Basics of Pt Assessment

Question 1

Scene Size Up

Answer 1

Steps taken when approaching the scene
• Ensure BSI & PPE
• Observe scene for safety of crew, patient, bystanders.
• Identify the mechanism of injury or nature of illness.
• Identify the number of patients involved.
• Determine the need for additional resources including Advanced Life Support.
• Consider C-Spine stabilization

Question 2

Initial Assessment (Components)

Answer 2

General Impression, Mental Status, ABC, identify Priority Pts and need for ALS

Question 3

Initial Assessment (General Impression)

Answer 3

• Mechanism of injury or nature of illness
• Age, sex, race
• Find and treat life threatening conditions (any obvious problems that may kill the patient
within seconds). Problems with Airway, Breathing, or Circulation
• Verbalize general impression of patient

Question 4

Initial Assessment (Mental Status)

Answer 4

If the pt. appears to be unconscious, check for responsiveness, (“Hey! Are you OK”?)
• Evaluate mental status using AVPU.
• Obtain a chief complaint, if possible

Question 5

Initial Assessment (Airway)

Answer 5

• Is the pt. talking or crying?
• Do you hear any noise?
• Will the airway stay open on its own?
• Does anything endanger it?
• Open the airway - head-tilt-chin-lift or jaw thrust – as needed
• Clear the airway – as needed
• Suction - as needed
• Insert an OPA/NPA - as needed

Question 6

Initial Assessment (Breathing)

Answer 6

• Do you see any signs of inadequate respirations?
• Is the rate and quality of breathing adequate to sustain life?
• Is the patient complaining of difficulty breathing?
• Quickly inspect the chest for impaled objects, open chest wounds, and bruising (trauma)
• Quickly palpate the chest for unstable segments, crepitation (trauma), and equal expansion of the chest
• If the pt. is responsive and breathing < 8 or > 24, administer oxygen using a NRB at 15 LPM.
• If the pt. is unresponsive and breathing is adequate, administer oxygen using a NRB at 15 LPM.
• If the pt. is unresponsive and breathing is inadequate, administer oxygen using a BVM at 15 LPM, with OPA.

Question 7

Initial Assessment (Circulation)

Answer 7

• If the pt. is unresponsive, assess for presence and quality of the carotid pulse.
• If the pt. is responsive, assess the rate and quality of the radial pulse.
• If radial pulse is weak or absent, compare it to the carotid pulse.
• For patients 1 year old or less, assess the brachial pulse.
• Is there life threatening hemorrhage?
• Control life threatening hemorrhage
• Assess the patient’s perfusion by evaluating skin for color, temperature and condition (CTC); can also check the conjunctiva and lips
• Assess capillary refill in infant or child < 6 yrs. old
• Cover with blanket and elevate the legs as needed for shock (hypoperfusion)

Question 8

Initial Assessment (Identify Priority Pts)

Answer 8

• Consider the need for Advanced Life Support
• If the patient is CRITICAL, UNSTABLE or POTENTIALLY UNSTABLE , begin packaging the patient during the rapid assessment while treating life threats and transport as soon as possible.
• In addition, perform the rapid trauma assessment for the trauma patient if he/she has significant mechanism of injury and apply spinal immobilization as needed.
• For the unresponsive medical patient perform the rapid medical assessment.
• If the patient is or STABLE, perform the appropriate focused physical exam (for the medical pt. perform the focused physical exam; for trauma patient perform the focused trauma assessment.)