  Explorer Post 911 |
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GLOVES ON, SCENE SAFETY what type of call is it, is it safe to enter such as an MVA, need to stop traffic first so you don't get run over |
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LEVEL OF CONSCIOUSNESS, CONSENT TO TREAT, GENERAL IMPRESSIONS "Hey, I'm an EMT, can I help you?" if no response, implied consent general impressions: possible spinal injury? patient turning blue? chief complaint likely medical or trauma? scene impressions: 60 cats and no litter-box in home? drug paraphernalia at patient's side? |
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ABC (AIRWAY, BREATHING, CIRCULATION) if pt. is able to talk, assume all are present (for now) if not, start CPR sequence (open airway, look listen and feel....) do a quick sweep behind trauma patient incase lying in pool of blood |
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VITAL SIGNS make sure that arm used for vital signs is not injured before applying BP cuff Heart rate (is it irregular? bounding? faint? visible in a spray of blood?) Respiratory rate and quality (shallow, gasping, pursed lips, gurgles) Blood pressure by palpation (don't need stethoscope this time) Skin signs (pale cool and clammy? pink warm and dry? dusky? burned off?) |
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HEENT HEAD: palpate scalp, back of head (trauma, pain, deformity) EYES: check pupils, check orbit for swelling/discoloration, can check lid color pe(m)arl: pupils equal, midline and reactive to light; note size if abnormal can see paleness in inner lids to determine skin signs in dark-skinned people head injury can cause "raccoon eyes" EARS: check for leaking blood or CSF (cerebrospinal fluid) NOSE: check for blood, facial fractures Throat/mouth: check for loose material that could block airway gum, shattered teeth, vomit, blood, odd piercings |
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NECK/C-SPINE check for pain, trauma (blood, knife, bruise), deformity (lump, odd position/angle) palpate C-spine for tenderness note JVD (veins distended) and tracheal deviation check if medic alert necklace |
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CHEST palpate shoulders/clavicles, sternum, compress ribcage note trauma, deformity, pain, asymmetrical motion during respiration check breath sounds (clear and equal bilaterally?) |
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ABDOMEN (4 QUADRANTS) check for guarding, pain or mass on palp note if rigid, distended, guts spread across the road |
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BACK must log-roll possible spinal injury pain, trauma, deformity breath sounds |
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PELVIS pain on compression? check for femoral pulses if significant trauma |
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EXTREMITIES perfusion/circulation, motor and sensation (CMS) check for medic alert bracelet/anklet LEGS: pedal pulses, toe movement, touch recognition, palpate long bones, check pain with torque note pain, trauma, deformity, shortening, ankle edema, foot temp/color ARMS: radial pulses, grip, cap refill should have already done quick check when taking vitals palpate, note pain, deformity |
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VITAL SIGNS Compare with first set Heart rate (is it irregular? bounding? faint? visible in a spray of blood?) Respiratory rate and quality (shallow, gasping, pursed lips, gurgles) Blood pressure (auscultate) |
PATIENT HISTORY (SAMPLE) |
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SIGNS AND SYMPTOMS symptoms are subjective: what the patient feels/says/observes (complains of shortness of breath) signs are objective: what rescuers can observe, measure (pt. in tripod position, use of accessory muscles during resp) |
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ALLERGIES Any Allergies to medication or medically relevant allergies allergies to latex, egg or horse (some meds processed with animals) allergies relevant to circumstances (hay fever, symptoms started when gardening) |
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MEDICATIONS note both prescription and OTC meds and dose (both directed and actual) last dose taken, are they being taken as directed, any recent changes/missed doses; if as-needed how often usually needed check bottle for name (is same as pt.'s), date, amount remaining (too full/empty) multiple meds all from different docs/clinics (risk of interactions) why is med prescribed/taken |
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PAST MEDICAL HISTORY (PMHx) any surgery, hospitalization, major/chronic illness (diabetes, hepatitis, CHF) any recent/relevant illness or injury (back surgery and MVA, flu and asthma) may need to ask less general question than "past history" to get answers |
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LAST MEAL/ORAL INTAKE Especially relevant if patient diabetic or might need surgery Note when, contents if relevant (esp. if possible allergic reaction) Note recent change in diet if relevant (fasting, high salt in heart patient, any change in diabetic) |
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EVENTS LEADING UP TO EMERGENCY relevant situation/scene info (just jogged 50mi, stung by bee, been "acting funny" all week, at ER twice today) paint picture of scene (patient on couch, surrounded by bottles, dead dog on lap) |
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PAIN HISTORY (OPQRST) |
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ONSET when did the pain begin what was the patient doing at that time? was the onset sudden or gradual? |
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PROVOCATION what makes it better or worse does movement or breathing or change in position increase the pain? |
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QUALITY describe the pain crushing, burning, dull, sharp, stabbing, throbbing, constricting, aching |
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RADIATION does the pain radiate anywhere chest pain radiating to left arm, back pain radiating to right leg |
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SEVERITY how bad is the pain can ask patient to rate on scale of 1 - 10, ten being worst |
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TIME how long has the pain been going on is it constant or intermittant if it's gone on for a while, what changed to make patient call for help? |
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