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Teaching the IPPSS - Secondary

A presentation for use in teaching the International Paramedic Secondary Survey. For more information about this please visit www.paramedicine.com

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Teaching the IPPSS - Secondary

  1. 1. The International Paramedic Secondary Survey Teaching Workshop Marc Colbeck
  2. 2. © Marc Colbeck and Paramedicine.com, used by permission of the author. See: https://creativecommons.org/licenses/by-nc-sa/4.0/ Maintaining this note in the file is sufficient attribution of authorship as per the author.
  3. 3. Let’s learn 1. Get into partners and we’ll go through each step of the survey 2. At each step we’ll give you examples of what you can say during a scenario to demonstrate that you are performing that step properly 3. We’ll also have some activities to help reinforce the material.
  4. 4. The remainder of the call after the primary … The secondary survey is based on the sentence “I see I had vitals assessed and treated” It’s meant to organise the rest of a call, after the primary survey has been completed. I C I H A D V A T http://www.antony.loveless.dsl.pipex.com/106.jpg April 2008. Follow along with the letters in the side bar
  5. 5. Make sure you know the sentence “I see I had vitals assessed and treated” (Which we write as ICI HAD VAT) Say it a few times to yourself, and then say it to your partner. I C I H A D V A T The secondary survey…
  6. 6. Identify Get the patient’s: • Name • Age • Date of Birth • Address • Health Care # I C I H A D V A T https://dynamicmedia.zuza.com/zz/m/original_/6/c/6c21cdcd-ea63-4143-aebc- 6fdbe4999818/647438b446b1988abb2e1e9dfcb7_Gallery.jpeg February 2018
  7. 7. To the Scenario Director • “I’ll get the patient’s information” What should I say? To the Patient • “What’s your name, can you tell me your date of birth and address?” • Do you have your health card with you”? (ask only what is appropriate at this point) Identify I C I H A D V A T
  8. 8. • Speak with your partner, each of you list the four items that we use to identify a patient. Identify I C I H A D V A T
  9. 9. Chief Complaint (or Condition) • Start with an open question such as ‘what’s wrong’? • Give them a full minute (at least) to answer. • Then ask more focused questions • Prioritise the ‘critical signs’ (brain, heart, lungs) • Ask ‘anything else’? (head, neck, chest, belly, back, arms, or legs?) https://www.rentalcluster.com/blog/wp-content/uploads/2013/03/How-to-handle-tenant-complaints.jpg February 2018 I C I H A D V A T
  10. 10. To the Scenario Director • “I’m going to check the chief complaint or condition” What should I say? To the Patient • “What seems to be the problem today?” [or] • “How can we help you today?” [or] • “Can you tell me why you called us today?” • “So, the main problem today seems to be …” • “I want to ask you a few important questions before we look into that in detail just to make sure I’m not missing anything really important. Is that ok? Are you feeling dizzy or lightheaded at all? Any confusion or fogginess? Are you having trouble breathing or catching or breath?” • “So, other than the … (main problem) are you having any other pain or discomfort in your head, your neck, your chest, your belly or back, or your arms or your legs”? Chief Complaint/Condition I C I H A D V A T
  11. 11. • Have students practice obtaining the chief complaint or condition from their partner (partners … just make one up!) • Be sure to include all the elements, in order. Chief Complaint/Condition I C I H A D V A T
  12. 12. Incident History • N: When did the patient last feel ‘Normal’ (for them)? • O: Describe the Onset of this situation (time and rate of onset, activity at onset, possible causes) • P: Which actions are now Provocative or Palliative? • Q: What is the Quality of the pain or sensation the patient is feeling? • R: Is there any Radiation of discomfort? If so, where, and under which conditions? • S: What is the Severity of the complaint? (using 0-10, or mild/mod/severe, or visual analogue scale prn) • T: Is this Typical for the patient? <AND> was there any precipitating Trauma? • U: Undigested food? When did the patient last eat or drink? What did they eat or drink? http://funnypicture.org/wallpaper/2015/03/funny-fails-and-falls-21-background.jpg February 2018 I C I H A D V A T What could possibly go wrong?
