Scene Size Up
1st major step
5 sub steps
BSI- Body Substance Isolation
Determine scene safety
Determine number of Pts
Determine medical or trauma
Determine need for additional recourses
Then continue to Primary assessment
2nd major step
8 sub steps
Overall view
Stabilize C Spine
Patient Status
Level of cautiousness (LOC)
Airway
Breathing
Circulations
Transport Decision
General Impression In Primary Assesssment
AAMBIRPC
AAMBIRPC
Overall view substeps
A-age,sex,race
A-Audible Breath Sounds
M-MOI or NOI
B-Body Fluids
I-Imminent Life Threats
R-Responsiveness
P-Position
C-Color
4 levels of Pt response to assessment
LOC substeps
A-alert
V-Verbal
P-pain
U-Unresponsive
3 separate assessments made in circulation
Pulse
Body fluids-Hemorrhage
Perfusion
3rd Major step
Significant trauma pt
not significant trauma pt
unresponsive medical pt (Medical AMS)
responsive medical pt (Medical A&O)
Significant MOI trauma
Trauma Significant steps
RPE-Rapid Trauma Assessment
Baseline Vitals
SAMPLE
Not Significant Trauma
and
Unresponsive medical pt (Medical AMS) steps
focused physical
vitals
SAMPLE
Medical Responsive (Medical A&O)
SAMPLE/OPQRSTI
Focused Physical
Baseline Vitals
what is the purpose of Rapid Physical Exam
expose patient to be able to see injuries
look for life threatening injuries
Techniques of RPE
IPA
DCAP-BTLS
IPA
Inspect
Palpate
Auscultation/stethoscope
DCAP
Deformaties
contusions
Abrasions
Penetration and Punctures
BTLS
Burns
tenderness
lacerations
swellings & symmetry
Components of RPE
Head
Neck
Chest
Abdomen
Pelvis
Extremities
Back
Components of RPE head
blood/CSF in ears, nose, mouth
Airway burns
Deformity
Pupil
Components of RPE Neck Anterior
JVD-jugular vein distension
Stoma Emphysema
Midline trachea
Medical alter tag
Components of RPE Neck Posterior
C1-C7
above scapula
Components of RPE Chest
Equal chest rise
Paradoxical motion
Components of RPE Abdomen
GBREAD
GBREAD
Guarding
Bruising
Rigidity
Evisceration
Aortic Aneurism
Distention
Components of RPE Extremities
PMS
PMS
Neurovascular check:
Pulse
Motor function
Sensation
Components of RPE Back
Holes
Have backboard ready
4th major step of pt assesssment
Reassessment
Re-evaluate Primary
Re-evaluate vital signs
Repeat appropriate focused assessment
evaluate interventions
re-establish priorities
MOI
Mechanism of injury
Trauma patients
NOI
Nature of illness
Medical patients
CC
Chief Complaint
HPI
History of Present Illness
Relates to OPQRSTI
PMH
PHx
Past Medical History
Relates to SAMPLE
Purpose of getting Pt History
get info related to medical complaint
Allergies, diagnosis, medications
Useful in determining if sick or not sick (field Impression)
Symtom
Cannot be observed
ex: nauseous, heart fluttering
Sign
Others can observe
ex: vomiting, pulse of 160
Gaining control of scene
Competence
Confidence
Compassion
Types of questions on History note taking
Open-ended questions
Closed-ended questions
Open-ended questions
Descriptive answer
Ex: describe how you feel
Closed-ended questions
Yes or No answers
Ex: do you feel suicidal
SAMPLE
S-signs and symptoms
A-allergies
M-medications
P-Past medical history
L-last oral intake
E-Events leading to injury/illness
OPQRSTI
O-onset
P-Proactive/palliative
Q-quality
R-region/radiations
S-Severity
T-time
I-Intervention
Proactive/Palliative
What makes symptom worse?
What makes symptom better?
Quality
How would you describe the symptom
Severity
scale 1-10
Time
When did the symptom start, for how long, has it happened before?
Intervention
have you done anything to fix it and did it work?
Pertinent Negatives
it reflects the differential diagnosis.
does not match up with the disease they are saying.
PRBABESS
P-pulse
RR-respiration
BS-breath sounds
AVPU-LOC
BP-blood pressure
Eyes-pupillary response
Skin-Perfusion
Sp02-Pulse Oximetry
Signs of Airway Obstruction
No breathing
snoring
gurgling
stridor
If the patient is not breathing what do you do?
open airway
provide PPV and O2
PPV
Positive Pressure Ventilation
Bradypnea
Slow rate
Trachypnea
Fast
Sub Q emphysema
Air leaking out of the lung into the tube
Crepitus
two bones rubbing together
Triage codes
Red-emergent, life threatening
Yellow-urgent, care needed within 45-60 minutes
green-non emergent
blue-cardiac arrest
black-dead
Crackles
lower airway problem
fluid in alveoli and bronchioles
pulmonary edmea
Rhonchi
Rattles
upper airway fluid/mucus
Stridor
Upper airway edema
allergic reactions
airway burns
Gurgling
Liquid in upper airway
Pulse
Carotid-Neck
Brachial-Arm
Radial-wrist
Femoral-thigh
Posterior Tibialis- Ankle
Dorsalis Pedis- Foot
Apical- Armpit
Cyanosis
Bluish tent on finger
Jaundice
orange or yellow eye
Turgor
Elasticity of skin
Top number of Blood Pressure
Systolic
90 or more is safe
Bottom number of Blood Pressure
Diastolic
Pulse Oximetry
Usually done on finger or toe
it measures 02 saturation in peripheral blood
Pulse Oximetry measurments
95 or greater-okay
90-94-mild hypoxia
below 89-moderate to severe hypoxia
Blood Glucose
Normal range: 80mg/dl - 120mg/dl
Core temperature
body
oral
rectal
tympanic-through ear canal