Rock Your Assessment: EMS Tricks, Tips & Techniques to Maximize Patient Information in Minimum Time.
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An 86-year-old male was involved in a motor vehicle accident resulting in an obvious tibia/fibula fracture with severe bleeding. He is complaining of back and neck pain, chest pain, dizziness, shortness of breath, and altered mental status. He also reports that his implanted defibrillator has fired. The patient requires assessment and stabilization of life threats from his multiple injuries and medical complaints.
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Rock Your Assessment: EMS Tricks, Tips & Techniques to Maximize Patient Information in Minimum Time.
- 1. S
- 3. An 86 y/o male involved in a one-car motor vehicle accident. Patient has an obvious tib /fib fracture with severe bleeding and is complaining of back & neck pain, chest pain, dizziness & shortness of breath. She has altered mental status and is moaning about her implanted defibrillator firing. What now?
- 6. Cloudy Earwax Fell Yesterday Bystander is Concerned!!!!!Daughter wants pt. transported!!!! Cold Bleeding from Tib/Fib Fx Green Sputum BP 96/70 Enjoys Jello! Chest Pain Trouble Breathing Ate paste as a child Severe Leg Pain Is worried that cat might have a fear of mice Back Surgery in 2009 . Is patient wet from soda, antifreeze or urine? Worried car is totaled No DNR on File Was on the way to visit his granddaughter for dinner Can’t eat hot dogs. Recent Antibiotic Prescription Ate Spanish Olives Urine has been “green-ish” Pulse weak and thready ??? EtCO2 44% Sinus Rhythm Dog has been burping recently. Respirations 32/min. 124 bpm Afraid of Spiders Anxiety Dizzy !!!!! Rales Rhinorrhea Weak Coughing Pale $%& Headache SpO2 90% Allergic to Peanuts
- 7. BP 180/100 Enjoys Jello! Ate paste as a child Is worried that cat might have a fear of mice Ate Spanish Olives EtCO2 44% Sinus Rhythm Dog has been burping recently. Respirations 32/min. 114 bpm Dizzy Weak SpO2 92%
- 8. An 86 y/o male Motor vehicle accident. Obvious tib / fib fracture Severe bleeding Back & neck pain Chest pain, dizziness & shortness of breath Altered mental status Implanted defibrillator firing
- 9. Duties Size Up Scene Manage Hazards Direct Resources Assess Patient Address Life Threats Preserve Evidence Pre-Notify Hospital Collaborate with other Responders Treat Patient Best Practices
- 12. Defined as • “Knowing what is going on so you can figure out what to do." And • "What you need to know to not be surprised."
- 13. You can perceive context & cues in the environment and still miss CRITICAL ones. You can perceive CRITICAL CUES and still not be able to make SENSE of them.
- 14. Situational Awareness / Attention Management is the prioritization of applying brain resources to: Visiting Nurse is Concerned Trouble Breathing Allergic to Peanuts!!! Distress, Dyspnea, Tachypnea, Identifying Cues PERCEPTION – 1 st Sister has medicalWheezing, Old Inhalers Power of Attorney Recent Antibiotic Prescription Had a lovely time at the flower show on Wednesday! Pulse 118 bpm Asthma Sensemaking PROCESSING – 2nd ECG = Sinus Rhythm w/ PVCs Respirations 32/min. BP 180 / 100 SpO2 88% Weak !!!!!!! Leg Pain Diaphoretic Anxiety EtCO2 28% Nebulizer PREDICTING Problem Surgery in 2004 for cysts. Numerous inhalers empty Pale!! Elderly Solving 3rd Now Petechiae
- 16. Naturalistic Decision Making • How people ACTUALLY make decisions. Good News • We can make rapid decisions with poor info. Bad News • We tend to this even if good info is available.
- 17. Signal Detection Theory • A means to discern SIGNAL from NOISE If we can raise SIGNAL with good attention And reduce NOISE by ignoring distractions Then we can make better decisions.
- 18. Thin Slicing • A method to identify patterns in very “thin slices” or “blinks” of time. May maximize SIGNAL Minimize NOISE More time/info only adds more NOISE.
- 19. Recognition Primed Decision Making • Identify Patterns in the Signal. • Select Action to achieve outcome. • Compare with previous similar experiences. • Implement Action or Alter Action. • Relies upon Attention and Perception.
- 20. Collect Intuitively Collect Collectively Collect Systematically Externalize Them
- 21. What we hear. What we see around us.
- 22. Who we ask. Patient Caregiver Family Bystander
- 23. What we ask. CC Why are we here? OPQRST Patient’s acute condition. SAMPLE Patient’s chronic condition.
- 24. What we Feel. Physical Exam What we Read. Patient Hx W-10 Med List Med Labels
- 25. Data Stethoscope BP Cuff SpO2 ABGT Smell & Taste
- 26. When To Accumulate Critical Cues 1) Enroute Phase - Size up 2) Approach Phase - Initial Assessment 3) Patient Phase – Rapid / Focused 4) Transport Phase – Detailed / Ongoing
- 27. Size Up Shift Dispatch Enroute Arrival
- 28. Initial Assessment Patient’s Side Load-n-Go / Stay-n-Play ABC’s Airway Breathing Circulation
- 29. Rapid Trauma HtT Medical ! Hx ! VS Focused
- 30. P in CUPS Prioritize Critical Unstable Potentially Unstable Stable
- 32. The OODA Loop • Col. Boyd F-86 Sabre • Observe • Orient • Decide MiG 15 • Act • Perception > Equipment
- 33. Immediate Life Threats Underlying Causes Limb Threats Tertiary Injuries
- 34. Obvious, open tib / fib fracture Severe bleeding & hypotension Back & neck pain Atraumatic chest pain & SOB Altered mental status Implanted defib firing, V-Tach
- 36. Time Information Overload Information Underload Multitasking Directive to Diagnose Compartmentalization
- 38. Hear See Who / What we ask Feel Data
Editor's Notes
- DEFINITION
- Are we looking INTO these items (implications) or simply AT them (past them).
- Baloon frame example.
- This is analogous to everyone on scene giving you simultaneous reports. Chaos
- Col. John Boyd in VietnamF-86 Sabre vs MiG 15