Archive for April, 2008

IX. Patient Assessment System – Checklist

April 29, 2008

Part 9 of 9: PATIENT ASSESSMENT CHECK LIST:

SCENE SURVEY:
Is the SCENE SAFE?
Is the PATIENT SAFE?

PRIMARY SURVEY: 
Are they CONSCIOUS?
Do they have an OPEN AIRWAY?
How is their BREATHING?
Do they have a PULSE? 
Are they BLEEDING?
Are there any serious injuries on the CHUNK CHECK?
Is their neck and spine STABLE?
Do they need to be MOVED?
Do we need to protect them from the ENVIRONMENT?
How is everyone else DOING?

SECONDARY SURVEY – VITAL SIGNS:
What is their RESPIRATORY RATE & EFFORT?
What is their HEART RATE & EFFORT?
What is their LEVEL OF CONSCIOUSNESS?
What is their SKIN COLOR, TEMPERATURE, & COLOR?

SECONDARY SURVEY – PATIENT EXAM:
HEAD  – scalp, face, eyes, nose, mouth.
NECK  – spine, trachea.
CHEST – clavicles, shoulders, ribs.
ABDOMEN – compress the abdomen.
PELVIS – compress the pelvis anterior/posterior and lateral.
LEGS  – circulation, sensation, and motion.
ARMS  – circulation, sensation, and motion.
BACK  – log roll and palpate the length of the spine.

SECONDARY SURVEY – AMPLE HISTORY:
ALLERGY – allergy to drugs, foods, insects, etc. 
MEDS  – prescription and non-prescription drugs.
PREVIOUS – significant past medical history, surgeries, etc.
LAST   – last intake & last output.
” EVENT – events leading up to this crisis.

SOAPnote:
Putting it all together and creating a treatment plan.

RESCUE PLAN:
” Looking at all factors and creating a rescue or evacuation plan.

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VIII. Patient Assessment System – Rescue Plan

April 22, 2008

Part 8 of 9: PAS – STOP – RESCUE SURVEY: Do we need help?

Are we staying or going?
What is our plan to get help?
Who is going to go to get help?
What do we do to protect the patient while waiting for help to arrive?
What do we do to protect ourselves while waiting for help to arrive?
Is the scene safe?

RESCUE PLAN: Do we need help?

Group’s condition:
How well is each individual in the group doing?
How well prepared is the group to stay put and bivouac?

Decisions:
Do we need to evacuate the patient or can we all go on?
If evacuation is needed, send for help.
While waiting for rescue – build a bivouac.

Sending for help:
Send two to get help if possible.
Send out a SOAPnote on the patient.
Send out a list of the rest in the group and how well prepared you are to bivouac.
Send out a map with your exact location and time marked on it.

While waiting for help to arrive:
Know where everyone is; pair people up to massage each other’s feet, etc.
Keep everyone busy.
Create shelter for everyone.
Get water or melt snow and make something warm to drink.
If food available, make a meal & eat.
Keep spirits up, be positive, reassure, make sure everyone has something to do.
Create light and warmth; build a fire.
Make yourselves big, easy to find.
Continuously monitor your patient.
Continuously monitor everyone else in the group.

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VII. PAS – Secondary Survey – SOAPnote:

April 15, 2008

Part 7 of 9: PAS – SOAP note: What is our patient care plan? 

The SOAP note is organized into the Subjective date, Objective date, the Assessment, and the Plan.

Subjective:
The subjective date is their age, sex, the mechanism of injury (MOI), and the chief complaint (C/C), i.e., what they are complaining of.

Objective: 
The objective date consist of their vital signs, the patient exam, and the AMPLE history.

Vital signs: 
Time the vitals signs are taken:   
RR & Effort    
HR & Effort(BP)    
LOC    
Skin: C/T/M    

Patient exam:  Describe locations of pain, tenderness & injuries.
                                                                                                                                               
AMPLE history:
Allergies:           
Medications:             
Past pertinent medical history:         
Last intake & output:           
Events leading up to accident:         

A – Assessment:  (problem list)
1.                                                                                                                                                  
2.                                                                                                                                                   

P – Plan:  (plan for each problem on the problem list)
1.                                                                                                                                                   
2.                                                                                                                                                  
3.  MONITOR – reSOAP your patient every 5 – 15 minutes.

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VI. PAS – Secondary Survey – AMPLE History:

April 8, 2008

Part 6 0f 9: PAS – AMPLE History: What is their past medical history?

ACTION:
Talk with your patient or others to determine the following information:

A – Allergies:
Are they allergic to any medications, foods, insects, etc.? 
If they are what happens and how is it treated?

M – Medications:
What medications are they taking, both prescription and over-the-counter?
If they are taking medications, how often and how much do they take and have they taken their meds today?

P – Previous Injury or Illness:
Is there any recent or past injury or illness that could contribute to the current problem?
Have they ever been hospitalized over night for any medical problems, is so what?

L – Last Input and Output:
When was the last time they had anything to eat or drink?
What did they eat and drink?
When was the last they voided or had a bowel movement?

E – Events leading up to the crisis:
What lead up to or occurred just prior to the critical event?

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V. PAS – Secondary Survey – Patient Exam:

April 1, 2008

Part 5 of 6: PAS – PATIENT EXAM: What are their injuries?

PRINCIPLES OF THE PATIENT EXAM:
You are trying to discover all possible injuries by:
LOOK:
Inspect:  Is there any bleeding, wounds, impaled objects, or deformities?
Compare:  Are their body parts symmetrical?
LISTEN:
Complaints: Are they complaining of pain or tenderness, if so, isolate where it hurts?
FEEL:
Palpation: Is there tenderness in muscles, bones, or joints?
Circulation:   Are there pulses in all four extremities?
Sensation:   Is there normal sensation in all four extremities?
Motion:   Is there normal range of motion is all four extremities?

ACTION:
Keeping the above principles in mind do a hands on head-to-toe exam:
HEAD:  scalp, face, eyes, ears, nose, mouth.
NECK: cervical spine, trachea.
CHEST: clavicles, gently compress the rib cage.
ABDOMEN: compress the abdomen in all four quadrants.
PELVIS: compress the pelvis front to back and laterally.
ARMS: palpate the muscles and flex the joints.
LEGS: palpate the muscles and flex the joints.
BACK: palpate the length of the back.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.