Ch. 5 - Assessment - CRC

When you arrive at the scene of an emergency, after ensuring the safety of yourself and others, you must quickly determine whether the patient has any life-threatening injuries or conditions by conducting a primary assessment. This includes assessing the patient’s level of responsiveness and his or her airway, breathing, and circulation. Once the primary assessment is complete, you can begin your secondary assessment, which includes interviewing the patient (or bystanders), assessing and documenting vital signs, and conducting a thorough physical exam. Having a clear plan of action will help you to respond effectively in any emergency situation. The important questions are “What are my priorities?” and “What interventions may be necessary?” The general steps in this section will provide answers to these questions (Figure 5–1).

These steps, conducted in this order, help to ensure your safety and that of the patient and bystanders. They will also increase the patient’s chance of a positive outcome.

Transcript

1. Ch 5 – Pg 79
2. Why Follow An Assessment Model? • Having a clear plan of action will help you to respond effectively • “What are my priorities?” • “What interventions may be necessary?” • These steps, conducted in this order, will increase the chance of a positive outcome Ch 5 – Pg 79-80
3. This assessment model may be modified depending on the situation. For example, a responsive patient may complain of an ankle injury. In this case, a full head-to- toe assessment is probably unnecessary, unless you have reason to suspect that additional injuries or conditions may be present Ch 5 – Pg 80
4. Ch 5 – Pg 80
5. Scene Assessment Hazard and Environment Potential hazards at scene? Does the environment create a risk? Are there any specific processes to mitigate hazards? Mechanism of Injury (MOI) / Chief Complaint What happened? / What is the problem? Number of Patients How many people are ill or injured? Additional Resources Required Fire department, law enforcement, utilities, etc.? Forming a General Impression What is your initial overall impression of the scene and the patient? Donning PPE Are you wearing appropriate PPE for the situation? Ch 5 – Pg 80
6. Once You Reach the Patient – Moving a Patient You should avoid moving a patient unless the situation makes it necessary, including: • Moving a patient away from dangerous materials or situations • Moving a patient with minor injuries to reach someone who may have a life-threatening condition • Moving a patient to provide appropriate care • See Ch 19 about how to move patients If the scene is unsafe to enter and the patient is able to do so, ask the patient to move to a safe location. Ch 5 – Pg 81
7. Primary Assessment A rapid systematic check to identify conditions that pose an immediate threat to life. • Introducing yourself and CC • Assessing LOR • Assessing SMR (C-Spine) • Simultaneously assess ABC’s • Performing SpO2 , RBS and Skin Check Ch 5 – Pg 82
8. Primary Assessment Chief Complaint (CC) • The injury or condition that the patient verbally identifies as the most serious • “What seems to be the problem?” • If a patient is unresponsive, the CC if unresponsiveness Ch 5 – Pg 82
9. Primary Assessment Level of Responsiveness (LOR) • Gently tap the patient on the shoulder and ask, “Are you okay?” • A patient who can speak or cry is responsive • If you must leave a patient who has a decreased level of responsiveness alone for any reason, place in recovery position to maintain an open airway Ch 5 – Pg 83
10. Primary Assessment Spinal Motion Restriction (SMR) • The reduction/limitation of spinal movement • Whenever you suspect a spinal injury, unless doing so would interfere with care for a life-threatening condition • Techniques for SMR are described in Ch 12 Ch 5 – Pg 83
11. Primary Assessment Suspect a spinal injury: • Patient found unresponsive with an unknown cause • Fall from a height >1m or 5 stairs • Motor vehicle collision, especially ejection • Patient’s helmet is badly damaged or broken • Severe blunt force to head or trunk • Penetrating injury to the head, neck, or trunk • Any diving mishap • Incident involving electrocution, including lightning strikes Ch 5 – Pg 84 // Ch 12 – Pg 228
12. Primary Assessment Airway, Breathing, and Circulation (ABC’s) Move the patient as little as possible • If the patient’s position prevents you from checking effectively, roll the patient gently onto their back, keeping the head/spine in as straight a line as possible Ch 5 – Pg 84
