Patient Assessment Model (PAM) Flashcards
Introduction
“Hi I’m a medic of the SAF, if you can hear me please do not move your head.”
Ask someone perform head grip
Rescue Scene Evaluation
What is the ENVIRONMENT?
Are there any HAZARDS?
What is the MECHANISM OF INJURY?
Order of primary survey
RSE Introduction + Head grip Level of consciousness (LOC) Delicate Spine Airway Breathing Circulation Rapid Body Survey Temperature Oxygen Position Decision Point
When do you activate Stretcher, Medical centre, Safety vehicle (SMS)?
NACTO factor hit
Neurological Airway + Breathing Circulation Trauma + Toxin (RBS) Others (RBS)
Temperature > 38.0 degree Celsius
Remember to sound off ______ if have/don’t have.
What to do if have?
NACTO factors + temperature >38.0 degree Celsius.
“Under NACTO, _____________”
If have, remember activate SMS. Physically say “You get a stretcher, you call the medical center, you get the safety rover.”
Level of consciousness
Alert,Verbal [Conscious]
Pain,Unresponsive [Unconscious]
- Rmb to trapeze squeeze if unconscious
Time: What time of day is it now?
Place: Where are you?
Person: Who am I?
- NACTO(N): Fainting, unconscious (FUN), Losing conscious, Ability to answer TPP
Delicate Spine
“Did you fall and hit your head? Did you fall from height” –> Yes, activate SMS
Palpate and check for deformities,tenderness,laceration (DTL) on neck
- -> Yes, activate SMS
- -> No, no spinal injury suspected, remove head grip
- NACTO (T): Spinal injury/fall from height
Airway
Patient conscious + talking (LOC:A) = Airway clear
If not, open airway and check (Head tilt chin lift, Jaw thrust if spinal suspected)
CI: Insert OPA if unconscious
“Measure from tip of lip to earlobe. Open mouth with cross finger technique. Insert OPA hard palate to soft palate. Rotate 180 degrees. Flange resting on tip of lips. OPA inserted”
Breathing
Look Listen Feel (Look for chest rise, Listen + Feel breathing)
- NACTO (A): [BOAS]
- Breathing difficulties
- Obstruction of airway
- Asthma attack
- Smoke inhalation (check nose for soot)
Circulation
Check radial pulse (wrist, trace from thumb)
If absent, check carotid pulse (neck, near Linus’ apple)
- NACTO (C): [PROC]
- PROfuse bleeding (Shock)
- Chest pain
CI: Do AED for unconscious patient here (Mention the 4 hazards to check for + HJPMS)
- Flammable gas
- Water
- Metal
- Explosives
Hair Jewelry Pacemaker Medicinal patch Sweat
Place pads, turn on AED, stand clear, no shocked advised, turn off AED
Rapid Body Survey
“I’m going to perform a rapid body survey to check for any life/limb threatening injuries.”
Inspect and palpate while maintaining constant eye contact (see when they react)
Head, neck, chest, abdomen, pelvis (pelvis rock, push down one side other comes up), lower extremities (One leg at a time,further leg first), upper extremities(further arm first, back (Ensure actually checking the part, esp for back)
Check for medication
Expose area in pain
For back, check upper, mid and lower 3 times each, ask witness if any blood on hands.
- NACTO (TO): [SHIPS SPIN,BED]
- Severe limb injuries
- Head/eye injuries
- Insect bites with rxn/ snake bite
- Penetrating wound
- gun Shot wound
- SPINal injury/fall from height
- Burn injuries (2nd degree or higher)
- Electric shocks
- Drug overdose
CI: Gunshot/puncture wound: Chest seal
CI: Burns (2nd/3rd degree: Flush wound with r.t. water)
Temperature
Oral/Tympanic thermometer
Change to °C, adult mode
- Temperature > 38.0°C, activate SMS
(MOI no suspected heat injury no need take)
Oxygen
Give 100% oxygen at 10L/min using NRM
(Recall NRM steps)
Let the reservoir bag fill up
Straps tighten
Nose clip fit
Misting seen
Position
“Are you comfortable in this position?” If yes don’t move casualty
- > Unconscious/Drowsy/spinal: Supine
- > Breathlessness/Chest injury: Semi fowler
Decision Point
Voice out all reasonings for decision
a) Suffering from any NACTO conditions?
b) Temperature above 38.0°C?