  13. 13. To the Scenario Director • “I’m going to take an incident history” What should I say? To the Patient • “Can you tell me when you last felt normal?” • “So, when did it actually start? What were you doing? Did it come on quickly or slowly?” • “Does anything make it feel better, or worse?” • “Can you tell me a bit what it feels like? If you had to explain how it feels, how would you describe it?” • “Does the pain go anywhere, or does it just stay in that one spot?” • “On a scale of 0-10 with 0 being no pain at all, and 10 being the worst pain you’ve ever experience, how would you rate this pain?” • “Have you experienced this before? Is this episode typical for you? How is it different?” “Have you hit it or hurt it anyhow?” • “When was the last time you ate or drank anything? What did you have? Have you thrown up at all since then?” Incident History I C I H A D V A T
  14. 14. • Origami exercise* • Explain to each other • Explain backwards • Have the students practice the Incident History • Have them perform the “I see I” assessment Incident History I C I H A D V A T *Origami exercise: Take a piece of paper and fold it in half, then fold it in half again. You should have a small booklet. Altogether there are now 8 panels to that piece of paper. Write out what you are trying to remember on one panel from memory. Check if you’re correct. Repeat 7 more times. If you don’t have it down pat by the last panel, get another piece of paper and do another 8 repetitions.
  15. 15. History Includes the Medical, Family and Social history • Wide → Narrow (General question about any problems → specific ‘review of system’) • Remember: • There’s you • There’s your family • There’s your life https://images.huffingtonpost.com/2015-02-23-medicalhistoryform-thumb.jpg February 2018 I C I H A D V A T
  16. 16. Medical History (you) • Any existing medical conditions? (Cardiac, Respiratory, Neuro, etc. Any disabilities?) • Ask “Anything else”? – be sure to exhaust all aspects of the patient’s medical history • Who is their regular medical provider? Alternative health-care providers? I C I H A D V A T
  17. 17. To the Scenario Director • “I’m going to take their history” What should I say? To the Patient • “Do you have any other medical problems? Problems with your heart, lungs, brain, liver, kidneys … anything like that?” • “Other than your (list the medical conditions they told you), do you have any other medical conditions?” • “Who do you see to help you with that? Who’s your doctor or care-giver?” Medical History (you) I C I H A D V A T
  18. 18. • Ask your partner their medical history • Partners, feel free to make up any story you want • If the patient mentions any of their medical history, what else must you always ask? Medical History (you) I C I H A D V A T
  19. 19. Family History (your family) Remember the order like this: 1. Are you a part of your family? (genetically speaking) 2. Is anyone in the family sick? 3. Is anyone in the family dead? 4. Is there anything else? I C I H A D V A T
  20. 20. What should I say? To the Patient • “Were you adopted?” • “Do you know of any diseases that run in your family? Are your relatives all healthy? • “Are both your parents still alive? How’s their health?” • “Is there anything else you think I should know?” Family History (your family) I C I H A D V A T
  21. 21. • Ask your partner their family history (all nine chapters – in order) • Partners, feel free to make up any story you want Family History (your family) I C I H A D V A T
  22. 22. Social History (An autobiography in 9 chapters) I C I H A D V A T First we’re born Then we get an education Then we get a job Then we start dating Then we get married Then we have kids Then we take drugs (cigarettes, alcohol, coffee) Then we retire and take a holiday Then we get sick and go into the hospital
  23. 23. What should I say? To the Patient • “What sex where you assigned at birth?” • “High school? TAFE? University?” • “What did-you/do-you do for a living?” • “What is your general household income?” • “Can you tell me a bit about your sexual history, how many partners have you had? Do you use protection?” • “Are you married?” • “Do you drink alcohol or smoke? How much?” • “How much coffee do you drink a day?” • “Do you use any drugs, like marijuana or anything else? How often?” • “Have you travelled out of the country in the last year? Where to?” • “What hospitals have you been in before? What was that for?” • “Is there anything else you think I should know?” Social History I C I H A D V A T
  24. 24. • Origami exercise – the full social history • Explain the social history to your partner • Ask your partner their social history (all nine chapters – in order!) as if they were a patient • Partners, feel free to make up any story you want • Can you do it backwards??  (get to the point where you can) Social History I C I H A D V A T
  25. 25. Allergies • Environmental? • Chemical? • Food? • Drugs? http://cims.hispanictips.com/uploads/2008/04/allergies.jpg October 2008. I C I H A D V A T Remember it this way: 1. You walk across a lawn with bare feet (environmental) 2. You pick up a plastic cooler-box (chemical) 3. You take out a peanut (food) 4. You take out a pill (drugs)
  26. 26. To the Scenario Director • “I’ll ask about allergies” What should I say? To the Patient • “Do you have any allergies to the environment, like grass or animals?” • “Are you allergic to any chemicals?” • “Are you allergic to any food?” • “Are you allergic to any drugs or medications”? • “Are you allergic to anything else?” Allergies I C I H A D V A T
