Patient Assessment

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Patient Assessment
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Scene Size - Up

• Scene safety / BSI
• Mechanism of injury / Nature of the illness
• Number of patients
• Consider need for additional manpower or
  specialized resources

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Primary Survey

• Goal of primary assessment
• To identify and initiate treatment of immediate
  or potentially life threatening problems
• Whether the patients Chief Complaint is trauma
  or medical related we begin with the primary
  assessment.

4
Primary Assessment Steps

• Form a general impression
• Introduce yourself and ask for patients chief
  complaint
• Determine patients Level of Consciousness
• Conscious unaltered LOC
• Conscious with altered LOC
• Unconscious
• AVPU
• Glascow Coma Scale

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Glasgow Coma Scale
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Airway

• Responsive Patient
• Are they talking to you or crying?
• Does patient exhibit any signs of dyspnea?
• Is breathing noisy?
• Unresponsive Patient
• Assume trauma unless confirmed not to be trauma
  related
• Open airway with either modified jaw thrust or
  head tilt chin lift
• Address foreign body obstruction
• Apply airway adjuncts if indicated
• Suction if indicated
• Assist ventilations if needed
• If airway is clear, move to next step

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Breathing

• Is spontaneous breathing present?
• Is breathing adequate or inadequate?
• How do we tell the difference?

8
Circulation

• Does patient have a pulse
• Carotid
• Radial
• Brachial (pediatric)
• Femoral
• Any bleeding that needs to be controlled
• Skin condition

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Decision Time

• After primary assessment we decide
• Does this patient have a medical problem?
• Does this patient have trauma injuries?
• Does this patient have both?
• Is this patient a load and go?
• Do we need ALS support

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Load and Go Patients

• Rapid trauma assessment
• Head to toe exam while maintaining C spine
  stabilization
• Note any obvious findings
• Assess any areas that will be inaccessible after
  immobilization (Neck / Back)
• Support and treat any life threats

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Assessment Acronyms

• DCAP BLS TIC
• OPQRST
• SAMPLE
• FAST
• GEMS Diamond

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Assessment Tools

• BP Cuff
• Stethoscope
• Pulse Oximeter
• Pen light
• Glucometer
• AED
• Senses
• Look listen and feel

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Trauma Patient

• Once loaded and enroute start secondary
  assessment
• Head to toe using DCAP BLS TIC
• Assess any previous treatments performed
• Bandaging and splinting
• Note any abnormal findings
• Notify medical command of assessment and ETA

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Key Point

• Trauma patients may have an underlying medical
  problem that is exacerbated by the injury
• OR
• A Medical problem may have resulted in a
  traumatic injury

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The Medical Patient

• Focus assessment on chief complaint
• Cardiac
• Respiratory
• Abdominal complaints
• Neurological complaints
• Perform interventions as indicated
• Notify medical command of findings, treatment,
  and ETA

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Reassessment

• Every 5 minute for unstable patients
• Every 15 minute for stable patients

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Changes in Condition

• Check previous interventions
• Start over with primary assessment

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Assessment Challenges

• Geriatrics
• Pediatrics
• Special needs patients
• Language barrier
• Multiple patients

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Skills Practice

• Review hands on assessments both medical and
  trauma using WVOEMS approved skills sheets as a
  guide