IVMS -ICM New Patient Assessment


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IVMS -ICM New Patient Assessment

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IVMS -ICM New Patient Assessment

  1. 1. The New Patient Assessment is...“F U N O” Website: http://ivmsicm.blogspot.com/ 1
  2. 2. The New Patient Assessment is...“F U N O” Marc Imhotep Cray, M.D. Companion Online Folder: IVMS-Physical Diagnosis Notes and Reference Resources
  3. 3. The New Patient Assessment is...• First Impression• Urgent Survey (ABCD)• Non-Urgent Survey• Ongoing Survey 3
  4. 4. Advanced AssessmentFurther develop assessment techniques Fully assess a situation, name and describe probable injuries or illnesses, and report treatment Obtain a relevant medical history from a responsive patient Properly prioritize treatment of multiple injuries and/or multiple patient situations 4
  5. 5. Think, Look, Listen, and Feel• Look – For deviations from normal (compare sides) – For swellings, lumps, bruises, and open wounds; deformities, abnormal angles and motion (or lack of motion); medic alert tags• Listen – To what patient says (avoid leading questions) – For abnormal sounds, especially respiratory• Feel – Pulses – Skin temperature and moisture – Body for lumps, indentations, abnormal soft or hard areas, and tender areas 5
  6. 6. Vital and Diagnostic Signs• Pulse - rate, rhythm, strength• Respiration - rate, depth, quality, sounds• Blood pressure – Slope vs. aid room – Radial vs. carotid pulse• Temperature – Skin – Body core• Capillary refill• Facial expression, skin color, moisture, turgor 6
  7. 7. Level of Responsiveness – AVPU• Alert• Responsive to verbal stimuli• Responsive to pain• Unresponsive= Level of consciousness (LOC) 7
  8. 8. First Impression and Primary Survey Decision Tree First Impression, Probable Mechanism of Injury, Need for Extrication? Danger to Patient Remove Danger Yes or Rescuers?Remove from Level of Responsiveness,Danger “Are You Okay?” Responsive Unresponsive Responsive Patient Unresponsive Patient Decision Tree Decision Tree 8
  9. 9. Responsive Patient Decision Tree 1st Impression; MOI Help Refusal Introduce Self, Offer HelpFollow Local Refusal of Help Protocol Assess Major Problems Sites(s) Indicated Rapid Survey SAMPLE Injured or Ill? No Abnormal ABC? Yes Lifesaving Intervention Treat Major or Chief Problems Call for Transportation, Any Special Equipment Transport Monitor 9
  10. 10. Unresponsive Patient Decision Tree First Impression, Unresponsive Mechanism of Injury Call for Help, Transportation, Any Special Equipment; Notify EMS Open Airway, Guard Cervical Spine No Breathing?Rescue Breathing, Remove Any Airway Obstruction Yes Carotid Pulse? No Begin CPR Yes Yes Successful? Observable Severe Control Bleeding Yes Bleeding? No No Continue CPR Abnormal Breathing and/or Pulse? Yes Transport Decision No Assess Head; Monitor LOR,* Assess: Neck, Chest, Abdomen, Stabilize Body Temperature Responses of Extremities to Pain Pelvis, Extremities Transport Decision Treat Urgent Problems *Level of Responsiveness Secondary Survey 10
  11. 11. Threats to Life Head injury, especially with altered LOC > 5 minutes or open skull fracture Unresponsiveness, shock Femur, pelvis, or two or more long bone fractures Chest injury or illness with respiratory distress Cervical spine injury, especially with paralysis, loss of sensation, or respiratory distress Limb amputation Crushing injury to abdomen or pelvis Heart attack, especially with cardiac arrest Stroke Anaphylactic shock Internal bleeding 11
  12. 12. Threats to Limb Major eye injuries Injury to extremity blood supply or nerves Crushing injury to extremity Hip, knee, or ankle dislocation Fractures or fracture-dislocations near elbow or knee Open fractures Back injury, especially with weakness, paralysis, or loss of sensation 12
  13. 13. Patient History Events from patient and bystanders Mechanism of injury Chief complaint SAMPLE – Signs and symptoms – Allergies - drugs, foods, insect bites – Medicine and drugs – Previous injury and medical history – Last meal – Events leading to injury and “anything else” 13