  27. 27. • What are the four different types of allergies? Explain to your partner. • Ask your partner about the four different types of allergies (as if they were a patient) • If the patient says yes to any of them, what else should we always ask? Allergies I C I H A D V A T
  28. 28. Drugs • Alternative/Complimentary “Remedies”? • Over the counter • Prescription (and compliance) • Illicit drugs • Anything else http://projects.exeter.ac.uk/davidrichards/images/drugs.png February 2018 I C I H A D V A T
  29. 29. To the Scenario Director • “I’ll ask about drugs” What should I say? To the Patient • “Are you taking any remedies, vitamins or supplements?” • “Do you take any over-the-counter medications, like aspirin or Panadol? How much? How often?” • “What medications, if any, have you been prescribed by a doctor? Are you taking those regularly? Have you taken them today?” • “Do you take any street drugs at all? Which ones? How often?” • “Is there anything else you think I should know?” Drugs I C I H A D V A T
  30. 30. • Explain to your partner the four different types of drugs we inquire about • Ask your partner about the four different types of ‘drugs’ we inquire about (as if they were a patient) • If the patient says ‘yes’ to any of them, what else should we always ask? Drugs I C I H A D V A T
  31. 31. Vital Signs https://www.hopkinsmedicalproducts.com/images/l/Pediatric-Vital-Signs-Kit-Pulse-Ox.jpg February 2018 I C I H A D V A T 3 on the head above the eyes 3 on the head below the eyes 3 on the chest/upper arm 3 on the wrist/fingers 1. Responsiveness (top of head) 2. Pain (fingers over forehead) 3. Skin (back of hand to forehead) 4. Pupil shape, size, response and accommodation 5. End tidal CO2 (from the nose) 6. Temperature (in the ear) 7. RR, depth, pattern, effort 8. ECG 9. BP 10.Pulse rate, rhythm, volume 11.Blood sugar 12.SpO2
  32. 32. To the Scenario Director • “I’ll ask my partner to take a full set of vitals” What should I say? To the Patient • “While I’m talking to you and asking questions, my partner is going to be doing a physical exam on you as well. Is that ok with you?” Vital Signs I C I H A D V A T
  33. 33. • Each student explains the 12 vital signs to the other – use the physical gestures to help remember them (it really works!) • Explain to partner • Explain it backwards Vital Signs *Origami exercise: Take a piece of paper and fold it in half, then fold it in half again. You should have a small booklet. Altogether there are now 8 panels to that piece of paper. Write out what you are trying to remember on one panel from memory. Check if you’re correct. Repeat 7 more times. If you don’t have it down pat by the last panel, get another piece of paper and do another 8 repetitions. I C I H A D V A T
  34. 34. Assessment The physical exam will be taught you to in the various units you take in your paramedic degree. For now, just follow a general head-to- toe format. Later you’ll learn to assess a patient by their anatomical systems. http://media.nj.com/gloucestercounty_impact/photo/9687523-large.jpg February 2018 I C I H A D V A T
  35. 35. To the Scenario Director • “I’ll ask my partner to perform a focused physical assessment” • “Physical exam revealed ________” (list important findings and pertinent negatives) What should I say? To the Patient Assessment I C I H A D V A T
  36. 36. Treatment 1. What treatment have they done? 2. What effect did that have? 3. What treatment have you done? 4. What effect did that have? 5. What further treatment do they need? http://www.abc.net.au/news/image/7288144-3x2-700x467.jpg February 2018 I C I H A D V A T
  37. 37. To the Scenario Director • “My treatment plan is going to be _____” What should I say? To the Patient • “Before we arrived did you take or do anything to try and help yourself feel better?” • “Here’s what we’d like to do to help you …” • Explain the procedure(s), risks, and benefits • Be sure to obtain consent Treatment I C I H A D V A T
  38. 38. Handover The ICI HAD VAT format can also be used to structure your handover report to another health care professional. I C I H A D V A T
  39. 39. Handover – medical scenario Narrative I This is Jane Everstone, she’s a 23-year-old female C found atraumatic, tripoding at home in her kitchen with moderate shortness of breath. I Apparently, she normally takes Ventolin prn about 2-3 times a month, but she ran out about a week ago and started developing shortness of breath at home today while baking. H Other than mild asthma she has no other past medical history. She’s been hospitalized twice with acute asthma over the past 8 years but never intubated and never admitted. A She reports no allergies. D Other than Ventolin she takes no other meds. She’s a social smoker. V She was tachypneic, tachycardic and anxious on our arrival, ECG sinus tach at 110. A On exam, she had accessory muscles use, global end-expiratory wheezes, pink skin, 4-5 word dyspnea, sitting in tripod position, room air sat of 91%, end-tidal CO2 of 50 with a bronchospastic waveform, i/e ratio of about 1 to 3, JVD to the angle of the jaw while high fowlers, no abnormal respiratory pattern, no signs of a tension pneumo. T She had no treatment prior to arrival, we’ve given 10 of Ventolin and 500 Atrovent with oxygen. We’ve got a 20G in her right AC TKO. Her wheezes have resolved to very subtle end-expiratory, sats are 98%, CO2 is now 38 with a normal waveform and she says she’s breathing easily now. Does anyone have any questions for us?