13. Primary Assessment Airway • If the patient is speaking, moaning or crying they have an open airway • Head-tilt-chin-lift (unresponsive, no head/spinal injury) • Jaw thrust (unresponsive, suspected head/spinal injury) Ch 5 – Pg 84
14. Primary Assessment Breathing • If the patient is speaking, moaning or crying they are breathing • If the patient is unresponsive, listen and feel air from the patient’s nose • Watch for the chest to rise and fall • Observe for ease of breathing and approximate rate • Assess for 10sec Ch 5 – Pg 84-85
15. Primary Assessment Circulation – Pulse • Radial artery: responsive adult/child • Carotid artery: unresponsive adult/child • At the side of the neck closest to you • Brachial artery: infant • Assess for 10sec (simultaneous with breathing) Ch 5 – Pg 85-86
16. Primary Assessment Pulse Oximetry (SpO2 ) • Measures the % of O2 saturation in the blood • Room Air Saturation: reading taken before administering supplemental O2 Ch 5 – Pg 86-88
17. Primary Assessment Pulse Oximetry (SpO2 ) – Oxygen Decision • Based on S&S, CC, and SpO2 • Treat the patient, not the tool! • Will be described in Ch.6 Ch 5 – Pg 87-88
18. Primary Assessment Circulation - Skin • Colour • Temperature • Moisture • Touch the back of your hand (with appropriate PPE) to the patient’s forehead Ch 5 – Pg 86
19. Primary Assessment Rapid Body Survey (RBS) • Quickly identify life-threatening injuries • If you discover anything, expose and examine the area to determine the extent of injury • If critical intervention required, pause and perform before continuing • Palpate for abnormalities: • Inflammation • Deformities • Fractures • As you palpate, check your gloves for blood or bodily fluids Do not put your hands anywhere you cannot see! Ch 5 – Pg 88
20. Primary Assessment Rapid Transport Category (RTC): • Life-threatening conditions • If working as a team, one responder can make preparations for transport • Examples on Pg 89 Non-Rapid Transport Category (Non-RTC): • Stable conditions • If the patient’s condition deteriorates, you must re-evaluate • If delaying transport could have a negative effect on the patient’s condition, transport immediately Transport Decision Ch 5 – Pg 89
21. Primary Assessment Patient Positioning • Most injured patients will find the most comfortable position for themselves • Moving can be beneficial: • Performing a proper assessment • Improving the patient’s condition or reducing pain • When patient’s position aggravates their condition Ch 5 – Pg 89-90
22. Primary Assessment - Recap • CC (and introducing yourself) • LOR • SMR (C-Spine) • ABC’s • SpO2 • RBS and Skin • Transport Decision (RTC/Non-RTC) • Patient Positioning (Comfort) Ch 5 – Pg 82-90
24. Reassessment • An ongoing process • Get into the habit of monitoring the condition of any patient you provide care for • Think about whether additional resources are required to deal with changes to scene or patient • Consider whether your transport decision is still appropriate • Reassessing a patient’s ABC’s should occur frequently Ch 5 – Pg 90-91
25. Secondary Assessment Gathering detailed information about the patient’s history; can reveal injuries or conditions that may become life-threatening. • Interview/SAMPLE • Vital Signs • Head-To-Toe Examination Ch 5 – Pg 91
26. Secondary Assessment Interview with Patient and Bystanders • Known as obtaining a patient’s history • Listen carefully but also watch for signs of injury or illness • You can sometimes ask family, friends or bystanders Ch 5 – Pg 91-92
27. Secondary Assessment Interview with Patient and Bystanders • If the patient is experiencing pain of any kind, use the mnemonic OPQRST Ch 5 – Pg 91-92
28. Secondary Assessment Vital Signs (VS) • Detailed physiological information • The first set is considered the baseline VS • Every 5min for unstable patients • Every 30min for stable patients • LOR • Respiration Rate • Pulse Rate • (Blood Pressure) • Skin Characteristics • Pupils • SpO2 Ch 5 – Pg 92
29. Secondary Assessment Level of Responsiveness (LOR) Ch 5 – Pg 92
30. Secondary Assessment Respiration Rate (RR) • A healthy person breathes regularly, quietly, and effortlessly • Rate, rhythm and volume • Try to assess breathing without the patient’s knowledge • Count for 15sec Ch 5 – Pg 94
31. Secondary Assessment Pulse Rate (PR) • If the heartbeat changes, so does the pulse • Rate, rhythm, and quality • A well-conditioned athlete may have a pulse of 50bpm or lower • Count for 15sec Ch 5 – Pg 94
32. Secondary Assessment Pulse Rate (PR) • A pulse may be hard to find: take your time • If a patient is breathing, their heart is also beating • Loss of circulation to an area can cause a loss of pulse • If you cannot find the pulse in one location, check it in another Ch 5 – Pg 95
