PowerPoint module from Action Training Systems

1. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

2. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

3. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
1. Initial stages of primary assessment
2. Airway Status
3. Breathing Status
4. Circulatory Status
5. Patient Priority
3

4. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

5. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Primary assessment will allow you to:
– Quickly identify the conditions that
represent an immediate threat to the
patient
– Take appropriate action
5

6. • Primary
assessment:
– Introduce yourself to
the patient
– Explain you are
there to help
6

7. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The steps of the primary assessment
are:
– Form a general impression
– Determine the chief complaint
– Assess mental status
– Assess the airway
– Assess breathing
– Assess circulation
– Determine priorities
7

8. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Observing the patient:
– Steps will typically
take less than sixty
seconds to perform
– You will form a general
impression of the
circumstances and
their condition
– This will help you
determine your
priorities for care and
transport
8

9. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• You will also:
– Determine the chief
complaint from patient
• In many cases the
patient will be able to:
– Answer all questions
about current problem
– Provide medical history
9

10. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If at any point you suspect
possible spinal injury:
– Follow your protocols
for providing
immediate manual
cervical stabilization
– Hold the patient’s head
in a neutral in-line
position
– Tell patient to remain
still
10

11. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Continue your
assessment:
– Immediately treat
any life threats
11

12. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Remember, the
steps and
interventions you
take will vary
based on whether
the patient is a:
– Medical patient
– Trauma patient
12

13. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If there are no
immediate life
threats to manage,
establish the
patient’s level of
consciousness by
talking to her and
asking questions
13

14. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Be aware that some
medical conditions
and injuries can:
– Alter a patient’s level
of consciousness
• In some cases you will
have to take specific
action to determine:
– The level of patient
responsiveness
14

15. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Specific actions to determine the
level of patient responsiveness, or
mental status (AVPU):
– Alert
– Verbal response
– Painful response
– Unresponsive
15

16. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Alert patient:
– Awake
– Acknowledges your
presence
• Determine if the patient
is oriented to person,
place and time; ask:
– What is your name?
– Can you tell me where
you are?
– Do you know what the
date is today?
16

17. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Use a verbal
stimulus to see if a
patient who
appears to be
unresponsive will
respond to you
17

18. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Painful stimulus
may be used:
– If verbal stimulus is
unsuccessful
– To see if a patient
who appears to be
unresponsive will
respond
18

19. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Trapezius squeeze:
– Only use if there is NO
risk of a spinal injury
– Stimulates the central
nervous system
– Patient response can
indicate higher brain
function present
19

20. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• To apply the trapezius
squeeze:
– Pinch the muscle—not
just the skin—near the
base of the neck
– Squeeze and twist, but
not enough to bruise
– Pain stimuli should not
cause injury
– Response indicates
that the brain is
responding, not just
the spinal cord
20

21. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Never perform this
maneuver if there is
any risk of spinal
injury because it
can cause the
patient to move her
neck
21

22. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If there is a risk of
spinal injury, apply:
– Interdigital pressure
• Pinch the webbing
between the thumb
and index finger
22

23. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Look for the patient to
purposefully withdraw
from the pain
• With some injuries, this
may only stimulate:
– The peripheral nervous
system
– Not the brain
• If spinal injury is
suspected use the
trapezius squeeze
23

24. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Unresponsive patient
does not respond to
either stimulus:
– Voice
– Pain
• Bystanders may be able
to provide information
on the patient’s history
24

25. Emergency Medical Technician
3 – Primary Patient Assessment
© 2014
25

26. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Assessing a patient’s
ABCs is a critical part of
performing your
assessment:
– Assessing and
controlling the
patient’s airway
– Breathing
– Circulation
26

27. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• In basic life support,
the airway is always a
priority
• An open airway will
permit sufficient air to
pass through the airway
to and from the lungs
27

28. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Assessing a
patient’s airway
status:
– Look for anything
that could cause an
obstruction
28

29. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• When an airway is
open:
– The patient’s chest will
rise and fall
– The patient is able to
speak normally without
distress
– The sound of the
patient’s voice is
normal for that patient
29

30. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• An open, or a patent
airway in a patient
is:
– Responsive
– Alert/Oriented
– Breathes easily on
his own
30

31. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• An inadequate airway is
an airway that is
compromised in some
way:
– Insufficient passage of
air to and from the
lungs
– Breathing may be
inhibited altogether
– Swelling caused by:
 Trauma
 Infection
 Allergic reaction
31

32. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Unresponsive patients
lose the ability to
control the:
– Tongue
– Epiglottis
– Gag reflexes
– Cough reflexes
• The tongue can slip into
the airway, causing
obstruction
32

33. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Immediately assessing
and managing is
imperative
• If it is your job to
monitor the airway,
don’t get distracted by
other activities on scene
• Reassess the airway
throughout your care
33

34. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• When a patient’s airway is blocked or
inadequate, notice the following
characteristics:
– Unusual sounds such as stridor or snoring
– Hoarseness or inability to speak
– Obstructions caused by the tongue, vomit
or blood
– Swelling in the mouth, the tongue or
oropharynx
34

35. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The absence of air or chest movement can
also be the result of a compromised airway
• An inadequate airway is commonly found
in:
– Trauma patients
– Drowning victims
– Anaphylactic shock patients
– Unresponsive patients who have vomited
35

36. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Manage any inadequate
airway as quickly as
possible
• Specific maneuvers can
be used to reposition
and open the airway
• These maneuvers will
help you assess and
support the patient’s
breathing
36

37. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If assisting an
unresponsive
medical patient:
– Open and maintain
the airway
– Using the head-tilt,
chin-lift technique
37

38. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If you suspect any
signs of trauma to
the head or neck:
– Use the jaw thrust
technique while
maintaining manual
cervical stabilization
38

39. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Look for and remove
any foreign body or
substances in the
mouth that are
impairing the airway
• Use the finger sweep
method to remove:
– Solid objects that you
can see in the mouth
39

40. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Suctioning can be
used to clear the
airway for
unresponsive or
responsive patients
of:
– Liquids/vomit
40

41. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If the upper airway is
obstructed as a result of
becoming narrowed,
inspiration may produce
a high-pitched sound
known as stridor
• Make sure the airway is
clear and continually
reassess airway
patency
41

42. Emergency Medical Technician
3 – Primary Patient Assessment
© 2014
42

43. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Once you have assured
the patency of the
airway, you will:
– Evaluate the patient’s
breathing status
• Absent or inadequate
breathing are life-
threatening conditions
that must be treated
immediately
43

44. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Look, listen and feel for
the patient’s breath:
– Observe the chest
movement and listen
for sounds
– Note depth and ease of
breathing
– Feel for warm air
coming from the mouth
or nose
44

45. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Assess breathing rate
and quality:
– Rate is the number of
full breaths per minute:
 One full breath consists
of one inhalation and
one exhalation
– Quality is whether
breathing is:
 Present
 Unlabored
 Adequate
 Equal on each side
 Done with normal effort
45

46. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Look for normal
breathing characteristics:
– Respiratory rate is not
too fast or too slow:
 Adult at rest is 12–20
breaths per minute
 Count the number of
respirations in 15 or 30
seconds to determine
the per-minute
respiration rate
– Breathing will produce a
visible rise and fall of
the chest
– Breathing will be quiet
– Patient will not expend
much energy to breathe
46

47. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Inadequate
breathing
characteristics
include respiration
rates:
– Below 10 breaths
per minute
– Above 24 breaths
per minute
47

48. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Some of the signs and symptoms of
inadequate adult breathing include:
– Tripod position
– Too slow or too fast
– Too shallow or too deep
– Abnormal sounds
– Increased effort
– Accessory muscles
– Nasal flaring
– Pale, cool, clammy, cyanotic skin
– Altered mental status
48

49. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The patient may be
sitting in the tripod
position
– Leaning forward
with the arms or
hands braced on the
knees or arms of a
chair
49

50. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The characteristics
of inadequate
breathing in an
adult include:
– Respiration rates
that are too slow or
too fast
– An inadequate tidal
volume
50

51. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Tidal volume is the:
− Amount of air moved in
and out of the lungs in
one breath
• Tidal volume multiplied
by the respiratory rate
gives the “minute
volume”:
− Amount of air moved in
and out over one
minute
− This must be adequate
to support life
51

52. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If the rise and fall of the
chest is shallow, look at
the abdomen to assess
respiration
• Many people will exhibit
more abdominal action
than chest action when
at rest
52

53. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Breathing can be of
adequate depth but be
too slow to oxygenate
the blood, creating a
condition known as
bradypnea
• This can lead to hypoxia
– Hypoxia can lead to
death
53

54. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Hypoxia:
– Breathing rate is too
slow to oxygenate
the blood:
 Below 10 breaths
per minute
 Try to increase the
rate with stimuli:
o Verbal
o Painful
54

55. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Breathing rate too
fast (tachypnea)
 Above 24 bpm
 Lungs do not
have sufficient
time to refill
55

56. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• At times you may
notice:
– Patient’s breathing is
noisy
– Gurgling noise without
secretions in the
mouth
– Hear wheezing
• Look for and inquire
whether the patient is
feeling fatigued from the
effort of breathing
56

57. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Abnormal effort in
breathing can be
observed with
“accessory muscle
use”:
– In the neck
– Between the ribs
– In the abdomen
57

58. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Retraction, or a
sunken-in
appearance of
tissues may be seen
above the:
– Sternum
– Clavicles
– Between the ribs
during inspiration
58

59. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Nasal flaring and
sweating could also be
present
• Pale, cool, and cyanotic
skin indicates
inadequate oxygenation
• As you assess the
patient, also note any
injury to the chest
• Observe him for
unusual chest wall
movement or damage
59

60. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• A paradoxical
movement can
result from a flail
chest:
– Ribs that are
fractured in two or
more places move in
the opposite
direction of the rest
of the chest wall
during breathing
60

61. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Even a patient who
is breathing
adequately can
benefit from oxygen
– A patient can quickly
stop breathing
– Change from
adequate to
inadequate
breathing
– Managing airway is
your top priority
61

62. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

63. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Access the patient’s
circulation:
– Assess for and
control any major
bleeding
– Serious blood loss:
 Life threatening
 Can lead to shock
63

64. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The patient could
still be at risk for
going into shock
even if:
– Major bleeding is not
present
– Internal bleeding
64

65. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Shock:
– Skin is pale
– Cyanotic at the:
 Lips
 Earlobes
 Fingernail beds
65

66. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• First determine the
presence of a pulse
• Then determine its
approximate rate,
regularity and
strength
66

67. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Assess the radial pulse
on a responsive patient:
– Locate the pulse site:
 Place your first three
fingers on the thumb
side of the patient’s
wrist
 Place your middle finger
over the crease between
the wrist and the
forearm
– Apply moderate
pressure to detect the
pulse:
 Too much pressure can
cause the pulse to fade
67

68. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Calculate patient’s pulse
rate:
– Count the number of
beats in 15 or 30
seconds and calculate
the per-minute pulse
rate
– Normal adult heart rate
is 60–100 beats per
minute:
 Cause for concern,
especially if the rate
stays either high or low
throughout your care:
o Above 100 beats per
minute
o Below 60 beats per
minute
68

69. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Check for a carotid
pulse if:
– Unable to detect a
radial pulse
– Patient is
unresponsive
69

70. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• To measure a carotid pulse:
– Locate the patient’s thyroid
cartilage with two fingertips
– Slide your fingers down
along the side of the
cartilage to its base nearest
you
– Feel for a pulse in the
groove, between the
trachea and large neck
muscle
– Do not use excessive
pressure
– Do not check the carotid
pulse on both sides of the
neck at the same time
70

71. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• If a carotid pulse is
NOT present or
detected within 10
seconds begin CPR
immediately
71

72. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• A patient’s
circulatory system
can also be
evaluated by testing
perfusion
• To assess for
adequate perfusion,
check the skin:
– Color
– Temperature
– Moisture
72

73. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Pale skin can indicate:
– Low body temperature
– Blood loss
– Poor blood flow to a
body part
– Shock
• Cyanotic skin can
indicate:
– Problem with the:
 Airway
 Respiration
– Poor blood flow
73

74. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Cool skin can indicate:
– Low body temperature
– Shock
• Dry or slightly moist skin
this is hot to the touch
indicate:
– Conditions such as heat
stroke
• Wet or sweaty skin can
indicate:
– Physical exertion
– Severe pain
– Shock
74

75. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Wet or sweaty skin
can indicate:
– Physical exertion
– Severe pain
– Shock
75

76. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

77. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The three patient
classifications for the
priority determination
are:
– Stable
– Potentially unstable
– Unstable
• A stable patient will
have vital signs in or
very near the normal
range
77

78. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• For a stable patient:
– Continue secondary
assessment on scene
78

79. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• For a potentially
unstable patient:
– May not have
immediate life
threats but is at risk
of deteriorating
because of the
nature of her
condition
79

80. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• For an unstable
patient:
– Airway, breathing or
circulation have
been compromised
80

81. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Consider a patient
to be unstable and
in need of
immediate
transport if there is:
– A life-threat that
cannot be controlled
or may recur
– A depressed level of
consciousness or
inability to follow
commands
81

82. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Signs of an unstable patient:
– Unresponsiveness
– Difficulty breathing
– Shock
– Childbirth complications
– Cardiac-related chest pain
– Uncontrolled bleeding
– Severe pain
82

83. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• For an unstable or
potentially unstable
patient:
– One EMT should
conduct a rapid
secondary assessment
– Another EMT prepares
patient transport
devices
 Equipment
 Stretcher
83

84. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Consider arranging for
an interception of an
advanced life support
team if one has not
arrived
• After loading the
patient, continue with
your secondary
assessment and
emergency care en
route
84

85. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014

86. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Initial Stages of Primary Assessment
• Airway Status
• Breathing Status
• Circulatory Status
• Patient Priority
86

87. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• The primary assessment allows you to
detect and correct immediate life
threats
• Whenever you provide care, you must
employ a thorough, systematic process
in order to accurately assess the nature
of the patient’s problem and take
appropriate action
87

88. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014
• Your patient depends
on you
• Everything depends on
the quality of your
assessment
88

89. Emergency Medical Technician
4 - Primary Patient Assessment
© 2014