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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

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    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
    Communication
    Prevention
    Evac

    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?’

    (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?
    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

    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
    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


    CPR
     
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  2. OP
    OP
    Sebe Bach

    Sebe Bach Just signed up

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    sorry it is so long! lol
     
  3. Coywolf

    Coywolf Sir Drinks-A-Lot
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    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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