Unit 4 - Assessment Flashcards
Keys to knowing the MOI
Understand the sport
Know what to look for
Optimal viewpoint
Pay close attention to the field of play
Primary Assessment Steps
- Introduce yourself (gain consent).
- Spinal Motion Restriction (SMR).
- Assess:
○ Chief Complaint (C/C)
○ Level of Responsiveness (LOR)
○ Airway
○ Breathing / Circulation - Pulse oximetry
- Perform Rapid Body Survey
- Reassessment (ABCs)
- EMS & Rapid Transport Decision.
Precautions of a spinal injury
○ Unresponsiveness
○ Unknown MOI
○ Fall > 1 m (3.3 ft) or 5 stairs
○ MVC or ejection from motor vehicle
○ Patient’s helmet is broken
○ Severe blunt force to head or trunk
○ Penetration wound to head or trunk
○ Diving accident
Chief Complaint (C/C)
- Always an injury or condition It is not the MOI!
- Ask the patient “what seems to be the problem?”
- If the patient is unresponsive, the C/C is unresponsive
Level of Responsiveness (LOR)
○ Alert: Eyes are open; patient is able to verbalize
○ Verbal: Patient responds to commands or questions.
○ Painful: Patient exhibits facial grimace; flexion, extension or withdrawal of body part; or moans.
○ Unresponsive: Patient makes no response
Assess Airway (A)
- Responsive Unresponsive
- Ask a question & evaluate if the response is clear & unobstructed.
§ If so, they have a clear airway.
- Ask a question & evaluate if the response is clear & unobstructed.
- Unresponsive
- Open: grasp the tongue & draw the mandible anteriorly or use cross-finger technique.
- Inspect: Look inside for mouth guard, broken or loose teeth, vomit, blood, gum, etc.
- Clean: manually or with suction.
- Secure: HTCL / JT / OPA / NPA
Assess Breathing (B) & Circulation (C)
- Look, Listen & Feel
- Assess (10 sec) the presence of breathing & circulation simultaneously.
- If either are present, include assessment of their quality.
S / S: Abnormal Breathing
- Inadequate rise & fall of the chest.
○ Too quiet breathing - Increased effort on respiration.
○ Loud breathing - Decreased LOR.
- Dyspnea.
○ Labored breathing - Cyanosis.
○ Patient is blue - Bradypnea
○ Slow breathing - Tachypnea.
○ Fast Breathing
Pulse Oximetry (Sp02)
- device that measures the % of hemoglobin saturated with oxygen.
- % of oxygen saturation of blood and pulse
- neurological, respiratory, cardiovasc complaints
- abnormal vital signs
- under effects of respiratory depressants
- multi system trauma patients
Normal SP02 and treatment
95-100%
No treatment
Mild Hypoxia and treatment
91-94%
Oxygen via a nasal cannula or simple mask
Moderate Hypoxia and treatment
86-90%
Oxygen via a NRM or BVM with oxygen reservoir
Severe Hypoxia and treatment
<85%
Oxygen via a NRM or BMV with oxygen reservoir
Rapid Body Servey (RBS)
- Rapid assessment for severe external bleeding, signs of internal bleeding or potential life- threatening fracture. - < 30 sec unless intervention is required.
When should you call EMS?
-Decreased LOR or unresponsive.
- Instability / absence of ABCs
- Severe or multi-system trauma
- Neurological deficits
- Internal or external hemorrhage
- Ongoing seizures
-Chest pain (MI suspected)
- Burns with signs of inhalation injury
- Extensive burns
- Abdominal distension & tenderness
- Unstable pelvic injury
- Femoral # (# = fracture)
- Amputation
- Childbirth complications
- Severe hypothermia
- Electrocution
- Decompression illness
Information to Provide EMS Dispatcher
- Location of the emergency.
- Telephone number from which the call is made.
- Caller’s name.
- What happened.
- Number of casualties.
- Condition of the casualties.
- Care being provided.
Secondary Assessment
- Patient History
○ SAMPLE
○ PQRST - Vital signs
- Physical Assessment
SAMPLE / MAPLES
M: medication (kind, dose, last time, why)
A: allergies (what are they? relevant?)
P: past medical history (anything like this? conditions?)
L: last oral intake (when, what, quantity)
E: events leading up
S: signs (objective) and symptoms (subjective)
PQRST
Onset (when, how long)
Provoke (what makes it worse/better)
Quality (describe pain: sharp, dull)
Region/Radiation (centralized, radiate)
Severity (how bad? 0-10)
Timing (constant, come and go)
Anatomical Differences in Children
- Tongue – larger
- Airway – smaller
- Nose & face – flat
- Brain tissue – thinner & softer
- Neck – short
- Respiratory rate – faster
- Ribs – more flexible
- Body surface – larger
- Bones – softer
- Skin – thinner
7 Vitals in secondary assessment
- Level of responsiveness (LOR)
- Respiration
- Pulse
- Sp02
- Skin characteristics
- Blood pressure
- Pupils
LOR in Secondary Assessment
- Reassess LOR: Glasgow Coma Scale (GCS)
- Eye opening.
- Best verbal response.
- Best motor response.
Glasgow Coma Scale (GCS)
Max = 15
Mild = 13-15
Moderate 8-12
Severe = <8 - coma
Respirations
- Assessing rate, rhythm & volume.
- “regular, quiet, effortless” shallow, deep, wheezy, laboured, raspy…
- Rate = 15 sec assessment X4
- Normal is 12-20
