Ch07 eec3

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Ch07 eec3

  1. 1. Seven Chapter Scene Size-Up, Initial Assessment, Baseline Vitals, and SAMPLE History
  2. 2. <ul><li>Components of the scene size-up and how they relate to your personal safety as well as to other parts of the call </li></ul><ul><li>Initial assessment, including identification and correction of life threats and priority determination </li></ul><ul><li>SAMPLE history and vital signs </li></ul>Seven Chapter CORE CONCEPTS
  3. 3. O VERALL ASSESSMENT SCHEME Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP
  4. 4. Scene Size-up An assessment to ensure the well-being of the EMT-Basic K EY TERM
  5. 5. Scene Safety <ul><li>Protect bystanders </li></ul><ul><li>(prevent them from becoming patients) . </li></ul><ul><li>Never enter an unsafe scene. </li></ul><ul><li>Make scene safe or call for </li></ul><ul><li>someone who can. </li></ul>(Continued)
  6. 6. S CENE SAFETY TECHNIQUES
  7. 7. Scene Safety Techniques: Observation <ul><li>Fighting or loud voices </li></ul><ul><li>Intoxicants or illegal drugs </li></ul><ul><li>Weapons </li></ul><ul><li>Crime scenes </li></ul><ul><li>Pets </li></ul>
  8. 8. Crash or Rescue Scenes Toxic Substances or Hazmat
  9. 9. Crime Scenes & Violence Unstable Surfaces: Slopes, Ice, Water
  10. 10. Scene Safety Techniques: Responses to Danger <ul><li>Use cover and concealment. </li></ul><ul><li>Retreat. </li></ul><ul><li>Use distractions if necessary. </li></ul><ul><li>Carry a portable radio. </li></ul>
  11. 11. Scene Safety Techniques: Planning for Safety <ul><li>Work together. </li></ul><ul><li>Make your equipment work </li></ul>for you. <ul><li>Dress for safety. </li></ul><ul><li>Use body armor, if necessary. </li></ul>
  12. 12. Body Substance Isolation <ul><li>Anticipate the need for BSI. </li></ul><ul><li>Always have BSI equipment </li></ul><ul><li>available. </li></ul><ul><li>Use appropriate equipment </li></ul><ul><li>to prevent exposure. </li></ul>(Continued)
  13. 13. BSI Review: Gloves Mask and Eye Protection (Continued)
  14. 14. BSI Review: Gown
  15. 15. Mechanism of Injury The physical event that caused an injury (fall, motor vehicle accident, etc.) K EY TERM
  16. 16. Mechanism of Injury: Trauma <ul><li>Determined from </li></ul><ul><li>Patient </li></ul><ul><li>Family </li></ul><ul><li>Bystander </li></ul><ul><li>Observation of the scene </li></ul>
  17. 17. <ul><li>Distance patient fell </li></ul><ul><li>Part of patient’s body </li></ul><ul><li>that struck surface </li></ul><ul><li>Type of surface </li></ul><ul><li>landed on </li></ul><ul><li>Did anything break </li></ul><ul><li>the fall? </li></ul>Mechanism of Injury: Falls
  18. 18. Mechanism of Injury: Motor Vehicle Collision - Head On (Continued)
  19. 19. Mechanism of Injury: Motor Vehicle Collision - Rear Impact (Continued)
  20. 20. Mechanism of Injury: Motor Vehicle Collision - Side Impact (Continued)
  21. 21. Mechanism of Injury: Motor Vehicle Collision - Rollover (Continued)
  22. 22. Mechanism of Injury: Motor Vehicle Collision <ul><li>Rotational </li></ul><ul><ul><li>Multiple injury patterns. </li></ul></ul>(Continued)
  23. 23. Mechanism of Injury: Motor Vehicle Collision <ul><li>Ejection </li></ul><ul><li>Deformed windshield, steering </li></ul><ul><li>wheel, etc. </li></ul><ul><li>Amount of vehicle deformity </li></ul><ul><li>Seat belt use </li></ul>
  24. 24. Mechanism of Injury: Vehicle Interior
  25. 25. <ul><li>Velocity </li></ul><ul><li>Body region penetrated </li></ul><ul><li>Exit wounds </li></ul>(Continued) Mechanism of Injury: Penetrating Trauma
  26. 26. Mechanism of Injury: Penetrating Trauma
  27. 27. Nature of Illness: Medical Patient <ul><li>Sources of Information </li></ul><ul><li>Scene </li></ul><ul><li>Patient </li></ul><ul><li>Family and bystanders </li></ul>
  28. 28. Adequacy of Resources <ul><li>Number of patients? </li></ul><ul><li>Hazardous materials? </li></ul><ul><li>Fire or rescue? </li></ul><ul><li>Unusual situations? </li></ul>(Continued)
  29. 29. <ul><li>Call for assistance before </li></ul><ul><li>beginning care. </li></ul><ul><li>Use triage procedures if </li></ul><ul><li>necessary. </li></ul>Adequacy of Resources
  30. 30. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
  31. 31. Form a General Impression <ul><li>Environment </li></ul><ul><li>Age </li></ul><ul><li>Sex </li></ul><ul><li>Apparent threats to life </li></ul>
  32. 32. Assess Mental Status <ul><li>A lert </li></ul><ul><li>V erbal stimulus </li></ul><ul><li>P ainful stimulus </li></ul><ul><li>U nresponsive </li></ul>
  33. 33. P RECEPTOR P EARL Many EMT-Bs, especially at the beginning of their careers, are reluctant to apply a painful stimulus. Out of shyness or a reluctance to harm the patient, they apply only a mild stimulus that is not sufficient to rouse the patient. The EMT then notifies the ED that the patient is unresponsive to verbal and painful stimuli. But on arrival at the ED, the staff is easily able to elicit a response with a brisk sternal rub or a pinch of the trapezius. Watch for this tendency with new or inexperienced EMT-Bs, and give them the benefit of your experience.
