapid Medical AssessmentRapid Medical Assessment http://www.youtube.com/watch?v=vvsQmxjPD_Y Anas Bahnassi PhD CDM CDE 19
  20. 20. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam:‐ Trauma  This is used for patients, with no significant  mechanism of injury, that have been  determined to have no life threateningdetermined to have no life‐threatening  injuries. This assessment would be used in  place of your Rapid Trauma Assessment. You h ld f th ti t’ hi fshould focus on the patient’s chief  complaint. An example of a patient requiring this assessment would be a patient who has  sustained a fractured arm with no other injuries and no life threatening  conditions. Anas Bahnassi PhD CDM CDE 20
  21. 21. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam:‐ Medical  This is used for patients with a medical  complaint who are conscious, and able to  adequately relate their chief complaint toadequately relate their chief complaint to  you, and have no life‐threatening conditions.  This assessment would be used in place of  R id M di l A t Y h ldyour Rapid Medical Assessment. You should  focus on the patient’s chief complaint using  OPQRST, obtain a baseline set of vital signs,  and perform a SAMPLE history. Anas Bahnassi PhD CDM CDE 21
  22. 22. Anas Bahnassi PhD CDM CDE 22
  23. 23. Basic Definitions:Basic Definitions: Detailed Physical Exam: y This is a more in‐depth assessment that builds on the Focused Physical  E am Man of o r patients ma not req ire a Detailed Ph sical E amExam. Many of your patients may not require a Detailed Physical Exam  because it is either irrelevant or there is not enough time to complete it. This assessment will only be performed while enroute to the hospital or if  there is time on‐scene while waiting for an ambulance to arrive. Patients who will have this assessment completed are  patients with significant mechanism of injurypatients with significant mechanism of injury,  unconscious, confused, or unable to adequately relate  their chief complaint. In the Detailed Physical Exam you  will perform a head to toe assessment to find isolatedwill perform a head to toe assessment to find isolated  and non‐life‐threatening problems that were not found  in the Rapid Assessment and also to further explore  h l d d i h R id Anas Bahnassi PhD CDM CDE 23 what you learned during the Rapid assessment.
  24. 24. Basic Definitions:Basic Definitions: Ongoing Assessment:g g This assessment is performed during transport on all patients. The Ongoing Assessment ill be repeated e er 15 min tes for the stableOngoing Assessment will be repeated every 15 minutes for the stable patient and every 5 minutes for the unstable patient. This assessment is used to answer the following questions: 1. Is the treatment improving the patient’s condition? 2 Are any known problems getting better or worse?2. Are any known problems getting better or worse? 3. What is the nature of any newly identified problems? Anas Bahnassi PhD CDM CDE 24
  25. 25. Acronyms used during patient  assessment: MOI – stands for mechanism of injury AVPU – used to classify the patient’s  mental status: • A = awake, alert, and orienteda a e, a e t, a d o e ted • V = alert to voice, but not oriented • P = alert to painful stimuli only • U = unresponsive to voice or painfulU = unresponsive to voice or painful  stimuli CUPS used as an additional tool toCUPS – used as an additional tool to  prioritize the patient for transport: • C = critical bl• U = unstable • P = potentially unstable • S = stable Anas Bahnassi PhD CDM CDE 25
  26. 26. Priority Illness/Injury severity Transport DecisionDecision Critical Patients either receiving CPR, in respiratory  arrest or requiring and receiving life‐ sustainingarrest, or requiring and receiving life sustaining  ventilatory /circulatory support C.U.PUnstable Poor general impression Scene Size‐up Unstable P Unresponsive with no gag or cough reflexes Responsive but unable to follow commands Initial Assessment Potentially  Unstable p Difficulty breathing Pale skin or other signs of poor perfusion (shock) Complicated childbirth Rapid Assessment And Transport Complicated childbirth Uncontrolled bleeding Severe pain in any area of the body Severe chest pain especially with aSevere chest pain, especially with a systolic BP of less than 100 mmHg I bilit t t f th b d Anas Bahnassi PhD CDM CDE 26 Inability to move any part of the body
  27. 27. Priority Illness/Injury severity Transport DecisionDecision Mi ill i i l t d i j S Stable Minor illness, minor isolated injury, uncomplicated extremity injuries, and/or any patient that cannot be categorized as Scene Size‐up Critical, Unstable, or Potentially unstable. Initial Assessment Focused  Assessment And Transport Anas Bahnassi PhD CDM CDE 27
  28. 28. Mechanisms of InjuryMechanisms of Injury Vehicle‐pedestrian: Collision Motorcycle  crash Death in the same passenger compartment: High‐speed vehicle  collision Medium speed vehicle collision  Roll‐over of vehicle (infants and children)  Falls greater than 20 feet (adults): Ejection from vehicle Falls greater than 10 feet (infants and children): Bicycle collisionFalls greater than 10 feet (infants and children): Bicycle collision Penetrations of the head, chest, or abdomen: (infants and children) Anas Bahnassi PhD CDM CDE 28
  29. 29. Patient Assessment Practice SheetPatient Assessment Practice Sheet Anas Bahnassi PhD CDM CDE 29
  30. 30. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 30
  31. 31. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 31
  32. 32. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 32
  33. 33. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 33
  34. 34. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 34
  35. 35. Patient Assessment Practice SheetPatient Assessment Practice Sheet Anas Bahnassi PhD CDM CDE 35
  36. 36. Clinical Pharmacy VI:Clinical Pharmacy VI:yy First AidFirst Aid Anas Bahnassi PhD CDM CDEAnas Bahnassi PhD CDM CDE abahnassi@gmail.com http://www.twitter.com/abpharmp p http://www facebook com/pharmaprofhttp://www.facebook.com/pharmaprof http://www linkedin com/in/abahnassihttp://www.linkedin.com/in/abahnassi