Patient Assessment Module Part 1

Transcription

1 REGION XI EMS Patient Assessment Module Part 1 SITE CODE E-1213-A 1 hour CE 1

2 Case scenario Someone calls for help 911 call Information Perception 2

3 Case scenario The call is taken Ask for information Give instructions Send appropriate units 3

4 Preparation enroute PPE Equipment Consider possibilities 4

5 Unconscious 40 year old male Full Arrest? Drug Overdose? Stroke? Diabetic Emergency? Seizure? Case scenario 5

6 Scene Size Up 6

7 Scene Size Up Scene safety issues Appropriate BSI/PPE Mechanism of injury (MOI) Nature of illness (NOI) 7

8 Scene Size Up Number/age of patients Triage Need for additional help 8

9 Priorities The responders come first! It is your responsibility to assess the scene 9

10 Priorities Scene safety can vary wildly Be aware of your surroundings Don t get tunnel vision 10

11 Actual and potential dangers Is it safe to approach the patient? Downed power lines? 11

12 Actual and Potential Dangers Look for traffic hazards, including other emergency vehicles Fire/smoke/Haz-mat/fumes Environmental concerns 12

13 Patient safety Are you able to work on the patient where they are, or do you need to move them to the rig? 13

14 Crowd Control Bystanders/crowds should be handled by the police whenever possible, and kept at a safe distance. Curious bystanders can pose a danger to you, your patient(s), and themselves 14

15 BSI/PPE precautions Appropriate PPE is the standard of care per Region XI policy. (Guidelines for Preventing Disease Transmission B16) All body fluids are to be treated as potentially infectious. When inserting King airway, always place a suction catheter in suction port 15

16 BSI Communicable/infectious diseases: TB, HIV/AIDS, Hepatitis, Influenza, Measles, Meningitis, Mumps, Chicken Pox/Shingles, MRSA, KPC, and other skin infections, Pertussis. New strain of SARS-like virus in the Middle East called MERS-CoV 16

17 BSI Exposure can occur by blood, respiratory secretions/droplets, saliva, fecal matter, and oral and nasal secretions 17

18 Minimize your risk All patients should be considered possibly infectious. Protect yourself! Wash your hands! PPE should be within easy reach on every call! 18

19 Mechanism of injury (MOI) Crash scenes: Protect yourselves and others from traffic and other actual or potential hazards. 19

20 MOI What are the forces involved in the crash? Head-on collision Rear-end collision Side- impact 20

21 MOI Rollover Vehicle into building, tree, power lines, etc Vehicle vs. pedestrian(s) 21

22 Head-on collisions Up and over Was the windshield cracked? Down and under 22

23 Rear-end collisions Head and neck injuries common- Whiplash! 23

24 Side-impact Blunt trauma most common Head injuries, as well as injuries to limbs Air-Bag Injuries 24

25 Rollovers Very serious Patient very likely to be ejected if not belted. All types of injuries: blunt trauma, head/neck/back injuries, fractures of arms/legs, etc 25

26 Vehicle crashes continued Where was the patient sitting? Seatbelt use? Air bags deployed? Steering wheel bent? Windshield intact? 26

27 Vehicle crashes continued Was the patient ejected? How fast was the vehicle going? Any intrusion into the passenger compartment? What did the vehicle look like??? 27

28 Haz-mat In any Haz-mat situation, remember, you may not enter the scene until the Haz-mat team declares it safe to do so. The Haz-mat team is in charge of the haz-mat scene Do not become a victim yourself!!! 28

29 Crime scenes The police are in charge of crime scenes! Be aware of fighting and loud arguments, weapons, alcohol/drug intoxication. History of prior violence? Unusual silence (such as domestic violence/abuse situations) 29

30 Other Potentially Unsafe Scenes Impaled objects Stab wounds GSW Check for multiple wounds. Always suspect injury to vital organs. Trauma Patient Transport C-8 30

31 Scene size up Assess the scene for: Medical documents/paperwork, Medicines/prescriptions, Medical devices- O2, etc. Supplements 31

32 New IL state uniform DNR form 32

33 Scene considerations Unusual behavior Poor lighting Animals Signs of abuse or neglect 33

34 Other scene size up concerns Number /age of patients. Number of ALS vs. BLS patients. Need for additional resources 34