33. Secondary Assessment Circulation - Skin Ch 5 – Pg 95 • Colour: • Normal, red, pink, pale, bluish/cyanotic • In patients with darker skin, cyanosis may appear ashen-grey, yellow-brown, or greyish-green • Temperature • Hot, warm, cool, cold • Moisture • Dry, clammy, sweaty
34. Secondary Assessment Pupils • Look closely at size, whether they react to light and are equal size • Check by shading each eye and then allowing light to enter, or by shining a light into each eye Ch 5 – Pg 96-97
35. Secondary Assessment SpO2 • Apply pulse oximeter to support patient assessment • Decide whether the patient requires supplemental O2 based on S&S, C/C and SpO2 Ch 5 – Pg 86-88
36. Secondary Assessment Head-To-Toe Physical Examination • To gather additional information about injuries or conditions • May not be immediately life- threatening, but they could become so • Look for medical identification products • Balance is necessary: • Ensure that you are palpating effectively • Handle gently to avoid aggravating any existing injuries • Look for abnormalities: • Discolouration • Deformity • Bleeding Ch 5 – Pg 10-101
37. Secondary Assessment Head • Look for blood or clear fluid in or around the ears, nose, and mouth Neck • Look and feel for any abnormalities • You will learn techniques for stabilizing and immobilizing the head and spine in Ch 12 Ch 5 – Pg 101
38. Secondary Assessment Shoulders • Check the clavicles and shoulders, including scapulas • If you find NO abnormalities, direct the patient to shrug their shoulders Ribs • Place your hands gently on the lower anterior portion of the patient’s ribs • Have the patient inhale and exhale, feeling for equal expansion of the lungs Ch 5 – Pg 101
39. Secondary Assessment Back • Palpate both sides of the spine, torso, scapulas, ribs, and upper pelvis • Balance exposing the patient against the need to protect privacy Abdomen • Check for distention, a pulsating mass beneath the skin • Apply light pressure to each of the abdominal quadrants • Each should be soft Ch 5 – Pg 101
40. Secondary Assessment Hips • Place hands on the sides of the hips and gently rock the pelvis, listening for crepitus and watching for any sign of pain or discomfort • Assess joint rotation and shortening of limbs Ch 5 – Pg 102
41. Secondary Assessment Finding Abnormalities • Expose and examine • Perform appropriate treatment/interventions • Document the information you find during the physical examination Ch 5 – Pg 102-103 Legs & Arms • Assess continuity of the bones, and the knee and ankle joints • Assess circulation by checking the capillary refill • Perform motor-sensory assessment
42. Secondary Assessment - Recap • Interview with Patient and Bystanders • Signs and Symptoms • Allergies • Medications • Past/Present Medical History • Last Oral Intake • Events Leading Up To • Vital Signs • LOR • Respiration Rate • Heart Rate • SpO2 • Pupils • Head-To-Toe Examination • Head – abnormal fluids • Neck – symmetry • Shoulders – clavicle and scapula • Chest – equal chest expansion • Back – continuity of entire back • Abdomen – 4 quadrants • Pelvis – light pressure, leg length/rotation • Lower and Upper Extremities – continuity and CMS • Circulation – capillary refill • Motor – wiggle toes/fingers • Sensory – which toe/finger Ch 5 – Pg 89-102
44. Documentation • Completed immediately or as soon as possible • Patient care cannot be delayed to fill out paperwork • Can simplify the transfer of care • Protect you from legal action Ch 5 – Pg 103
45. Ongoing Assessment • Monitor the patient’s ABC’s and VS’s • RTC/Unstable: VS every 5min • None-RTC/Stable: ABC’s every 10min, VS every 30min • Keep the patient calm and comfortable • Re-inspect any injuries, bandages, etc. periodically • If any life-threatening emergencies develop, stop whatever you are doing and provide appropriate interventions immediately Ch 5 – Pg 103
46. Reassessment/Ongoing Assessment: • Check on your patient regularly • RTC/Unstable: VS 5 min • Non-RTC/Stable: ABC’s 10 min // VS 30min Interview/SAMPLE: • S&S // Allergies // Medications // Pertinent Hx // Last Oral Intake // Events Leading Vital Signs: • LOR // RR // HR // Pupils // Skin // SpO2 Head-to-Toe: • Head // Neck // Shoulders // Chest // Abdo // Pelvis // Legs & Arms – CMS Treatment/Interventions: • Provide critical interventions for life-threatening conditions when you find them • Stabilize moderate/minor conditions and provide definitive treatment after Ax’s