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11)Initial Assessment

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11)Initial Assessment

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

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