7 - Primary Assessment Flashcards
When an emergency occurs, one of the most essential aspects of your job is the
primary (initial) assessment
Process used to quickly identify those conditions that represent an immediate threat to the patient’s life, so that you may properly tram them as they are found.
Primary assessment
An effective primary assessment includes:
1) creating a general impression of the patient
2) checking for responsiveness
3) checking the airway, breathing & circulatory status
The four main components to consider during a scene size-up include:
1) Scene safety
2) The MOI or NOI
3) Number of patients involved
4) Resources needed
Determining the MOI and NOI:
1) look around the scene for clues to what caused the emergency and the extent of the damage
2) consider the force that may have been involved in creating an injury
3) if a patient is unconscious, determining the MOI or NOI may be the only way you can identify what occurred
When to summon more advanced medical personnel:
1) unconsciousness or altered LOC
2) Breathing problems
3) Chest pain, discomfort or pressure lasting more than a few minutes, that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back.
4) Persistent abdominal pain or pressure
5) No pulse
6) Severe external bleeding
7) Vomiting blood or passing blood
8) Severe burns
9) Suspected poisoning
10) Seizures
11) Stroke
12) Suspected or obvious injuries to the head, neck or spine
13) Painful, swollen, deformed areas or an open fracture
CRITICAL FACT
Primary assessment is essential to the job of an EMR to ensure proper care. However, a scene size-up to evaluate safety, MOI or NOI, number of patients and resources needed should always be done first.
CRITICAL FACT
To determine the MOI or NOI, check the scene for clues and consider the force that may have been involved.
CRITICAL FACT
Many conditions warrant summoning advanced medical personnel. These include breathing problems, prolonged chest pain, seizures and suspected head, next or spinal injures ect.
CRITICAL FACT
Always check for life-threatening conditions: lack of consciousness, abnormal breathing, blocked airway, no pulse or severe bleeding
CRITICAL FACT
To asses LOC, ask simple questions such as “What is your name?” LOC can range from being fully alert to unconsciousness. Always approach a patient from the front to avoid head turning.
Alert
Patients who are alert are aware of their surroundings, able to acknowledge your presence and able to respond to your questions.
Verbal
Sometimes the patient is only able to react to sounds, such as your voice. The patient’s eyes may be closed but they open when hearing your voice or when the patient is told to open them. The patient may appear to be lapsing into unconsciousness.A patient who has to be stimulated by sound to respond is described as responding to verbal stimuli.
Painful
A pat heir who does not respond to verbal stimuli or commands, but does respond when someone inflicts pain, is described as responding to painful stimuli. Pinching the earlobe or the skin above the collarbone are examples of painful stimuli used to try to get a response.
Unresponsive
Patients who do not respond to any stimuli are describes as being unconscious or unresponsive to stimuli.
The airway can become blocked by:
fluids, solid objects, the tongue or swollen tissue caused by trauma or severe allergic reaction
Normal breathing rate for an adult is
between 12 and 20 breaths per a minute.
CRITICAL FACT
Look, listen and feel for breathing for no more than 10 seconds.
Adult breathing rates
- 12-20 breaths per minute
- Normal chest rise and fall
- Quiet breathing
- No great effort of breathing
- Rates may alter due to emotional and physical conditions
Children breathing rates
- 15-30 breaths per minute
- Sometimes breathe irregularly, so may need to assess for 1 minute and repeat frequently
- Rates may alter due to emotional and physical conditions
Infant breathing rates
- 25-50 breaths per minute
- Have periodic breathing (periods of rapid, shallow breathing that occurs during sleep; normal for infants)
CRITICAL FACT
It is important to remember that the respiratory status of a patient can change suddenly.
CRITICAL FACT
The respiratory status of a patient can change suddenly.
Number of ventilations per minute for an adult
About 12 (1 ventilation about every 5 seconds)
Number of ventilations per minute for a child or infant
About 20 (1 ventilation about every 5 seconds)
Number of ventilations per minute for a newborn
30-60 (1 ventilation about every 1-2 seconds)
The most commonly used method of checking for adequate circulation is to
check for a pulse
A normal pulse for an adult ranges from
60 to 100 beats per minute.
A well conditioned athlete may have a pulse of
50 beats per minute or lower
An adolescent (11-14) may have a pulse rate of
60-105
A toddler (1-3) pulse ranges from
80-130
Preschool-age (3-5 years) pulse ranges from
80-120
School age (6-10) pulse ranges from
70-100
Newborn pulse ranges from
120-160
Infant (1-5 months) pulse ranges from
90-140
Infant (6 months to 1 year) ranges from
80-140
CRITICAL FACT
A “normal’ pulse is relative. Ask about any known congenital disorders or other natural explanations for an irregular pulse as part of your patient history.
Signs of an abnormal pulse include:
1) irregular pulse
2) weak and hard-to-find pulse
3) excessively fast or slow pulse
Four aspects of skin conditions to note:
1) Color: is it pale and ashen, or flushed and pink?
2) Temperature: is it hot or cold?
3) Moisture: is it moist or dry?
4) Capillary refill: is it normal or slow?
CRITICAL FACT
Check vital signs, such as pulse and respiratory rate, often while you wait for more advanced medical personnel to take over.
Steps in determining whether shock should be treated immediately:
1) Decreases responsiveness
2) A heart rate that is too fast or too slow
3) Skin signs of shock
4) A weak or no radial pulse