Ch07 eec3
- 1. Seven Chapter Scene Size-Up, Initial Assessment, Baseline Vitals, and SAMPLE History
- 2. Components of the scene size-up and how they relate to your personal safety as well as to other parts of the call Initial assessment, including identification and correction of life threats and priority determination SAMPLE history and vital signs Seven Chapter CORE CONCEPTS
- 3. O VERALL ASSESSMENT SCHEME Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP
- 4. Scene Size-up An assessment to ensure the well-being of the EMT-Basic K EY TERM
- 5. Scene Safety Protect bystanders (prevent them from becoming patients) . Never enter an unsafe scene. Make scene safe or call for someone who can. (Continued)
- 6. S CENE SAFETY TECHNIQUES
- 7. Scene Safety Techniques: Observation Fighting or loud voices Intoxicants or illegal drugs Weapons Crime scenes Pets
- 8. Crash or Rescue Scenes Toxic Substances or Hazmat
- 9. Crime Scenes & Violence Unstable Surfaces: Slopes, Ice, Water
- 10. Scene Safety Techniques: Responses to Danger Use cover and concealment. Retreat. Use distractions if necessary. Carry a portable radio.
- 11. Scene Safety Techniques: Planning for Safety Work together. Make your equipment work for you. Dress for safety. Use body armor, if necessary.
- 12. Body Substance Isolation Anticipate the need for BSI. Always have BSI equipment available. Use appropriate equipment to prevent exposure. (Continued)
- 13. BSI Review: Gloves Mask and Eye Protection (Continued)
- 14. BSI Review: Gown
- 15. Mechanism of Injury The physical event that caused an injury (fall, motor vehicle accident, etc.) K EY TERM
- 16. Mechanism of Injury: Trauma Determined from Patient Family Bystander Observation of the scene
- 17. Distance patient fell Part of patient’s body that struck surface Type of surface landed on Did anything break the fall? Mechanism of Injury: Falls
- 18. Mechanism of Injury: Motor Vehicle Collision - Head On (Continued)
- 19. Mechanism of Injury: Motor Vehicle Collision - Rear Impact (Continued)
- 20. Mechanism of Injury: Motor Vehicle Collision - Side Impact (Continued)
- 21. Mechanism of Injury: Motor Vehicle Collision - Rollover (Continued)
- 22. Mechanism of Injury: Motor Vehicle Collision Rotational Multiple injury patterns. (Continued)
- 23. Mechanism of Injury: Motor Vehicle Collision Ejection Deformed windshield, steering wheel, etc. Amount of vehicle deformity Seat belt use
- 24. Mechanism of Injury: Vehicle Interior
- 25. Velocity Body region penetrated Exit wounds (Continued) Mechanism of Injury: Penetrating Trauma
- 26. Mechanism of Injury: Penetrating Trauma
- 27. Nature of Illness: Medical Patient Sources of Information Scene Patient Family and bystanders
- 28. Adequacy of Resources Number of patients? Hazardous materials? Fire or rescue? Unusual situations? (Continued)
- 29. Call for assistance before beginning care. Use triage procedures if necessary. Adequacy of Resources
- 30. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
- 31. Form a General Impression Environment Age Sex Apparent threats to life
- 32. Assess Mental Status A lert V erbal stimulus P ainful stimulus U nresponsive
- 33. P RECEPTOR P EARL Many EMT-Bs, especially at the beginning of their careers, are reluctant to apply a painful stimulus. Out of shyness or a reluctance to harm the patient, they apply only a mild stimulus that is not sufficient to rouse the patient. The EMT then notifies the ED that the patient is unresponsive to verbal and painful stimuli. But on arrival at the ED, the staff is easily able to elicit a response with a brisk sternal rub or a pinch of the trapezius. Watch for this tendency with new or inexperienced EMT-Bs, and give them the benefit of your experience.
- 35. Open and Maintain Airway Medical Patients: Use head tilt, chin lift. Suction and insert oral or nasal airway as necessary. (Continued)
- 36. Trauma Patients: Immobilize the head manually. Use jaw thrust as necessary. Suction and insert oral or nasal airway. Open and Maintain Airway
- 38. Breathing If breathing is inadequate, ventilate with 100% oxygen. If respirations are adequate but faster than 24/minute, give high-concentration oxygen.
- 39. P RECEPTOR P EARL New EMT-Bs, in their desire to explain to the patient everything that is going on, may say something like, “I’m going to count your breaths right now, so just relax.” Of course, the patient who knows someone is counting his or her breathing rate will think about it and probably breathe either faster or slower as a result. If you hear new EMT-Bs using this approach, remind them that counting a respiratory rate should be done without bringing the patient’s attention to it.
- 40. Circulation: Pulse, bleeding, skin
- 41. In adults and children, check radial pulse first. If no radial pulse, check carotid pulse. Pulse If no carotid pulse, start CPR and use AED as appropriate.
- 42. Infants: Check brachial pulse.
- 43. Look for and control severe bleeding.
- 44. Skin Color Temperature Condition
- 46. Identify Priority Patients Poor general impression Unresponsive Responsive but not following (Continued) commands Difficulty breathing Shock (hypoperfusion)
- 47. Uncontrolled bleeding Severe pain anywhere Complicated childbirth Identify Priority Patients Chest pain with systolic blood pressure < 100
- 48. Focused history and physical exam (medical) or Focused history and physical exam (trauma) Determine Next Assessment Step
- 49. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
- 50. Baseline Vital Signs Respirations Pulse Skin Pupils Blood pressure
- 51. Respirations
- 52. Normal Shallow Labored Noisy Quality of Breathing
- 53. Pulse Strong or weak Regular or irregular
- 54. If you cannot feel a radial pulse, check the carotid pulse.
- 55. Check skin color, temperature, and condition.
- 56. Pale Cyanotic Flushed Jaundiced Abnormal Skin Colors
- 57. Abnormal Skin Temperatures Hot Cool Cold
- 58. Abnormal Skin Conditions Wet Very dry
- 59. Pupils
- 61. Palpation Auscultation Measuring Blood Pressure
- 62. Pulse Oximetry Measures oxygen circulating in the blood 95 – 99% considered normal
- 63. Pulse Oximetry Precautions Not accurate in shock or hypothermia False readings in carbon monoxide poisoning Movement and nail polish can cause inaccurate readings NOTE: Do not withhold oxygen from a patient who may need it because the oximeter reads “normal.”
- 64. Reassessment of Vital Signs Stable patient: every 15 minutes Unstable patient: every 5 minutes
- 65. Sample History S igns and symptoms A llergies M edications P ast medical history L ast oral intake E vents leading to the injury or illness
- 66. Pertinent past history should include medical, surgical, and trauma factors.
- 67. 1. What are the components of a scene size-up? 2. List the steps in the initial assessment of a patient. 3. Give examples of patients who should be handled as a “high priority.” 4. What does the acronym SAMPLE stand for? 5. What is the range of normal vital signs? R EVIEW QUESTIONS