INITIAL ASSESSMENT
People, (Patients, Family & Bystanders) Will Rely On You. Identify Patients That Need Rapid Assessments, Critical Interventions and Immediate Transport.
INITIAL ASSESSMENT
TOPIC OVERVIEW
- The General Impression
- Assessing Mental Status, Using AVPU Scale
- ABC’s During the Initial Assessment
- Who’s a Priority, How to Decide
Components of Initial Assessment
- General Impression
- Assess Mental Status
- Assess Airway
- Assess Breathing
- Assess Circulation
- Identify Priority Patients
INITIAL ASSESSMENT
- General Impression
- Determines Priority of Care
- Immediate Assessment
- Environment
- Patient’s Chief Complaint
- Look, Listen, Smell
INITIAL ASSESSMENT
- General Impression
- Is it Medical or Trauma
- If Trauma - What is the Mechanism Of Injury
- Other Factors
GENERAL IMPRESSION
- Life Threatening Conditions
- Immediately Treat When Found
- Identify Nature of Illness (Medical)
- Identify Mechanism of Injury (Trauma)
GENERAL IMPRESSION
- Assess Mental Status
- Easiest Way - Talk
- Introduce Yourself
- If Patient Talks Back
- ABC’s Intact
- Mentating In Some Capacity
MENTAL STATUS
- Levels of Mental Status
- A - Alert
- V - Verbal - Responds to Verbal Stimuli
- P - Pain - Responds to Painful Stimuli
- U - Unresponsive - No Gag Reflex or Cough
INITIAL ASSESSMENT
- Airway Assessment – Is The Patient….?
- Responsive or Unresponsive
- Breathing or Not Breathing
- Airway Open or Airway Occluded
- Open Airway – Medical
- Open Airway – Trauma
- Jaw-Thrust / Maintain C-Spine Stabilization
- Airway Adjuncts
- Assess Breathing
- Adequate or Inadequate
- Adequate – Administer O2
- 15 Liters per Minute, Non-Rebreather Mask
- Inadequate
- Responsive - Breathing > 24 or < 8 / Minute
- Assure Open Airway
- Assist Ventilations if Inadequate Breathing
- Ventilate Non-Breathing Patients
- Assess Circulation
- Radial – Responsive
- Carotid – Unresponsive or No Radial ë
- If Pulseless Start CPR
- If Over 8 Y/O Start CPR & Apply AED
- Assess Skin – Sign of Perfusion
- Color
- Normal – Pink
- Abnormal – Pale, Cyanotic, Flushed, Jaundice
- Temperature
- Normal – Warm
- Abnormal – Hot, Cool, Cold, Clammy
- Condition
- Normal – Dry
- Abnormal – Moist, Wet, Diaphoretic
- Capillary Refill
- Infants & Children
- Normal – Less Than 2 Seconds
- Abnormal – Greater Than 2 Seconds
Identify Priority Patients
- Poor General Impression
- Unresponsive
- Responsive
- Hypoperfusion (Shock)
- Difficulty Breathing
- Chest Pain w/ BP < 100
- Uncontrolled Bleeding
- Severe Pain Anywhere
- Complicated Childbirth
- Expedite Transport of Patient
- Consider ALS Back-up
- In This Area Get ALS Back-up
- Meet Them Enroute to Hospital
- Proceed With Appropriate Assessment
- Focused History (Medical)
- Physical Exam (Trauma)