35 Establish control on the scene Identify yourself Communicate with personnel already on scene. Establish rapport 35

36 Maintain Control Scene Safety - dynamic - fluid Situational Awareness 36

37 Primary Survey 37

38 Primary Survey Quick Assessment Designed to Identify Life Threats 38

39 General Impression Visual assessment Across the room Patient s posture Facial expression Level of consciousness Respiratory status Skin color 39

40 Impression? What are you thinking? Is there an immediate life threat? 40

41 Impression? What are you thinking? Is there an immediate life threat? 41

42 Impression? Case scenario What are you thinking? Is there an immediate life threat? 42

43 Case scenario Our patient. 40 year old male Unresponsive Snoring respirations Diaphoretic 43

44 Special Populations Pediatric Geriatric Special Needs 44

45 Pediatric Assessment Triangle 45

46 Sick or not sick? 46

47 Sick or not sick? 47

48 Geriatric Patients Environmental Assessment Social Assessment Medical Assessment 48

49 Patients with special needs Talk to caregiver to establish patient s baseline Involve patient in conversation if possible May require additional equipment Treat your patient, not their equipment 49

50 Level of Consciousness AVPU A = Alert V = Responds to verbal P = Responds to pain U = Unresponsive 50

51 On AVPU scale- what is she? She responds only when you speak loudly. 51

52 On AVPU scale What is she? She speaks to you and clearly believes you are her son. 52

53 Assessing Level of Consciousness Speak to him Tap or gently shake shoulder Elicit painful response with sternal rub Case scenario 53

54 A is for Airway Open airway Look for Tongue obstruction Foreign Objects Secretions Edema 54

55 Airway assessment for pediatrics Crusty nose can be an airway obstruction Large tongue can further obstruct airway Place padding under shoulders 55

56 Airway assessment for geriatrics Dentures may cause airway obstruction Difficult seal without dentures 56

57 Airway Interventions Positioning Suctioning Use of airway adjuncts Nasopharyngeal airway Oropharyngeal airway 57

58 B is for Breathing Spontaneous respirations Respiratory rate Symmetrical chest rise and fall Breath sounds 58

59 Assess Breathing Case scenario Assess rate and effort Assess work of breathing Assess breath sounds 59

60 Breathing assessment for pediatrics 60

61 Breathing assessment for geriatrics Loss of lung and chest wall elasticity Decrease in cough / gag reflex Long history of smoking 61

62 Breathing Interventions Oxygen Nasal cannula Non rebreather mask Nebulizer treatments Assist respirations with BVM King airway Pulse oximetry Intubation Capnography 62

63 C is for Circulation Check pulses Assess for bleeding Assess skin parameters Color Moisture Temperature 63

64 Assess Circulation Case scenario Normal capillary refill < 2 sec May be delayed if fingers cold 64

65 Circulatory assessment for pediatrics Capillary refill Central and peripheral pulses 65

66 Circulatory assessment for geriatrics Poor perfusion is serious Radial pulse may be hard to find if patient in shock Pulse may be irregular 66

67 Circulation Interventions Stop bleeding Treat shock Keep warm Trendelenberg Insert IV / IO access and administer fluid bolus 300cc bolus for adults 20cc/kg bolus (up to 3x) for children 67

68 D is for Disability(Neuro) AVPU Glasgow Coma Scale Pupils PEARL= Pupils Are Equal & Responsive to Light 68

69 Case scenario Pupillary Assessment Pinpoint pupils Dilated pupils Fixed pupils Size range 69

70 Glasgow Coma Scale Less than 8, intubate 70

71 E is for Expose /Environment Remove clothing from injured areas and examine. Remember to keep your patient warm. Increase heat in amb. Blankets Remove any wet clothing 71

72 Patient Assessment Part 1 Patient Assessment Part 1 is completed. Please complete the quiz, then the completion certificate. Submit a copy of the certificate to your Resource Hospital, your employer and keep a copy for your records

73 References AAOS Emergency Care and Transportation of the Sick and Injured. Editor Andrew Pollak, Brady Emergency Care 12 th edition, Daniel Limmer & Michael O Keefe, EMS REGION XI CHICAGO PARAMEDIC STANDING MEDICAL ORDERS & POLICIES AND PROCEDURES 2012 Chicago EMS Medical Directors Consortium National EMS Education Standards and Instructional Guidelines NHTSA website and Sanders, M. J., Mosby s Paramedic Textbook, Revised 2nd Edition TNCC Provider Manual, Emergency Nurses Association,