  40. 40. Handover – trauma scenario Narrative I This is Brian Fraser, he’s a 42-year-old male found resting on a chair at a construction site where he’s a tradey, with the site first-aider. C He has a fairly deep and ragged laceration on his right lateral calf from some exposed sharp metal at the work site. I Apparently, he stumbled on uneven ground into this exposed metal. Didn’t fall, didn’t hit his head, it’s isolated trauma. H He’s got no past medical history. A No allergies. D He takes no medications. He’s a pack-a-day smoker. V Vitals are all fine, A on exam he’s got this 4-5 cm horizontal gash on right calf, he says the metal went fairly deep. T We’ve got it bandaged and it’s holding – it was initially a well-controlled venous bleed. We gave him some methoxy for pain which helped. It looks like a pretty dirty cut though and he’s not sure of his last tetanus shot. Does anyone have any questions for us?
  41. 41. Handover – cardiac arrest scenario Narrative I This Alison Motluk, 56-year-old female C found vital signs absent on her kitchen floor, CPR was in progress by the family. I Apparently, she was complaining of difficulty breathing then passed out from a seated position. Family called 000 and was coached to CPR, which was probably started within a minute or two of collapse. H No relevant past medical history, allergies or drugs. A (above) D (above) V (obviously none when discovered) A We found her, airway clear, easy to ventilate, good compressions in progress, she accepted an OPA and NPAs. T Monitor showed VF which we defibrillated twice. Second defib she went into asystole for about 2 minutes which coarsened up to VT, which we shocked and she came into a perfusing idioventricular at about 20 with no radials but a definite weak carotid. We continued compressions due to low output and she picked up to a sinus brad at about 50, which she’s maintaining with a systolic of about 86. We’re assisting her shallow ventilations with a BVM. She’s spontaneous at about 10 a minute, sats are 98% with 100% oxygen by BVM. Physical exam was unremarkable, no signs of trauma. Her son rode with us and he’s in the waiting room. He’s the one who did CPR and he’s pretty shook up, we talked to him and told him he did great but you might want to tell him that too. The rest of the family is following and should be here soon. Does anyone have any questions for us?
  42. 42. 1. Are there any questions? 2. Each partner – explain the full mnemonic to the other 3. Each partner – perform the full secondary assessment 4. Each partner – perform the full primary and secondary assessment. Final Activity I C I H A D V A T
  43. 43. The International Paramedic Secondary Survey I C I H A D V A T
  44. 44. About this presentation 1. This work is shared under a Attribution-NonCommercial-ShareALike 4.0 International (CC BY-NC-SA 4.0) Creative Commons License. 2. See: https://creativecommons.org/licenses/by-nc-sa/4.0/ 3. This work is authored by Marc Colbeck, based on the following work: Colbeck, M. A., Maria, S., Eaton, G., Campbell, C. B., Batt, A. M., & Caffey, M. R. (2018). International Examination and Synthesis of the Primary and Secondary Surveys in Paramedicine. Irish Journal of Paramedicine, 3(2), 1–9. https://doi.org/10.32378/ijp.v3i2.91 4. Maintaining and showing the second and last slide (in their entirety) in the presentation, is considered a sufficient statement of authorship under the License. You may add the presenters name to the first slide of the presentation. 5. Please visit www.paramedicine.com for more information. 6. You are not obligated to, but we would appreciate hearing about where this work was used in order to give us an idea of where it is spreading to. Feedback is greatly appreciated!

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