11)Initial Assessment
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11)Initial Assessment

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11)Initial Assessment 11)Initial Assessment Presentation Transcript

  • Initial Assessment
  • Initial Assessment
    • Rapid means of assessing:
      • Pt condition
      • Life threats
      • Priority of care
        • “ Stay & Play”
        • “ Load a& Go”
    • Quickly evaluate the 3 major organ systems
      • Respiratory
      • Circulatory
      • Nervous
    • Identify and treat most life threatening conditions and transport.
    • AVPU
    • ABC
  • General Impression
    • Helps form a general sense of severity of pt
      • Based on immediate assessment of scene and C/C
        • Cardiac arrest
        • Medical or Trauma
        • MOI/NOI
        • Age, Sex, Race
    • If life threatening condition is found treat immediately
      • Unresponsive
      • Inadequate breathing
      • Inadequate perfusion
      • Severe bleeding
  • Life Saving Treatments
    • Airway management
    • + pressure ventilation
    • Supplemental O2
    • Bleeding control
    • CPR
    • Defibrillation
    • Medical direction
    • ALS intercept
    • Rapid transport
  • Assessment of Mental Status
    • Mental status is most sensitive indicator of CNS activity
      • Level of consciousness (LOC) = CNS function
    • AVPU
      • A -Alert
        • Pt alert to Person/Place/Time
          • Alert and Oriented X 3---- AOX3
        • Pt alert to Person/Place/Time/Event
          • Alert and Oriented X 4---- AOX4
      • V -Verbal
        • Pt responds to verbal stimuli
      • P -Painful
        • Pt unresponsive to verbal but responds to pain
        • Sternal run, pinch nail beds, etc
      • U -Unresponsive
        • Pt unresponsive to both verbal and painful stimuli
    • C-Spine control if trauma suspected/unresponsive
      • Log Roll to supine if not
  • Sternal Rub
  • Log Rolling
    • Log rolls
    • Movement of a supine/prone pt
      • EMT 1: Maintain C-spine
      • EMT 2 & 3: Position kneeling at pt side
      • EMT 2: Raise pt nearest arm over pt head
      • EMT 2: Place 1 hand on pt shoulder the other on pt hip
      • EMT 3: Place 1 hand on pt waist and the other at knees
      • EMT 2 & 3: On count of 3 from EMT 1, roll pt onto side
      • Place pt on backboard, transport
  • Measuring C-Collars
    • All pts who have sustained significant trauma
    • Est early manual stabilization of C-Spine and maintain it until pt immobilized to LBB.
    • How to measure a c-collar
      • Bring pt head gently into neutral position
      • Measure distance between bottom of the pt chin and the top of the pt shoulders with a hand
      • Compare measurement with indicator lines on c-collar
      • Side c-collar behind pt neck moving it as little as possible
      • Hold the front of the collar while bringing the back around the neck and velcro in place
      • Make sure pt can still swallow and breathe
  • Manual Stabilization by 1 rescuer
  • Measuring C-Spine
  • Sizing C-Collar
  • Securing C-Collar
  • Maintaining C-Spine Control
  • Airway
    • Responsive Patient
      • Is the pt talking/crying
        • Yes = Assess adequacy
        • No = Open airway
    • Unresponsive Patient
      • Is the airway open?
        • Open it
        • Assess if clear
        • If not clear it
          • Medical Pt
            • Head tilt chin lift
          • Trauma Pt
            • Jaw thrust
  • Breathing
    • Look – Listen – Feel
    • If pt breathing and responsive
      • Oxygen may be dictated by MOI/NOI
    • Breathing more than 24 bpm or less than 8 bpm
      • Receive high flow oxygen/BVM
    • If unresponsive and breathing:
      • Maintain airway and provide high flow oxygen
    • If breathing is inadequate:
      • Open and maintain airway, assist in ventilation, use adjuncts.
    • If pt is not breathing:
      • Open and maintain airway with adjuncts, assume ventilatory support
  • Circulation
    • Assess the pt pulse
      • Unresponsive
        • Carotid
      • Responsive
        • Radial
      • 1 y/o or younger
        • Brachial
      • Absent pulseless
        • CPR & AED
    • Assess for major bleeding
      • If found, Treat it:
        • Direct Pressure
        • Elevation
        • Pressure Points
        • Tourniquet
  • Skin
    • Clues to perfusion and oxygenation
    • Components
      • Color
      • Temp
      • Moisture
      • Capillary Refill
  • Skin Color
    • Locations of assessment
      • Nail beds, oral mucosa, conjunctiva
      • Pediatric
        • Palms of hand/Sole of feet
      • Normal = Pink
      • Abnormal
        • Pale
          • Poor Perfusion
        • Cyanotic
          • Blue/grey= Poor oxygenation/perfusion
        • Flushed
          • Heat or CO exposure
        • Jaundiced
          • Liver/Gallbladder problems
  • Temperature
    • Place back of gloved hand on pt skin
    • Normal = Warm
    • Abnormal
      • Hot
        • Fever/Heat exposure
      • Cool
        • Poor perfusion/Cold exposure
      • Cold
        • Extreme cold exposure
        • Excessively dead…
    • Also check for moisture
      • Diaphoresis or extremely dry
  • Capillary Refill
    • Evaluation
      • Press on pt nail bed until it is blanched/white
      • Release and count time until pink returns
    • Normal
      • 2 seconds or less
    • Abnormal
      • More than 2 seconds
  • Identify Priority Patients
    • Consider transport decision
      • Load and Go
      • Stay and Play
    • Priority Patients
      • Poor General Impression
      • Unresponsive (No gag)
      • AMS
      • SOB
      • Shock
      • Complicated childbirth
      • Chest pain with systolic pressure less than 100mmHg
      • Uncontrollable bleeding
      • Severe pain
    • Provide lifesaving treatment throughout initial assessment as needed
    • Transport unstable pt and pt with conditions needing immediate hospital treatment
  • Remember… It all starts with your ABC’S!!!