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Patient Assessment | Part One

Patient Assessment
SOAP Format: Subjective, Objective, Assessment, Plan

Symptom: subjective indication of a disease or condition as perceived by patient -complaint, history etc.

Sign: objective finding, vital signs, what you see

Phases of Scene Assessment

1 – Scene size up: scene safety is #1

  • BSI
  • Dispatch is based on:
  • Patient condition/medical history
  • Scene condition
  • Number of patients
  • Previous Knowledge
  • On-Scene Observation

2 – Initial Assessment
General Impression = immediate sensory assessment of the situation combined with the patient’s chief complaint

  • Consider c-spine
  • Level of consciousness (AVPU)
  • Chief Complaint
  • A – Airway
  • B – BVM inadequate rests < 10 or > 30
  • C – Circulation
  • Or CAD – Circulation, Airway, Breathing
  • Prioritize/Transport Decision

Assessing Effective Ventilation

  • Rise and fall of chest wall
  • Auscultation of lungs
  • Skin Color
  • Heart rate
  • Pulse oximetry

Pulseless Patient

  • Medical patient over 12 start CPR and apply AED
  • Medical patient under 12 start CPR
  • Trauma patient start CPR

Pulse <60  Pulse >100 – Potentially life threatening especially with hypotension, chest pain or severe dizziness.
Rule of Thumb: if there’s a radial pulse, the systolic is approx. 80 mmHg. Carotid 60, Femoral 70, Brachial 70

Skin, Temperature, Color and Condition

  • Warm, pick dry is normal. And using diaphragm muscles for inspiration
  • Pale cold clammy – could be shock
  • Hot and dry – heat injury, overdose or infection
  • Red – alcohol, cocaine, anaphylaxis, stroke, heart attack, hyperthermia
  • Yellow – jaundice, liver disease, gallbladder disease, kidney disease
  • Mottled red, pale, blue – poor perfusion, often seen in cardiac arrest
  • Capillary refill < 2 seconds, most useful under 6 years old

Priority Patients:

Poor general impression
Chest pain/ cardiac
Hypoxia
Uncontrolled bleeding
Unresponsive
Multiple trauma
Severe pain anywhere
Altered mental
Can’t follow commands
Hypertension
Shock

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