  14. 14. Head and Neck  LOC; Expression  Wounds, indentations, deformities,MeningesCerebrum lumpsCerebral cortexCorpus callosumThalamus  Ears and nose - blood, CSFHypothalamusOptic tractNasal Cerebellum  Mastoid process - Battle’s sign  Eyes - PERL, raccoon eyesPituitarygland PonsZygomatic Medulla oblongata Atlas  Mouth - dentures, foreign objects, blood AxisMandible 3rd Cervical vertebrae  Cervical spine  Deviation of trachea  Stoma  Medic alert tag SKULL, LEFT SIDE 14
  15. 15. Chest, Abdomen, and Pelvis Wounds, indentations, deformities, lumps Unusual breathing or noises Equal chest expansion Distension, tenderness, swelling, rigidity, masses Quadrants - especially upper - liver and spleen Crepitus, range of motion 15
  16. 16. Extremities Skul l Cr aniu m  Wounds, shortening, Face Cer vic al ver t ebr ae Shoulder gir dle M andib le deformities, unusual positions, tenderness Clavicle Scapula Thorax U pper l i m b St er num Rib  Circulatory function - pulses Hum er us Spi nal col um n and capillary refill Disk Radius Ver t ebr a Pel vi s I lium Sacr um Ulna  Nervous function - motor PubisHand Coccyx I schiu mCarpalsM et acar palsPhalanges Low er l i m b Fem ur and sensory Pat ella  Medic alert bracelets Fibula Tibia Foot Tar sals M et at ar sals Phalanges Calc aneus S K E LE TON , A N TE R IO R V IE W 16
  17. 17. Back Cra n iu m Sp le n iu s c a p its L e v a to rs c a p u la e Ma n d ib le  Wounds, deformities, C la v ic le Sc a p u la Rh o mb o id e u s min o r Hu me ru s Rh o mb o id e u s ma jo r In fra s p in a tu s Te re s ma jo r Sa c ro s p in a lis Se ra tu s a n te rio rBra c h io ra d ia lis &Ex te n s o rc a rp ira d ia lis lo n g u sAn c o n a e u s Tric e p s b ra c h i Ob liq u u s E x te rn u s a b d o min is unusual positionsPa lma ris lo n g u s  Lumps and tenderness,Fle x o rd ig ito ru m s u b limis Glu ta e u s me d iu s P e lv isFle x o rc a rp iu ln a risEx te n s o rd ig ito ru mc o mmu n is & Sa c ru m Uln aDig itq u in tip ro p riu s Co c c y x Ra d iu s Fe mu r Se mite n d in o s u s especially spine Ad d u c to r ma g n u s Va s tu s la te ra lis Bic e p s fe mo ris Gra c ils F ib u la T ib ia Pe ro n a e u s lo n g u s So le u s MU S C LE S , D E E P LA Y E R , P OS TE R IOR V IE W 17
  18. 18. History TakingDocument:Vital signsAbnormal findingsImportant normal findingsAt regular intervals 18
  19. 19. Assessment and Complications• Assessment – Determine mechanism of injury! – Monitor and record vitals! – Ask specific pain questions!• Signs and complications – Anticipate vomiting - keep airway open! – Watch for and treat shock! – Be aware of peritonitis and position! 19
  20. 20. “OPQRST” Pain Questions• Onset - when start, sudden or gradual• Provoke - position, movement, local or general• Quality - sharp, dull• Radiating - if so, from where to where• Severity - mild-moderate-severe or scale of 1-10• Time - how long, continuous or intermittent, worse or better 20
  21. 21. Multiple Injuries and Patients• Polytrauma - “life over limb”• Emphasize ABCDE• Immobilize whole body vs. multiple splints• Critical transport decision 21
  22. 22. Pediatric Concerns Provide special emotional handling  Expect frightened, modest, or shy behavior  Move slowly, explain, use simple terms, maintain eye contact  Be kind and soft-spoken  Be honest about pain and procedures  Use help from parent or sibling Remember trauma most common cause of death Keep in mind small children and hypothermia risk Size basic life support to size of patient 22
  23. 23. Probable Occurrence of Death Mechanism of injury or preceding illness Early  Injuries incompatible with life  No pulse, respiration, heartbeat, response to pain over several minutes  Widely dilated, unresponsive pupils, rapid glazing  Pale, cool skin, blue lips and nails  Relaxed body sphincters, wastes Late  Rigor mortis  Livor mortis - lividity  Odor of decay “Cold and dead” vs. “warm and dead” 23