EMT Chapter 11 The Primary Assessment

how long do you take a pulse?

30 seconds, then multiply by two

how many parts make up a primary assessment?

6

if a patient shows signs of life, what order do you do ABCs?

ABCs

commission

Actions performed on the patient that are wrong or improper are called, errors of __________. (like assisting the patient with the wrong medicine or giving the patient medicine when there was no need for it)

EMTs must adapt the expectations of the primary assessment based upon the age of the patient

Adjust assessment to social and physiological norms of children

How should you assess airway, breathing, and circulation during the primary assessment?

Airway and breathing are first assessed by talking to the patient. If patient can speak, then at least at some level the airway and breathing are intact. If no airway is present, steps must be taken to provide one. Breathing is assessed by ensuring adequacy of breathing and recognizing respiratory arrest or respiratory failure. Circulation is assessed by evaluating pulses, skin, and gross bleeding.

Assess Mental Status: AVPU

Alert Document orientation to person, place, and time Verbal response Painful response Unresponsive

Findings that indicate critical patient

Altered mental status Anxiety Pale, sweaty skin Obvious trauma to head, chest, abdomen, pelvis Specific positions indicating distress

Circulation

Assess pulse Assess skin Assess bleeding

General Impression

Assesses environment, patient's chief complaint, and appearance Helps determine patient severity Helps set priorities for care and transport "Look Test": feeling from environmental observations as well as first look at patient Patients appearing lifeless Resuscitate by beginning CPR compressions Prepare AED as soon as possible

if a patient appears lifeless and has no pulse, what order do you do ABCs?

CAB

data element

Each individual box in the pre-hospital care report is called a __________.

Approach to the Primary Assessment

Focus on life threats Airway (A), breathing (B), circulation (C) May vary depending on Patient's condition On the scene resources Other Order of A-B-C depends on initial impression of patient Sequence will vary A-B-C if patient has signs of life C-A-B if patient appears lifeless, no pulse Immediate interventions may be needed

Primary Assessment Steps

Forming a general impression Assessing mental status Assessing airway Assessing breathing Assessing circulation Determining patient priority

Assessing skin

Good circulation: warm, pink, dry skin Shock: pale, clammy (cool and moist) skin With dark-skinned patient, check color of lips or nail beds, which should be pink if circulation is good.

omission

If an important part of assessment or care is left out, it is called this kind of error. (like not giving the patient oxygen when they needed it or writing that you gave oxygen but you didn't)

Subjective Information

Information from the patient's point of view. "I feel dizzy."

SPO2

Oxygen saturation is defined as the ratio of oxyhemoglobin to the total concentration of hemoglobin present in the blood

Patient Characteristics

Patient characteristics determine the form of assessment Medical or traumatic problem? Altered mental status? Child or adult? Patient assessment may need to be adjusted based on the patient's characteristics. Mental status, nature of illness, and severity of injury all impact the assessment technique. General impression and evaluation of mental status vary greatly between conscious patients and unconscious patients. EMTs must consider spinal immobilization during the primary assessment of a trauma patient.

Chief Complaint

Patient's description of why EMS was called May be specific—"abdominal pain" May be vague—"not feeling good"

1 to 5 watts

Portable radios have an output of _____ to _____ watts.

Potentially unstable

Potential for deterioration can indicate potentially unstable category

Assess Circulation

Pulse-Rate, Rhythm and Regularity Skin Colour Temp and Condition, Major Bleeding, Perfusion

for immediate airway intervention

Rapidly identify the need for

Chapter 17

Report writing and radio reporting are critical skills that are just as important as starting IVs and giving medication. Written reports and recorded on-line consultations are legal documents that can be called into evidence. They should be concise and professional. A common phrase used to describe medical documentation is: "If you did not write it down, you did not do it." Review your reports carefully to ensure all of the assessments and care you provided are reflected in your documentation and that your care reflected the standard of care and your protocols. The quality of your written documentation and verbal communication conveys your level of professionalism to other members of the healthcare team.

Situations calling for breathing assistance

Respiratory arrest Not alert, inadequate breathing Some alertness, inadequate breathing Adequate breathing, but signs suggesting respiratory distress or hypoxia

Determining Patient Priority

Stable Vital signs in normal range Potentially unstable Potential for deterioration can indicate potentially unstable category Unstable Threat to ABC's rules out stability

objective statements

Statements that are observable, measurable, or verifiable. observable = "The patient has a swollen, deformed extremity." measurable = "The blood pressure was 120 over 80." verifiable = "The patient uses a prescribed inhaler."

20 to 50 watts with a range of 10 to 12 miles

The output of a mobile radio is generally _____ to _____ watts with a range of ____ to _____ 15 miles

Pertinent Negative Information

These are examination findings that are negative, or things that are not true. "Patient denies difficulty breathing with his chest pain."

Unstable

Threat to ABC's rules out stability

Federal Communications Commission, FCC

To maintain order on the airwaves, the __________, assigns and licenses radio frequencies.

Immediate Intervention

Treat any life-threatening ABC problem as soon as discovered! : Any life threats found while evaluating the ABC's must be treated immediately.

omission and commission

Two types of errors may be committed during a call: __________ and __________.

