# patient assessment system



## Sebe Bach (Apr 3, 2018)

hey, so these are some of my notes from a wilderness medicine certification I did years ago.
this kinda knowledge is especially good for travelers as it emphasizes improvisation and lack of resources.
the patient assessment system is the smallest "chunk" of knowledge that is useful in this field (other than maybe first aid/CPR) and could easily be taught in a two hour workshop. 

please let me know if you have any questions! im thinking of writing a zine on this subject, so it would be helpful to know which parts are confusing

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Wilderness - time away from definitive medical care (1hr or more)
Urban -> 911 -> ambulance -> ER -> stay or home
Time: long term care
Environment- safety, temp

Gear: improv
Communication
Prevention
Evac

No war stories

Patient assessment system:

Scene size up


Life threats - abcde


Head to toe, vital signs, history


Problem list + plan


Monitor

Scene safe? Risks to self, crew, patient

Identify method of injury (MOI)

Body substance isolation (BSI)


Gloves, b) sunglasses, c) cover nose and mouth

Number of patients


General impression

1 - im number 1

2 - what happened to you

3 - dont get it on me

4 - any more?

5 - dead or alive

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Approach patient - introduce : ‘hi my name is …, I have some medical training? Can I help you out?’

(consent)

Stabilize c-spine (cervical/neck)


Initital assessment -

A - airways 1) open 2) empty

Is there anything in your mouth?
Stop+fix

B- breathing

Is it happening?
Does it hurt?

Stop+fix

C - circulation -> pulse, blood sweep

Stop+fix

D - decision ->

Was there a MOI for possible spine injury?

Yes -> maintain


No -> let go

“Tell us what happened”

E - environment -> protect

“Is there anything we could add to make you more comfortable?”

Expose- look at injury

Head to toe exam

C - circulation

S - sensation

M - movement


L - look

A - ask

F - feel


Vital signs - looking for trends

Time: take regular vitals

LOR - level of responsiveness

HR - heart rate - 72 strong and reg

RR - respiratory rate

SCTM - skin color temp moisture

BP - blood pressure

Pupils - PERRL

Temp - thermometer


LOR - A - awake and oriented

4. Event

3. Time

2. Place

1.person


Not awake

Response to:

Verbal stimuli

Painful stimuli - pinch back of arm

Unresponsive


Heart rate(HR)


Rate - normal - 50-100 beats per min

Rhythm - regular, irregular

Quality - strong, weak


Respiratory rate - dont tell what you are doing

Rate - 12- 20 breath/min

Depth - shallow/deep

Effort - easy/labored


SCTM - skin color, temp, moisture

Normal - pink, warm, dry

Stressed - pale, cool, damp, clammy


Blood pressure

Systolic/diastolic


Listen for first and last beat

Oscaltation - bp cuff plus stethescope

Palpation - pluse/bp cuff

Estimation - pluse


Pupils-

Equal, round, reactive to light


Let patients do things they can for themselves


History - dont ask leading questions

(nausea, headache, dizzy)

S - symptoms, how do you feel?

A - allergies - do you have any?
M - meds

P- past history - is there anything else I should know?

L - last in/out

E - events prior


No matter what you think the diagnosis may be, never forget the history


Symptoms (things you need to be told) vs signs (visible)


SOAPA - legal issues are a good reason to document


S - summary - age, sex, chief complaint, MOI, LOR

O - observation - patient found __________ + LOR

Head to toe, vitals, sample

A - assessment list - problem list

MOI for spsine


Ankle pain


dehydration

P - plan - treatment list

Maintain c-spine


RICE + support


hydrate

A - anticipated problems

Request backboard

Shock secondary to dehydration


CPR


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## Sebe Bach (Apr 3, 2018)

sorry it is so long! lol


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## Coywolf (Apr 3, 2018)

Dude, fuck ya! WFR patient assesment system!! SO useful, this could be used by street medic for all those protests/activism rallies out there 

I'm an EMT now, and I remember my first WFR class years ago! 

Thanks for posting this!


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