  34. 34. Assess the airway.
  35. 35. Open and Maintain Airway <ul><li>Medical Patients: </li></ul><ul><li>Use head tilt, chin lift. </li></ul><ul><li>Suction and insert oral or </li></ul><ul><li>nasal airway as necessary. </li></ul>(Continued)
  36. 36. <ul><li>Trauma Patients: </li></ul><ul><li>Immobilize the head manually. </li></ul><ul><li>Use jaw thrust as necessary. </li></ul><ul><li>Suction and insert oral or </li></ul><ul><li>nasal airway. </li></ul>Open and Maintain Airway
  37. 37. Assess breathing.
  38. 38. Breathing <ul><li>If breathing is inadequate, </li></ul><ul><li>ventilate with 100% oxygen. </li></ul><ul><li>If respirations are adequate but faster than 24/minute, give </li></ul><ul><li>high-concentration oxygen. </li></ul>
  39. 39. P RECEPTOR P EARL New EMT-Bs, in their desire to explain to the patient everything that is going on, may say something like, “I’m going to count your breaths right now, so just relax.” Of course, the patient who knows someone is counting his or her breathing rate will think about it and probably breathe either faster or slower as a result. If you hear new EMT-Bs using this approach, remind them that counting a respiratory rate should be done without bringing the patient’s attention to it.
  40. 40. Circulation: Pulse, bleeding, skin
  41. 41. <ul><li>In adults and children, check </li></ul><ul><li>radial pulse first. </li></ul><ul><li>If no radial pulse, check carotid </li></ul><ul><li>pulse. </li></ul>Pulse <ul><li>If no carotid pulse, start CPR </li></ul><ul><li>and use AED as appropriate. </li></ul>
  42. 42. Infants: Check brachial pulse.
  43. 43. Look for and control severe bleeding.
  44. 44. Skin <ul><li>Color </li></ul><ul><li>Temperature </li></ul><ul><li>Condition </li></ul>
  45. 45. Infants/children: Capillary refill
  46. 46. Identify Priority Patients <ul><li>Poor general impression </li></ul><ul><li>Unresponsive </li></ul><ul><li>Responsive but not following </li></ul>(Continued) commands <ul><li>Difficulty breathing </li></ul><ul><li>Shock (hypoperfusion) </li></ul>
  47. 47. <ul><li>Uncontrolled bleeding </li></ul><ul><li>Severe pain anywhere </li></ul><ul><li>Complicated childbirth </li></ul>Identify Priority Patients <ul><li>Chest pain with systolic blood </li></ul>pressure < 100
  48. 48. Focused history and physical exam (medical) or Focused history and physical exam (trauma) Determine Next Assessment Step
  49. 49. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
  50. 50. Baseline Vital Signs <ul><li>Respirations </li></ul><ul><li>Pulse </li></ul><ul><li>Skin </li></ul><ul><li>Pupils </li></ul><ul><li>Blood pressure </li></ul>
  51. 51. Respirations
  52. 52. <ul><li>Normal </li></ul><ul><li>Shallow </li></ul><ul><li>Labored </li></ul><ul><li>Noisy </li></ul>Quality of Breathing
  53. 53. Pulse <ul><li>Strong or weak </li></ul><ul><li>Regular or </li></ul>irregular
  54. 54. If you cannot feel a radial pulse, check the carotid pulse.
  55. 55. Check skin color, temperature, and condition.
  56. 56. <ul><li>Pale </li></ul><ul><li>Cyanotic </li></ul><ul><li>Flushed </li></ul><ul><li>Jaundiced </li></ul>Abnormal Skin Colors
  57. 57. Abnormal Skin Temperatures <ul><li>Hot </li></ul><ul><li>Cool </li></ul><ul><li>Cold </li></ul>
  58. 58. Abnormal Skin Conditions <ul><li>Wet </li></ul><ul><li>Very dry </li></ul>
  59. 59. Pupils
  60. 60. Abnormal Pupil Conditions
  61. 61. Palpation Auscultation Measuring Blood Pressure
  62. 62. Pulse Oximetry <ul><li>Measures oxygen </li></ul><ul><li>circulating in the blood </li></ul><ul><li>95 – 99% considered normal </li></ul>
  63. 63. Pulse Oximetry Precautions <ul><li>Not accurate in shock or hypothermia </li></ul><ul><li>False readings in carbon monoxide poisoning </li></ul><ul><li>Movement and nail polish can cause inaccurate readings </li></ul>NOTE: Do not withhold oxygen from a patient who may need it because the oximeter reads “normal.”
  64. 64. Reassessment of Vital Signs <ul><li>Stable patient: every 15 minutes </li></ul><ul><li>Unstable patient: every 5 minutes </li></ul>
  65. 65. Sample History <ul><li>S igns and symptoms </li></ul><ul><li>A llergies </li></ul><ul><li>M edications </li></ul><ul><li>P ast medical history </li></ul><ul><li>L ast oral intake </li></ul><ul><li>E vents leading to the injury </li></ul>or illness
  66. 66. Pertinent past history should include medical, surgical, and trauma factors.
  67. 67. 1. What are the components of a scene size-up? 2. List the steps in the initial assessment of a patient. 3. Give examples of patients who should be handled as a “high priority.” 4. What does the acronym SAMPLE stand for? 5. What is the range of normal vital signs? R EVIEW QUESTIONS

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