ABCs
airway, breathing, and circulation
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
chief complaint
in emergency medicine, the reason EMS was called, usually in the patient's own words
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.
interventions
actions taken to correct or manage a patient's problems
mental status
level of responsiveness
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, asses
priority
the decision regarding the need for immediate transport of the patient versus further assessment and care at the scene
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
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
Primary Assessment Steps
Forming a general impression
Assessing mental status
Assessing airway
Assessing breathing
Assessing circulation
Determining patient priority
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
Findings that indicate critical patient
Altered mental status
Anxiety
Pale, sweaty skin
Obvious trauma to head, chest, abdomen, pelvis
Specific positions indicating distress
Chief Complaint
Patient's description of why EMS was called
May be specific�"abdominal pain"
May be vague�"not feeling good
Assess Mental Status: AVPU
Alert
Document orientation to person, place, and time
Verbal response
Painful response
Unresponsive
If airway is not open or is endangered
take measures to open
Situations calling for breathing assistance
Respiratory arrest
Not alert, inadequate breathing
Some alertness, inadequate breathing
Adequate breathing, but signs suggesting respiratory distress or hypoxia
Circulation
Assess pulse
Assess skin
Assess bleeding
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 c
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.
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.
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
Stable
Vital signs in normal range
Potentially unstable
Potential for deterioration can indicate potentially unstable category
Unstable
Threat to ABC's rules out stability
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
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
Primary assessment
is a systematic approach to quickly find and treat immediate threats to life.
General impression
although subjective, can provide extremely useful information regarding urgency of a patient's condition.
for immediate airway intervention
Rapidly identify the need for
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.
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 adequa
Assess Circulation
Pulse-Rate, Rhythm and Regularity
Skin Colour Temp and Condition, Major Bleeding, Perfusion
2 terms that primary assessment are also known as
primary survey and initial assessment
ABCs
airway, breathing, and circulation
after a primary assessment, how would you handle a potentially unstable patient?
expedite transport, fewer assessments and interventions
after a primary assessment, how would you handle an unstable patient?
rapid transport, only life-saving assessment and interventions on scene
after primary assessment, how would you handle a stable patient?
slower pace, more detailed secondary examination
chief complaint
the reason the EMS was called; usually in the patient's own words
clinical judgment
a judgment based on experience in observing and treating patients
exsanguinating
very severe, life-threatening
flail chest
multiple broken ribs
general impression
first impression of the patient's condition based off environment, chief complaint, and appearance
give 5 examples of high priority conditions
poor general impression
unresponsive
shock
uncontrolled bleeding
severe pain anywhere
how can chest injury affect the patient?
reduce the rate and depth of breathing, and functioning of lungs
how do you classify a stable patient?
normal or slightly abnormal range vital signs
a stable airway
no immediate life-threats
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
how is a general impression formed?
looking, listening, and smelling
how long do you take a pulse?
30 seconds, then multiply by two
how many parts make up a primary assessment?
6
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
if a patient appears lifeless and has no pulse, what order do you do ABCs?
CAB
if a patient shows signs of life, what order do you do ABCs?
ABCs
intervention
actions taken to correct or manage a patient's problem
Levine's sign
the global position of heart attack; a fist clenched over the chest
mental status
a patient's level of responsiveness
primary assessment
the portion of patient assessment that focuses only on life threats, specifically ABCs
priority
the decision regarding need for immediate transport vs further assessment and care at the scene
what are 3 indicators of possible shock?
anxiety, pallor, sweatiness
what are the 3 steps of airway in ABCs?
open the airway, suction if necessary, place an OPA or NPA if needed
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 are the parts of primary assessment in order?
general impression
mental status/c-spine (when appropriate)
airway
breathing
circulation
priority
what can a patient in tripod position indicate?
significant difficulty breathing
what can altered mental status indicate?
many underlying conditions such as hypoxia, shock, diabetes, overdose, or head trauma
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
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 alert but has inadequate breathing?
assist ventilations with 100% oxygen, synchronizing ventilations to the patient's to work together
what do you do with a patient that is not alert and has inadequate breathing?
provide positive pressure ventilation with 100% oxygen
what does AVPU stand for?
alert, verbal response, painful response, unresponsive
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
what should you first do with a patient with suspected spinal injury?
apply manual stabilization of the head and neck
Base Station
a two-way radio at a fixed site such as a hospital or dispatch center.
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.
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.
mobile radio
a two-way radio that is used or affixed in a vehicle
portable radio
a hand-held two-way radio
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.
watt
the unit of measurement of the output power of a radio
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
1 to 5 watts
Portable radios have an output of _____ to _____ watts.
Federal Communications Commission, FCC
To maintain order on the airwaves, the __________, assigns and licenses radio frequencies.
SPO2
Oxygen saturation is defined as the ratio of oxyhemoglobin to the total concentration of hemoglobin present in the blood
data element
Each individual box in the pre-hospital care report is called a __________.
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.
Subjective Information
Information from the patient's point of view.
"I feel dizzy.
Pertinent Negative Information
These are examination findings that are negative, or things that are not true.
"Patient denies difficulty breathing with his chest pain.
omission and commission
Two types of errors may be committed during a call: __________ and __________.
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)
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)
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 pr