Lecture Two: Patient Assessment Definitions
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The document outlines key definitions and procedures for patient assessment, emphasizing the importance of scene safety, initial assessment, and ongoing evaluations during emergency situations. It highlights basic concepts such as the golden hour, initial and focused history assessment, and rapid trauma evaluation, detailing specific assessment processes for different types of patients. Acronyms like MOI and AVPU are introduced to aid in prioritizing and understanding patient conditions.
Lecture Two: Patient Assessment Definitions
- 3. Basic Definitions:Basic Definitions: Scene Size‐up :p Steps taken by first aid providers hen approaching the emergencwhen approaching the emergency scene. Determinee scene safety Take BSI precautions, noting the mechanism of injury or patient’s nature of illness Determine the number of patients, and deciding what, if any additional resources are needed including BSI stands for body substance isolation. It means the gloves, gowns, masks an other objects weg Advanced Life Support. gowns, masks an other objects we use to protect ourselves from our patients blood, vomit, feces, saliva and other substances 3Anas Bahnassi PhD CDM CDE
- 4. Basic Definitions:Basic Definitions: Initial Assessment: The process used to identify and treat life‐p y threatening problems, concentrating on Level of Consciousness, Cervical Spinal Stabilization Airway Breathing andStabilization, Airway, Breathing, and Circulation. You will also be forming a General Impression of the patient to determineImpression of the patient to determine the priority of care based on your immediate assessment and determining if h i i di l ithe patient is a medical or trauma patient. The components of the initial assessment may be altered based on the patient Anas Bahnassi PhD CDM CDE 4 presentation.
- 5. Basic Definitions:Basic Definitions: Golden Hour May be defined as the period during which all efforts are made to save a life before irreversible pathological changes can occur p g g thereby reducing or preventing death in the second and third phase. The first platinum 10 minutes becomes important to make this golden hour effective and should be distributed aseffective and should be distributed as follows to make it fruitful: Assessment of the victim and primary survey 1 minAssessment of the victim and primary survey 1 min Resuscitation and stabilization 5 min Immobilization and transport to nearby hospital 4 min Anas Bahnassi PhD CDM CDE 5
- 6. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam: In this step you will:p y Reconsider the mechanism of injury Determine if the Rapid Trauma Assessment or a Focused Assessment is neededa Focused Assessment is needed Assess the patient’s chief complaint Assess medical patients complaints and signs and symptomsand symptoms Obtain a baseline set of vital signs, and perform a SAMPLE history. Th t f thi t b lt dThe components of this step may be altered based on the patient’s presentation. Anas Bahnassi PhD CDM CDE 6
- 9. OPQRST HISTORYOPQRST HISTORY • Branch of SAMPLE History • Focuses on Signs and SymptomsFocuses on Signs and Symptoms • Gives a clearer picture of patient’s li i l d i iclinical case and its severity 9Anas Bahnassi PhD CDM CDE
- 10. OPQRST Historiy Onset O O t• O = Onset • When the complaint first startedstarted. • The patient’s activities at the time of onset/immediatelytime of onset/immediately before • “What were you doing when this started” • Chest pain patient – mowing lawn • Anaphylaxis patient – stung by beep y p g y • Diabetic patient – Working in hot day without food 10Anas Bahnassi PhD CDM CDE
- 11. OPQRST History Provocation • P = Provocation • What actions make the symptoms better/worse • “Is there anything thatIs there anything that makes it better? Anything that makes it worse?” • Chest pains – Worse with activity Better with rest • SOB – Better when sitting• SOB – Better when sitting Worse when lying flat • Etc… 11Anas Bahnassi PhD CDM CDE
- 12. OPQRST History Crushing Quality • Q = QualityQ Quality • Subjective description ofdescription of complaint in pt own words Stabbing own words • “Would you please describe the paindescribe the pain. What does it feel like” Burning • Chest pains – Crushing, vice‐like, elephantelephant 12Anas Bahnassi PhD CDM CDE
- 13. OPQRST History Radiation • Is the pain local or does it travel to another part of the bodybody • “Is the pain in one place or does it spread to other partsdoes it spread to other parts of your body?” • Chest pains • L shoulder, arm, jaw, neck ,back 13Anas Bahnassi PhD CDM CDE
- 14. OPQRST History Severity • Severity• Severity • 1‐10 scale gauging pain • “On a scale of 1‐10, 1 , being the least pain you’ve felt and 10 being the worst pain you’ve ever felt can you rate the pain?” 14Anas Bahnassi PhD CDM CDE
- 15. OPQRST Hx Time • T = Time • Duration of the clinical case and associated complaints • “How long has this been going on?”How long has this been going on? • Chest pains – Woke pt from sleep that night • Allergic rxn‐ 15‐20 min 15Anas Bahnassi PhD CDM CDE
- 16. Basic Definitions:Basic Definitions: Rapid Trauma Assessment: This is performed on patients with significant mechanism of injury to determine potential life threateningdetermine potential life threatening injuries. In the conscious patient, symptoms should b ht b f d d i th R idbe sought before and during the Rapid Trauma assessment. You will estimate the severity of the injuries, re‐consider your transport decision, reconsider Advanced Life Support, consider the platinum 10 minutes and the Golden Hour, rapidly assess the patient from head to toe. Obtain a baseline set of vital signs, and Anas Bahnassi PhD CDM CDE 16 Obtain a baseline set of vital signs, and perform a SAMPLE history.
