EMT Ch 9 Patient Assessment Knowledge Objectives (J&B 11ed)

Describe the assessment of airway status in patients who are both responsive and unresponsive, including examples of possible signs and causes of airway obstruction in each case as well as the appropriate EMT response.

Assess: patency and adequacy Responsive: talking or crying means patent, listen to how pts speak to determine adequacy; stop and clear pts airway if there is a problem Unresponsive: assess patency (trauma = jaw thrust manuever, no trauma = head tilt-chin lift) Signs of obstruction (unconscious): Obvious trauma, blood, or other obstruction; Noisy breathing, such as snoring, bubbling, gurgling, crowing, stridor, or other abnormal sounds; Extremely shallow or absent breathing

List the minimum standard precautions that should be followed and personal protective equipment (PPE) that should be worn at an emergency scene, including examples of when additional precautions would be appropriate.

Assume all blood, bodily fluids, nonintact skin, and mucous membranes pose a threat of exposure to communicable disease minimum: gloves additional: glasses, mask

Discuss some of the possible environmental, chemical, and biologic hazards that may be present at an emergency scene, ways to recognize them, and precautions to protect personal safety.

Be aware of the environment: - location (in/outdoors, public/private) - weather and its effect on terrain - water, mud, ice - uneven/unstable surfaces - sharp metal, broken glass - road and traffic hazards - violence - fire, explosions - Chemical: hazardous materials, carbon monoxide - Electrical: downed power lines - Biological: biohazards (blood, body fluids), infectious diseases, airborne pathogens Precautions: - Wear proper BSI and PPE - Roadway: high-visibility safety vest, traffic markers (cones, flares, signs), traffic personnel, strategic positioning of vehicles - Call for additional resources - Any actions to protect yourself should also be done for the pt whenever possible

Explain the importance of assessing a patient's level of consciousness (LOC) to determine altered mental status, and include examples of different methods used to assess alertness, responsiveness, and orientation.

LOC gives insight about neurologic and physiologic status Consciousness: - unconscious - conscious w/ altered LOC - conscious w/ unaltered LOC Responsiveness: APVU (awake/alert, verbal stimuli, pain, unconscious) Orientation (mental status): Person, Place, Time, Event

Describe how to determine the mechanism of injury (MOI) or nature of illness (NOI) at an emergency and the importance of differentiating trauma patients from medical patients.

MOI (trauma): classified according to type/amount of force, duration, location on body; Blunt vs penetrating trauma, fragile/easily injured areas of body, unseen injuries, potential for infection NOI (medical): general type of illness pt is experiencing; CC Determination: search for clues; talk with the pt, family, or bystanders; meds, substances, unsanitary conditions, sounds, smells. Also: Be aware of scenes with multiple pts exhibiting similar signs/symptoms (may indicate scene is unsafe! ex: carbon monoxide poisoning) Importance: direct assessment and care of pt; determine appropriate equipment/resources; may be ambiguous (consider pt unconscious at bottom of ladder: did they fall, hit head, and lose consciousness [trauma] or did a medical problem cause of loc and fall?)

Discuss the steps EMTs should take to survey a scene for signs of violence and to protect themselves and bystanders from real or potential danger.

Situations at risk for violence: - violent pts - distraught family - angry bystanders - gangs - unruly crowds Request assistance of law enforcement and move to a safe location. Scan for weapons (both typical and any object that could act as a potential weapon). Place self between pt and potential weapon to prevent access. Remain aware of the scene and any changes.

Explain how the different causes and presentations of emergencies will affect how EMTs perform each step of the patient assessment process.

The steps represent a logical approach to evaluation but the order should be dictated by the PTs chief complaint MOI/NOI. It may be necessary to re-order or prioritize the steps after scene size up based on your findings.

Explain why it is important for EMTs to identify the total number of patients at an emergency scene and how this evaluation relates to determining the need for additional or specialized resources, implementation of the incident command system (ICS), and triage.

You can only transport one pt at a time for multiple pts use ICS, identify # of pts, and begin triage ICS: system to manage a variety of emergency scenes (resources from other entities, ex: FD, PD, ALS, air medical support, additional ambulances, CPS) Triage: prioritizing multiple pts based on severity of condition

Explain the process of forming a general impression of a patient as part of primary assessment and the reasons why this step is critical to patient management.

general impression used to determine priority of care; observe demographics, level of distress, appearance, LOC, and ABCs. Observe behavior and answers to questions Determine if stable, stable but potentially unstable, or unstable

Describe the principal goals of the primary assessment process, including how to identify and treat life threats and determine if immediate transport is required.

goal: identify & begin treatment of imminent life threats assess: significant trauma, bleeding, LOC, ABCs significant trauma, AMS, problems with A, B or C warrant immediate transport risk for sudden death: airway obstruction, respiratory failure, respiratory arrest, shock, severe bleeding, cardiac arrest

Identify the components of the patient assessment process.

1. scene size-up 2. primary assessment 3. history taking 4. secondary assessment 5. reassessment