Patient Assessment

UCLA Center for Prehospital Care

Count the White Shirt Passes

Patient Assessment and Management Model

Scene size-up Primary Assessment (Initial assessment ) Critical Management and Transport Decisions Secondary Assessment

Focused history and physical: Unresponsive Medical / Major Trauma Patient Focused history and physical: Responsive Medical / Minor Trauma Patient

Detailed physical exam Management of specific Problems or Injury

Reassessment (Ongoing assessment)

Scene Size-up & Primary Assessment

Why to find potential life threats When - upon arrival, pts condition changes, after interventions

Scene Size-up
Assess for:

Personnel / Patient Safety with BSI

Environmental hazards
Number of patients Mechanism of injury

Additional resources / special equipment

Need for extrication / spinal immobilization

Scene Size-up
Assess for:

Personnel / Patient Safety with BSI

Safety to include the use of Personal Protective Equipment (PPE)

Safety to include the use of Personal Protective Equipment (PPE)

Scene Size-up
Assess for:

Environmental hazards

Scene Size-up
Assess for:

Number of patients

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Mechanism of injury

Scene Size-up
Assess for:

Additional resources / special equipment

Need for extrication / spinal immobilization

Scene Size-up
Assess for:

Personnel / Patient Safety with BSI

Environmental hazards
Number of patients Mechanism of injury

Additional resources / special equipment

Need for extrication / spinal immobilization

Primary Assessment

General impression

Life-threatening conditions

Patient Rapport

Primary Assessment

Assess/manage:

AVPU/Spinal Considerations

Orientation as appropriate (Person, Place, Time, Event)

Airway Breathing Circulation

Intervene whenever necessary!!!

pulses skin signs obvious bleeding

Primary Assessment

Disability/Deformity:

Altered mental status

Obvious neurological deficits Abnormal body presentation (posture)

Subtle Signs of Hypoxia

Primary Assessment

Determine:

Chief complaint / problem Big Sick vs. Little Sick.

Make a transport decision

Initial Contact / Primary Assessment

Initial Contact / Primary Assessment

Initial Contact / Primary Assessment

Initial Contact / Primary Assessment

Initial Contact / Primary Assessment

Secondary Assessment

Two approaches based on patients chief complaint:

responsive medical / minor trauma unresponsive medical / major trauma

To Include:

Neuro Exam if ALOC History of chief complaint (OPQRST, AEIOUTIPS) History of patient (SAMPLE) Vital signs Detailed or pertinent physical exam Reassessment

Rapid Assessment

The goal is to identify the life threatening injuries that caused the disturbance or loss of function found during the primary assessment .

Airway, breathing, circulation, or acute change in mental status

Use inspection, palpation, auscultation, and the smell of certain odors to help you uncover these findings. Head to Toe, Rapidly

Use of the DCAP-BTLS mnemonic will help you recall important indications of trauma

Deformities C A P B T L S

DCAP BTLS

D Contusions A P B T L S

DCAP BTLS

D C Abrasions P B T L S

DCAP BTLS

D C A Punctures & Penetrations B T L S

DCAP BTLS

D C A P Burns T L S

DCAP BTLS

D C A P B Tenderness L S

DCAP BTLS

D C A P B T Lacerations S

DCAP BTLS

D C A P B T L Swelling

Rapid Assessment

Detailed / Pertinent Physical Exam

Head

Pelvis

Neck
Chest Abdomen

Legs
Arms Back

Physical Exam - Head

Physical Exam - Head

Physical Exam - Head

Physical Exam - Head

Physical Exam - Head

Physical Exam - Neck

Physical Exam - Neck

Physical Exam - Neck

Physical Exam - Chest

Physical Exam - Chest

Physical Exam - Abdomen

Physical Exam - Abdomen

Physical Exam - Pelvis

Physical Exam - Legs

Physical Exam - Legs

Physical Exam - Arms

Physical Exam - Arms

Physical Exam - Back

Detailed Body Check

Reassessment

Repeat initial assessment Repeat relevant portion of the focused exam This is repeated:

Every 5 minutes for priority patients Every 15 minutes for stable patients

Evaluate response to treatment Compare results to baseline