If any a/b = LOAD AND GO
If none of a/b = STAY & TREAT`
Load and go
- Get 3 other witness to get casualty on stretcher and load on vehicle with proper lifting techniques (underarm for conscious)
- Ask one witness to get casualty’s identification and medication if any
- Assess casualty’s ABC once on safety vehicle (go check gundu)
- Close doors of safety vehicle
- Connect oxygen to mains if available
- Ask driver to drive to nearest medical center and ETA
- Call medical center and GRACE IT
Gender Race Age Chief complaint ETA Identification Treatment given
Treatment and Evacuation
Reassess ABC every 5 min
Carry out appropriate treatment protocol depending on the scenario
Administer IV always (Maintenance if radial present OR Chest pain, Bollus if radial absent). Max 2 bollus 1 maintenance
Secondary Survey components
- Chief complaint
- History of chief complaint (LOTAARRRP,MMA)
- Vital signs (8)
- Head to toe examination
- Report and record
- Write everything on a piece of paper
History of chief complaint
Location Onset Type Aggravating Associated Relieving Recurring Radiating Precipitating
Medical history (Any other medical conditions?)
Medication (Any current prescriptions? Any in past 24h?)
Allergies (Food, Environment, Drugs)
Vital signs
TPR + BP + SpO2 + GCS + Skin condition + Pain score
- Temperature
- Pulse (Radial/carotid for 10s x 6)
- Respiration (Breaths for 10s x 6)
- Blood pressure (Propaq,blood pressure cuff, radial pulse)
- Radial pulse present (90-120)
- Radial pulse absent (60-90) - SpO2 (Propaq)
- GCS (Can you point at my nametag and read out my name? Can GCS score = 15, don’t go bobo point yourself, check card)
- Skin condition (back of palm w/o gloves)
- Pain score (1 to 10, 1 being least pain, 10 being most pain)
Check vitals every 5min for unstable casualty
Check vitals every 15min for stable casualty
Head to toe examination
RBS w/o pants, eye contact with casualty?
Report and record
Pass de paper + MIST
Mechanism of injury
Injury
Signs & symptoms
Treatment given
What are the critical interventions and when to do?
- Massive haemorrhage (Before or after LOC)
- Puncture/gunshot wound (RBS)
- Burns, 2nd/3rd (RBS)
- OPA insertion (Airway)
- AED (Circulation)
Critical intervention for burn?
Expose 2nd/3rd degree burn
Cool burn area with rt and Low pressure water
- thermal 10min
- liquid chemical till liquid chemical gone
- powder chemical rub off with gloves
Don’t use ice/cold water
Don’t rupture blister
Treatment for burns?
FAN dry wounded area
Apply PU film, unless blister
IV (check radial for bolus/maintenance)
First thing to do for heat injury?
Move casualty under shelter if RSE suspect heat injury
Treatment for heat injury?
- Remove all clothing + LBS
- Cool with EM cool/ ice packs
A) Lay EM cool on stretcher first, EM cool chest one go under arm, words facing up,
* don’t apply EM cool over AED, thigh one while analysis, after analysis take off AED then put the rest
B) ice packs at neck,armpits, groin, irrigate/sponge with cool water
- Fan casualty
- IV (check radial for bolus/maintenance)
7Rs for heat injury treatment
- Recognise signs and symptoms
- Reduce temperature
- Rest in shade
- Remove all clothing
- Rehydrate
- Resuscitate
- Rush to medical centre
SOB asthma treatment
Inhaler
- Shake, Expiry, Allergy, Name
- Exhale
- Form seal around inhaler with mouth
- Breathe in, press inhaler
- Hold breathe 10sec
- Exhale through nose
- Repeat step 2-6
IV (check radial pulse for bolus/maintenance)
SOB Allergic reaction treatment
Epipen
- Expiry, Allergy, Name (EAN)
- uncap, stab outer third of thigh
- Bend needle on solid object once administered
IV (check radial pulse for bolus/maintenance)
Immediate respiratory failure (IRF) signs and symptoms
Any of the 3
- Breathing difficulty (more than 30, less than 10) [breathing]
- Use of accessory muscles eg neck muscles [RBS]
- Inability to speak in complete sentences [LOC]
IRF treatment
- Bag with BVM
2. Match casualty breathing rate at first, slow it down/bring it up afterwards (12bpm)
