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patient assessment system

Discussion in 'Staying Healthy' started by Sebe Bach, Apr 3, 2018.

  1. Sebe Bach

    Sebe Bach Just signed up

    Apr 3, 2018
    anything i can get
    Portland, OR, United States
    View on map:
    My Website(s):
    +5 / -0
    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


    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

    No war stories

    Patient assessment system:
    1. Scene size up

    2. Life threats - abcde

    3. Head to toe, vital signs, history

    4. Problem list + plan

    5. Monitor
    Scene safe? Risks to self, crew, patient

    Identify method of injury (MOI)

    Body substance isolation (BSI)

    1. 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


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


    Stabilize c-spine (cervical/neck)

    Initital assessment -

    A - airways 1) open 2) empty

    Is there anything in your mouth?

    B- breathing

    Is it happening?
    Does it hurt?


    C - circulation -> pulse, blood sweep


    D - decision ->

    Was there a MOI for possible spine injury?
    1. Yes -> maintain

    2. 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


    Not awake

    Response to:

    Verbal stimuli

    Painful stimuli - pinch back of arm


    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


    Listen for first and last beat

    Oscaltation - bp cuff plus stethescope

    Palpation - pluse/bp cuff

    Estimation - pluse


    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
    1. MOI for spsine

    2. Ankle pain

    3. dehydration
    P - plan - treatment list
    1. Maintain c-spine

    2. RICE + support

    3. hydrate
    A - anticipated problems

    Request backboard

    Shock secondary to dehydration

    • Useful Useful x 4
    • Epic Epic x 1
  2. OP
    Sebe Bach

    Sebe Bach Just signed up

    Apr 3, 2018
    anything i can get
    Portland, OR, United States
    View on map:
    My Website(s):
    +5 / -0
    sorry it is so long! lol
  3. Coywolf

    Coywolf Sir Drinks-A-Lot
    StP Supporter

    Dec 12, 2014
    Public land activist
    Moab, UT, United States
    View on map:
    +967 / -23
    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!
    • Agree Agree x 3
    • Like Like x 1