Patient Assessment Week 1 Scene Size-Up ● Body Substance Isolation: BSI ● PENMAN ○ Personal, partner, and patient safety ○ Environmental hazards ○ Number of patients ○ Mechanism of injury or nature of illness ○ Additional resources ○ Need for extrication or spinal immobilization http://www.uscemsc.org/wp-content/uploads/2014/07/STS-817-Patient-Assessment-and-Prioritizing-Care.pdf Primary Assessment ● General Impression ● Mental Status ○ Alert ○ Verbal stimuli ○ Painful stimuli ○ Unresponsive ● ABCs ○ Airway ○ Breathing ○ Circulation ● Chief Complaint ● Treatment Prioritization http://www.uscemsc.org/wp-content/uploads/2014/07/STS-817-Patient-Assessment-and-Prioritizing-Care.pdf Secondary Assessment ● Patient History: SAMPLE ○ Signs and symptoms ○ Allergies ○ Medications ○ Past or pertinent medical history ■ Age ■ Weight ■ Physician information ○ Last oral intake or use of toilet ○ Events leading up to injury or illness http://www.uscemsc.org/wp-content/uploads/2014/07/STS-817-Patient-Assessment-and-Prioritizing-Care.pdf Secondary Assessment ● Follow-Up Questions: OPQRST ○ Onset ○ Palliating or provoking factors ○ Quality of pain ○ Region, radiation, or reoccurance ○ Severity of pain ○ Time since onset http://www.uscemsc.org/wp-content/uploads/2014/07/STS-817-Patient-Assessment-and-Prioritizing-Care.pdf Vital Signs ● Blood Pressure ● Eyes ● Level of Consciousness ○ A&O: person, place, time ○ GCS: eyes, verbal, motor ● Lung Sounds ● Skin Signs ● Respirations ● Pulse ● Pulse Oximetry ● Pain http://www.uscemsc.org/wp-content/uploads/2014/07/STS-819-Abnormal-Vitals-and-Associated-Causes.pdf Physical Exam ● Focused or Full Physical ● DCAPBTLS ○ Deformities, disabilities ○ Contusions, crepitus ○ Abrasions, avulsions ○ Penetrations, punctures ○ Burns, bruises, bleeding ○ Tenderness ○ Lacerations ○ Swelling, scars, signs of shock Physical Exam ● Head: Skull, Eyes, Ears, Nose, Mouth, Face ○ Drainage of CSF ○ Asymmetry of head and face ○ Raccoon eyes ○ Battle signs ○ Soot or singed nasal or facial hair ○ Emesis ○ NG tube ○ Pupils Physical Exam ● Neck, Cervical Spine, and Shoulders ○ Subcutaneous emphysema or crepitus ○ Jugular vein distention (JVD) ○ Tracheal deviation ○ Medical alert tags ○ Accessory muscle use ○ Stoma ○ Tracheostomy ○ Central venous catheters ○ Step-off Physical Exam ● Chest: Clavicles, Sternum, Ribs ○ Paradoxical movement ○ Sucking chest wound ○ Accessory muscle use ○ Pacemaker ○ Subcutaneous emphysema or crepitus ○ Internal cardiac defibrillator ○ Central catheters ○ Chest tubes Physical Exam ● Abdomen ○ DR. GERM ■ Distention ■ Rigidity ■ Guarding ■ Evisceration ■ Rebound Tenderness ■ (Pulsating) Mass ○ Signs of pregnancy ○ Gastrostomy tube ○ Colostomy ○ Medication pumps Physical Exam ● Pelvis ○ Incontinence ○ Priapism ○ Vaginal bleeding ○ Urinary catheter ● Extremities ○ CMS ○ Strength ○ Track marks ○ AV shunt or fistula ○ Medical alert tags Physical Exam ● Back ○ Step-off ○ Sacral Edema ○ Exit wounds ○ Melena Reassessment ● Every 5 minutes for an unstable patient ● Every 15 minutes for a stable patient .