BSI/PPE

Body Substance Isolation/

Personal Protective Equipment

NOI

Nature of Illness

What is the Initial Assessment?

General Impression

• Age, Gender, Race, Position Found
• Det. NOI if not already done
• Locate & treat life threats/Quick CPR check
• Verbalize a gen impression of patient

List the General Impression

• Age, Gender, Race, Position Found
• Det. NOI if not already done
• Locate & treat life threats/Quick CPR check
• Verbalize a gen impression of patient

Mental Status

• Check for responsiveness
• Det. mental status / Level of Conciousness
• AVPU
• Det. Chief complaint if not already done

What does the term AVPU stand for?

Alert, Verbal, Pain & Unresponsive 

What are the ABC's?

Airway, Breathing & Circulation

Airway

• Can patient speak or cry?
• Are there any unusual breathing sounds (stridor, wheezing, etc.)
• Can the patient maintain his/her own airway?
  • Suction, as necessary
  • Modified jaw-thrust, as necessary
  • Insert OPA or NPA as necessary

Breathing

• Is the patient breathing?
• Is the patient complaining of difficulty breathing?
• Inspect the chest for obvious deformities (paradoxical motion - rule out trauma)
• Palpate the chest for unstable segments, crepitation & equal expansion of the chest
• Auscultate - Is breathing adequate?  Is the rate and quality adequate to sustain life? (OBTAIN A QUICK RESPIRATORY R&Q)
  • Ventilate if: respiratory rate is <10 and/or signs of inadequate oxygenation are present. Connect to oxygen as soon as possible
  • Provide oxygen via non rebreather if pt exhibits SOB or difficulty breathing, or via nasal cannula PRN

Circulation

• Is there life threating hemorrhage? (control it if possible (donot control minor bleeding at this time)
• Assess pulses for presence and quality:
  • Carotid if unresponsive, radial if responsive
  • If Radial pulse is weak, or absent compare it to/check carotid pulse
• Assess patients perfusion by evaluating the skin color, Temperature and condition (CTC)
  • The patients conjuntivae and lips may be used to assess perfusion, cap refill on patients <6 yrs old
• Treat for hypoperfusion (shock) as necessary - BP & Pulse
  • Position patient supine, elevate legs, maintain temp (cover with blanket)

OPQRSTI

• Onset
• Provoke
• Quality
• Radiation
• Severity
• Time
• Intervention

Onset

What were you doing when the symptoms started?

Provocation

What makes the symptoms better or worse?

Quality

What does the pain/discomfort feel like?

Radiation

Does the pain/discomfort move? If yes, where?

Severity

How servere is the pain on a scale of 1 - 10?

Time

How long has the problem been going on?

Has it changed over time?

Interventions

Have you taken anything to alleviate the pain/symptom?

What are the pertinent questions asked for Cardiac & Respiratory?

OPQRSTI

Onset, Provocation, Quality, Radiation, Severity, Time, & Intervention

- SAMPLE

OB/GYN

Are you pregnant? Has water broken?

How long have you been pregnant?

Do you feel like you have to move your bowels?

Any previous pregnancies? If yes, how many?

When was your last period? Pain/Contractions?

Bleeding or discharge?

Pre-natal care?

Do you feel the need to push?

AMS

(Altered Mental Status)

Describe episode

Associated symptoms

Evidence of Trauma?

Seizures?  Fever?

Onset? Duration?

Compliant with Meds?

Interventions?

Behavioral

How do you feel?

Talk of suicidal? Feeling Suicidal?

Is patient a danger to self or others?

Any medical problems?

Psychiatric history?

Compliant with meds?

Interventions?

Environmental

Pertinent Questions

Source (hot / cold)?

Environment?

Loss of Conciousness?

General or localized?

Duration?

Alcohol use?

Shivering?

General or local effects?

SAMPLE

Environmental

Physical Exam

Distal Pulses?

Skin condition?

Med-Alert tag

Poisoning

What are the pertinent questions?

What is the substance?

How much was ingested?

Over what time period?

Any other substances?
What is your estimated body weight?

- SAMPLE

 Poisoning

Physical Exam

Is the airway clear?

Respiratory adequacy?

Medic-Alert tag

Allergic Reaction

What are the pertinent questions?

What was the exposure?

What was the Method of exposure?

What is the effect? (results)

What is the progression?

Difficulty breathing?

- SAMPLE

Allergic Reaction

Physical Exam

Uticaria (hives)

Itching?

Discoloration?

Swelling? (Esp. mouth & resp. tract)

Respiratory adequacy?

Medic-alert tag

Cardiac & Respiratory

Physical Exam

Lung sounds

Pain upon palpation of chest?

Pain on movement?

Pedal Edema?

Jugular Venous Distention?

Clubbed Fingers?

Medic-alert Tag

OB/GYN

Physical Exam

Crowning?

Discharge (mucus, amniotic fluid, etc)

Bleeding?

B/P adequate?

Swollen feet?

Seizures?

Med-alert Tag

AMS

(Altered Mental Status)

Physical Exam

Apparent head trauma?

Hemiplegia?

Strange odor on breath?

Med-alert Tag

SAMPLE

Signs and symptoms - What is the patient feeling/What have you seen?

Allergies - to medications, foods, etc.

Medications - Prescription, OTC and herbal

Past Medical History - Med probs, hospitilizations & surgers

Last Oral Intake - what was the last thing you ate and when?

Events leading up to this incident - what happened before the incident?

Baseline Vital Signs

Obtain a full set of vital signs:

Respirations - Rate, Quality & rhythm

Pulse - Rate, Quality & rhythm

Blood Pressure

Level of Conciousness - use AVPU

Skin - Color, temp & condition

Pupils

When do you perform a Rapid Medical Assessment?

Performed if the patient is unconscious, confused or unable to relate their chief complaint.

What are the following steps taken in the Rapid Trauma Assessment?

Inspect/Palpate each area of the body for the following (in addition to DCAP-BTLS):

Head - Blood/fluid from ears, nose or mouth. keep airway clear.

Neck - Jugular venous distention, crepitation, apply CSIC, if necessary not already done.

Chest - Paradoxical motion, crepitation, breath sounds at the midclavicular line, midaxillary at nipple line and at bases.) 

Abdomen - Inspect the abdomen one quadrant at a time. Pain, firm/soft distention

Pelvis - if no pain, gently compress iliac crests

Extremities - Crepitation distal pulses, sensory & motor function

Posterior - log roll patient while maintain c-spine immobilization