Stable

Vital signs in normal range

Three results of assessing pulse

Within normal limits Unusually slow Unusually fast During primary assessment, pulse check is performed rapidly. It is not necessary to take the pulse for a full 30 seconds and obtain an exact rate. Any result other than within normal limits is cause for concern.

repeater

a device that picks up signals from lower-power radio units, such as mobile and portable radios, and retransmits them at higher power. it allows lo power radio signals to be transmitted over longer distances.

portable radio

a hand-held two-way radio

clinical judgment

a judgment based on experience in observing and treating patients

AVPU

a memory aid for classifying a patient's level of responsiveness or mental status. The letters stand for alert, verbal response, painful response, unresponsive

mental status

a patient's level of responsiveness

Cell Phone

a phone that transmits through the air instead of over wires so that the phone can be transported and used over a wide area.

Base Station

a two-way radio at a fixed site such as a hospital or dispatch center.

mobile radio

a two-way radio that is used or affixed in a vehicle

intervention

actions taken to correct or manage a patient's problem

interventions

actions taken to correct or manage a patient's problems

ABCs

airway, breathing, and circulation

what does AVPU stand for?

alert, verbal response, painful response, unresponsive

General impression

although subjective, can provide extremely useful information regarding urgency of a patient's condition.

drop report or transfer report

an abbreviated form of the PCR that an EMS crew can leave at the hospital when there is not enough time to complete the PCR before leaving.

what are 3 indicators of possible shock?

anxiety, pallor, sweatiness

what should you first do with a patient with suspected spinal injury?

apply manual stabilization of the head and neck

what do you do with a patient that is alert but has inadequate breathing?

assist ventilations with 100% oxygen, synchronizing ventilations to the patient's to work together

what are the 3 steps of breathing in ABCs?

check for breathing check to see if the breathing is adequate check for hypoxia

what are the 3 steps of circulation in ABCs?

check for pulse check the skin check for life-threatening bleeding

what indicates a high priority transport?

conditions in which there is usually little or no treatment that can be given in the field and will make a difference in the patient's well-being

after a primary assessment, how would you handle a potentially unstable patient?

expedite transport, fewer assessments and interventions

general impression

first impression of the patient's condition based off environment, chief complaint, and appearance

what are the parts of primary assessment in order?

general impression mental status/c-spine (when appropriate) airway breathing circulation priority

general impression

impression of the patient's condition that is formed on first approaching the patient, based on the patient's environment, chief complaint, and appearance.

chief complaint

in emergency medicine, the reason EMS was called, usually in the patient's own words

Primary assessment

is a systematic approach to quickly find and treat immediate threats to life.

Priority decision

is the determination of the need for either immediate intervention or transport (or both). This decision is completed after assessing ABC's and is directly related to recognizing life threats.

mental status

level of responsiveness

how is a general impression formed?

looking, listening, and smelling

what can altered mental status indicate?

many underlying conditions such as hypoxia, shock, diabetes, overdose, or head trauma

flail chest

multiple broken ribs

how do you classify a stable patient?

normal or slightly abnormal range vital signs a stable airway no immediate life-threats

how should you be concerned with altered mental status during primary assessment?

not with the cause, but with the impact it has on your patient

how do you classify an unstable patient?

one with no immediate life-threats but may deteriorate over time due to the nature of their problem

what are the 3 steps of airway in ABCs?

open the airway, suction if necessary, place an OPA or NPA if needed

what do you do if a patient is in respiratory arrest?

perform rescue breathing

what do you do if you discover a life-threatening condition during primary assessment?

perform the appropriate intervention

give 5 examples of high priority conditions

poor general impression unresponsive shock uncontrolled bleeding severe pain anywhere

2 terms that primary assessment are also known as

primary survey and initial assessment

what do you do with a patient that has adequate breathing but signs/symptoms of respiratory distress or hypoxia?

provide oxygen based on patient's need as determined by examination, patient's complaint, and pulse oximetry readings

what do you do with a patient that is not alert and has inadequate breathing?

provide positive pressure ventilation with 100% oxygen

after a primary assessment, how would you handle an unstable patient?

rapid transport, only life-saving assessment and interventions on scene

how can chest injury affect the patient?

reduce the rate and depth of breathing, and functioning of lungs

what can a patient in tripod position indicate?

significant difficulty breathing

after primary assessment, how would you handle a stable patient?

slower pace, more detailed secondary examination

If airway is not open or is endangered

take measures to open

priority

the decision regarding need for immediate transport vs further assessment and care at the scene

priority

the decision regarding the need for immediate transport of the patient versus further assessment and care at the scene

primary assessment

the first element in a patient's assessment; steps taken for the purpose of discovering and dealing with any life-threatening problems. the six parts of primary assessment are: forming a general impression, assessing mental status, assessing airway, assessing breathing, assessing circulation, and determining the priority of the patient for treatment and transport to the hospital.

Levine's sign

the global position of heart attack; a fist clenched over the chest

primary assessment

the portion of patient assessment that focuses only on life threats, specifically ABCs

chief complaint

the reason the EMS was called; usually in the patient's own words

watt

the unit of measurement of the output power of a radio

exsanguinating

very severe, life-threatening

high-priority conditions

•poor general impression •unresponsive •responsive, but not following commands •difficulty breathing •shock •complicated childbirth •chest pain consistent with cardiac problems •uncontrolled bleeding •severe pain anywhere