EMT Ch 12 Ongoing Assessment
pallor
an extreme or unnatural paleness, may indicate shock
reassessing the circulation of a young child or infant
do not forget to chck capillary refill. The pink should return in less than 2 seconds. Small children with small nail beds you can press on the top of a hand or foot to check capillary refill.
Check interventions
ensure adequacy of oxygen delivery and artificial ventilation be sure to check the entire path of oxygen from the to the mask/face for kinks or disconnection and availility. ensure management of bleeding ensure adequacy of other interventions. also check the non rebreather bag to be sure it is not deflating fully and check the regulator. Increase the flow rate it the bag deflates when patient breaths. Check cervical collars, backboard straps and splints for adjustment.
While doing the ongoing assessment
explain to a conscious patient what you are doing, talk in a reassuring tone and consider the patients feelings such as anziety or embarrassment.
reassess and record vital signs
pulse, respiration, skin, pupils and blood pressure. Compare results. May evaluate oxygen saturation in accordance with local protocol. Record vital signs as soon as you take them.
repeating the initial assessment
reassess the mental status maintain an open airway monitor breathing for RATE and QUALITY reassess the pulse for rate and quality monitor skin color and temperature re-establish patient priorities.
documenting is important so you can see
trends in the patients condition
ongoing assessment for Stable and Unstable patients
Stable patients every 15 min, alert and vitals are in normal range and no serious injury. Unstable patients every 5 min., altered mental status, difficulty with airway, breathing or circulation, including severe blood loss or a significant mechanism of injury. When in doubt, repeat every 5 min. or as frequently as possible.
repeat the focused physical exam assessment
a chest injury may become apparent as muscles get tired and you see paradoxical motion that was not present before.
trending
changes in a patients condition over time, such as slowing respirations or rising pulse rate, that may show improvement or deterioration, and that can be shown by documenting repeated assessments. Document the changes
ongoing assessment
the steps to take to become aware of the patients condition which can change gradually or suddenly. Detect changes AFTER life threatening interventions and must never be skipped unless you are too busy saving the patients life. And often AFTER you have done the DETAILED physical exam.
ongoing assessment involve 4 steps
repeat initial assessment (to check for life threatening problems) reassess vital signs, repeat the focused assessment related to the patient's specific complaint or injuries and check any interventions you have performed.
Ongoing assessment for a stable patient
repeat initial assessment checking for immediate life threatening problems, general impression, mental status, ABC's and external bleeding and checking oxygen route. reassess focused hystory and physical exam, checking on chief complaint.
Ongoing assessment for an unresponsive trauma patient.
scene size up, initial assessment, significant mechanism of injury and compromised airway. C-spine stabilization and jaw thrust, insert oral airway and oxygen and complete the rapid assessment, backboard and load him, detailed physical exam in the ambulance en route. Proceed with ongoing assessment. Repeat initial assessment to check for life threatening problems, mental status, ABC's, suction if needed and oxygen. If breathing drops Below 8 per minute and shallow is FROPVD at a rate of 12 per min. Now ventilation is needed and pulse is rapid and weak, Skin is pale, cool, and sweaty. REPEAT VITALS. Reassess rapid trauma assessment, no new findings Check interventions, straps, oxygen etc.
establishing mental status for a child or infant is done by
shouting or flicking the feet, crying would be adequate
initial assessment is
the general impression, AVPU, ABC's and priority.