firefighter prehospital care program module 7 &...
TRANSCRIPT
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Secondary Patient Assessment Reporting & Documentation
Firefighter Prehospital Care Program Module 7 & 8
Firefighter Prehospital Care Program Firefighter Prehospital Care Program Module 7 & 8Module 7 & 8
Document 1.3
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Secondary Assessment -Objectives
• Conduct a more thorough examination than in the primary assessment
• Head to toe examination• Identify and treat any missed life threatening
conditions (treat as soon as found)• Identify and treat non-life threatening conditions after
the secondary assessment is complete• Obtain vital signs• Establish dialogue with patient and family, collect
information and reassure• Verify chief complaint, obtain list of allergies,
medications, and medical history• Report to paramedics
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Overview• Complete history, vital signs, and head to toe
examination• Reassess ABCs and look again for life threats• Treat life threats as soon as found• Treat other problems after the secondary survey• Report to paramedics
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Patient Interview
hName
hAge
hChief Complaint (CC)
h Incident History
hS.A.M.P.L.E.
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S.A.M.P.L.E.S - Signs and symptoms
A - Allergies
M - Medications
P - Previous medical history
L - Last oral intake
E - Events leading up to incident
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Pain AssessmentO - Onset
P - Provocation
Q - Quality
R - Radiation
S - Severity
T - Time
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Baseline AssessmentLevel of Consciousness (LOC)
hA.V.P.U
hPatient Alert to surroundings
hResponsive to Verbal stimulation
hResponsive to Painful stimulation
hUnresponsive to painful stimulation
hGlasgow Coma Scale (GCS)
Level of Awareness (LOA)
h Person / Place / Time
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Baseline Vital SignsPulse:
h Rate (measure beats for 30 seconds and X 2)
hRhythm - regular or irregular
hVolume – weak or full
Normal Values:hAdult 60 - 90 bpm
hChild 80 - 150 bpm
hInfant 120 - 150 bpm
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Baseline Vital SignsRespirations:
Rate (measure beats for 30 seconds and X 2)
Rhythm – regular or irregular
Volume – shallow or full
Normal Values:
hAdult 12 - 20
hChild 15 - 30
hInfant 25 - 50
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Baseline Vital Signs
Skin:h Colour
h Temperature
h Condition
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Blood Pressure (BP)h2 main techniques:
Palpation & auscultation
hSystolic reading(when heart is contracting)diastolic reading (betweenheartbeats)
hFollow along with the slides…
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Blood Pressure Cuff Parts
Cuff
Pressure gauge
Inflation bulb
Air bladder(hidden inside cuff)
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Step 1:Choose an appropriately sized cuff
• The cuff air bladdershould go about 80% of the way around the arm
• A wrong sized cuff will give a wrong reading; you may omit taking a BP if you don’t have the right cuff size The bladder takes up only
part of the cuff!
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Step 2: Apply the cuff• Find the brachial artery
(between the tendon of the biceps and the humerus)
• Wrap the cuff securely around the upper arm with the “artery” marking pointing to the brachial artery pulse
• Make sure clothing is not caught under the cuff
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Step 3: Inflate the cuff• Find the radial or
brachial pulse• Inflate the cuff until
you can no longer feel the pulse (this occurs at about the systolic blood pressure level)
• Inflate the cuff another 20 mmHg above that
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Step 4: Apply the Stethoscope
• Place the diaphragm of the stethoscope over where the brachial pulse had been palpated
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Step 5: Deflate the cuff• Deflate the cuff slowly
(2 mmHg/second)• Record the systolic
pressure when you first hear a “thud-thud-thud”
• Record the diastolic pressure when you lose the sounds or they become very quiet
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Blood Pressure by PalpationhFind the radial pulsehApply the cuff as beforeh Inflate the cuff until the
radial pulse is lost; then inflate it another 20 mmHg
hDeflate cuff slowlyhSystolic pressure is when
radial pulse returnshDiastolic pressure is not
obtainedhRecord only systolic
reading
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Normal Blood Pressure ValuesSystolic:
Adult: age + 100 (up to 150 mmHg)
Child : 2 x age + 80
Diastolic:
Adult: 65 - 90 mmHg
Child: 50 - 80 mmHg
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Low or High Blood Pressures• Low blood pressures (below 90/60 in adults)
suggest shock (lack of blood flow to vital organs)
• Long term high blood pressures (above 160/100) can damage organs (heart, kidneys, brain); Sometimes this takes years
• Short term high blood pressures also occur with pain, fright, emotional upset
• Patients who ask about their blood pressure should be encouraged to ask their physicians about any concerns they may have
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Pupils
hAre the Pupils Equal And Reactive to Light (PEARL) ?
hPupils may be dilated, constricted, or mid-size
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Assess the headhObserve for discharge
(blood or fluid)
hAssess pupil size
hObserve for “Battle’s Sign”
hCLAPS-D and TICS-D
hReassess airway
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Assess the neckhCLAPS-D
hTICS-D
hDistended neck veins (JVD)
hTracheal Deviation
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Assess the chest & back
hCLAPS-D
hTICS-D
hAuscultation
* Reassess Critical Interventions
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Assess the abdomenhPulsating Masses
hPalpate 4 quadrants
hCLAPS-D and TICS-D
hRigidity
hTenderness
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Assess the pelvishCLAPS-D and TICS-D
hObserve for incontinence and / or blood
hStability in 3 planes
If any instability or crepitus is found, there should be no further assessment of the pelvis at any point
• Priapism?
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Assess the lower extremities
hCLAPS-D
hTICS-D
hCirculation (skin colour and pulse in foot)
hSensation to touch
hMovement
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Assess the upper extremitieshCLAPS-D
hTICS-D
hCirculation (skin colour and pulse)
hSensation
hMovement
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Medical Report
• Patient’s name
hPatient’s age
hChief complaint
hIncident history
hTreatment
hVitals
hAssessment findings
hResponse to treatment
What we found
What we did
What we have now
What we found
What we did
What we have now
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Pocket Medical Report• No patient name to be recorded on this form• Available to assist crews with assessment and reporting skills• PMR Given to TEMS crew with no copy required by TFS• Use PMR as a guide – not a mandatory TFS form
TORONTO FIRE SERVICES & SOCPC POCKET MEDICAL REPORT Incident address Age M Please read important information on the back of this form F Chief Complaint Incident History Primary/Secondary Survey Airway/Breathing/Circulation Level of consciousness (A V P U) Details Head/Neck Chest/Abdomen Pelvis/Extremities Past Medical History
Cardiac Respiratory Details Stroke Diabetes Seizures
Medications List (use reverse side) or collect medications & send with patient Allergies ASA Codeine Sulpha Penicillin Other? Time Pulse Blood Pressure Respirations 1st set / hr / ---------------------------------------------------------------------------------------------- 2nd set / hr / Treatment
CPR and defibrillation Oxygen C-spine support Splinting Wound dressing
Document 1.13
Important Instructions Due to patient confidentiality issues DO NOT include the patient’s name on the Pocket Medical Report. The patient’s name, if available, should be collected as it will be required for completion of the TFS ‘A’ form.
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Summary
• A head to toe examination• Identified and treated any life threatening
conditions missed during the primary survey• Identified and treated non-life threatening
conditions after completion of the secondary survey
• Obtained and recorded vital signs, including blood pressure
• Establishing a dialogue with patient and family to collect information, confirm the chief complaint, and identify any other medical issues
• Organizing and delivering a patient report
In this module we have discussed and/or practiced:
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Any Questions ?
Photography credits:
Michael FeldmanKirk FudgeUri RateneksBill SaultNatasha Skvorets