- 18. Basic Definitions:Basic Definitions: Rapid Medical Assessment: This is performed on medical patientsThis is performed on medical patients who are unconscious, confused, or unable to adequately relate their chief complaint. This assessment is used toThis assessment is used to quickly identify existing or potentially life‐ threatening conditions. You will f h d idperform a head to toe rapid assessment. obtain a baseline set of vital signs, and perform a SAMPLE history. Anas Bahnassi PhD CDM CDE 18
- 20. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam:‐ Trauma This is used for patients, with no significant mechanism of injury, that have been determined to have no life threateningdetermined to have no life‐threatening injuries. This assessment would be used in place of your Rapid Trauma Assessment. You h ld f th ti t’ hi fshould focus on the patient’s chief complaint. An example of a patient requiring this assessment would be a patient who has sustained a fractured arm with no other injuries and no life threatening conditions. Anas Bahnassi PhD CDM CDE 20
- 21. Basic Definitions:Basic Definitions: Focused History and Physical Exam:Focused History and Physical Exam:‐ Medical This is used for patients with a medical complaint who are conscious, and able to adequately relate their chief complaint toadequately relate their chief complaint to you, and have no life‐threatening conditions. This assessment would be used in place of R id M di l A t Y h ldyour Rapid Medical Assessment. You should focus on the patient’s chief complaint using OPQRST, obtain a baseline set of vital signs, and perform a SAMPLE history. Anas Bahnassi PhD CDM CDE 21
- 23. Basic Definitions:Basic Definitions: Detailed Physical Exam: y This is a more in‐depth assessment that builds on the Focused Physical E am Man of o r patients ma not req ire a Detailed Ph sical E amExam. Many of your patients may not require a Detailed Physical Exam because it is either irrelevant or there is not enough time to complete it. This assessment will only be performed while enroute to the hospital or if there is time on‐scene while waiting for an ambulance to arrive. Patients who will have this assessment completed are patients with significant mechanism of injurypatients with significant mechanism of injury, unconscious, confused, or unable to adequately relate their chief complaint. In the Detailed Physical Exam you will perform a head to toe assessment to find isolatedwill perform a head to toe assessment to find isolated and non‐life‐threatening problems that were not found in the Rapid Assessment and also to further explore h l d d i h R id Anas Bahnassi PhD CDM CDE 23 what you learned during the Rapid assessment.
- 24. Basic Definitions:Basic Definitions: Ongoing Assessment:g g This assessment is performed during transport on all patients. The Ongoing Assessment ill be repeated e er 15 min tes for the stableOngoing Assessment will be repeated every 15 minutes for the stable patient and every 5 minutes for the unstable patient. This assessment is used to answer the following questions: 1. Is the treatment improving the patient’s condition? 2 Are any known problems getting better or worse?2. Are any known problems getting better or worse? 3. What is the nature of any newly identified problems? Anas Bahnassi PhD CDM CDE 24
- 25. Acronyms used during patient assessment: MOI – stands for mechanism of injury AVPU – used to classify the patient’s mental status: • A = awake, alert, and orienteda a e, a e t, a d o e ted • V = alert to voice, but not oriented • P = alert to painful stimuli only • U = unresponsive to voice or painfulU = unresponsive to voice or painful stimuli CUPS used as an additional tool toCUPS – used as an additional tool to prioritize the patient for transport: • C = critical bl• U = unstable • P = potentially unstable • S = stable Anas Bahnassi PhD CDM CDE 25
- 26. Priority Illness/Injury severity Transport DecisionDecision Critical Patients either receiving CPR, in respiratory arrest or requiring and receiving life‐ sustainingarrest, or requiring and receiving life sustaining ventilatory /circulatory support C.U.PUnstable Poor general impression Scene Size‐up Unstable P Unresponsive with no gag or cough reflexes Responsive but unable to follow commands Initial Assessment Potentially Unstable p Difficulty breathing Pale skin or other signs of poor perfusion (shock) Complicated childbirth Rapid Assessment And Transport Complicated childbirth Uncontrolled bleeding Severe pain in any area of the body Severe chest pain especially with aSevere chest pain, especially with a systolic BP of less than 100 mmHg I bilit t t f th b d Anas Bahnassi PhD CDM CDE 26 Inability to move any part of the body
- 27. Priority Illness/Injury severity Transport DecisionDecision Mi ill i i l t d i j S Stable Minor illness, minor isolated injury, uncomplicated extremity injuries, and/or any patient that cannot be categorized as Scene Size‐up Critical, Unstable, or Potentially unstable. Initial Assessment Focused Assessment And Transport Anas Bahnassi PhD CDM CDE 27
- 28. Mechanisms of InjuryMechanisms of Injury Vehicle‐pedestrian: Collision Motorcycle crash Death in the same passenger compartment: High‐speed vehicle collision Medium speed vehicle collision Roll‐over of vehicle (infants and children) Falls greater than 20 feet (adults): Ejection from vehicle Falls greater than 10 feet (infants and children): Bicycle collisionFalls greater than 10 feet (infants and children): Bicycle collision Penetrations of the head, chest, or abdomen: (infants and children) Anas Bahnassi PhD CDM CDE 28
- 29. Patient Assessment Practice SheetPatient Assessment Practice Sheet Anas Bahnassi PhD CDM CDE 29
- 30. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 30
- 31. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 31
- 32. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 32
- 33. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 33
- 34. Patient Assessment Practice SheetPatient Assessment Practice Sheet Initial Assessment Anas Bahnassi PhD CDM CDE 34
- 35. Patient Assessment Practice SheetPatient Assessment Practice Sheet Anas Bahnassi PhD CDM CDE 35
- 36. Clinical Pharmacy VI:Clinical Pharmacy VI:yy First AidFirst Aid Anas Bahnassi PhD CDM CDEAnas Bahnassi PhD CDM CDE abahnassi@gmail.com http://www.twitter.com/abpharmp p http://www facebook com/pharmaprofhttp://www.facebook.com/pharmaprof http://www linkedin com/in/abahnassihttp://www.linkedin.com/in/abahnassi