IX. Patient Assessment System – Checklist

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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V. PAS – Secondary Survey – Patient Exam:

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.

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IV. PAS – Secondary Survey – Vital Signs:

Part 4 of 9: Patient Assessment System – Vital Signs:

STOP – SECONDARY SURVEY: How hurt are they?
The Secondary Survey consist of:
How well are they? Vital Signs
What are their injuries? Patient Exam
What is their past medical history? AMPLE History
What is our patient care plan?  SOAPnote

VITAL SIGNS: How well are they doing? 

Respiratory Rate and Effort:
Respiratory rate and effort shows us how well the Respiratory System, the airway and lungs, is doing at oxygen exchange and in particular, in supplying the brain with O2.
LOOK – Do they look like they are having difficulty breathing?
LISTEN – Are they complaining of shortness of breath or difficulty breathing?
FEEL – Is the chest moving properly with breathing?

Heart Rate and Effort (blood pressure):
The heart rate and effort, blood pressure, tells us how well the Circulatory System, the heart and blood vessels, are doing.
LOOK – Do they look shocky?
LISTEN – What is there heart rate, beats per minute.
FEEL – Take a blood pressure by palpation (systolic), if you do not have a BP cuff.

Level of Consciousness:
Level of consciousness tells us how well the Central Nervous System, the brain and spinal cord, are doing.

Action:
Level of Consciousness (LOC) is determined using the AVPU scale:
Awake, Verbal, Painful, Unresponsive.

Conscious: “The lights are on, is anyone home?”
Awake, their eyes are open but, are they alert oriented times 3, person, place, and time?
Person, do they know who they are?
Place, do they know where they are?
Time, to they know the day, week, and year?

Unconscious: If their eyes are closed they are unconscious, but how responsive are they?
Verbal stimuli, “Hello, anyone in there?”
Speak to them, do they react to hearing their name?
Do they follow simple commands?
Painful stimuli, “That’s got to hurt.”
A knuckle rubbed on their sternum?
Is it an appropriate response to pain?
Unresponsive, “Speak to me; say something.”
No response to verbal or painful stimuli.

Skin color, temperature, and moisture:
Skin color varies by individual and race.
Look – What is their skin color, pale, ashen, cyanotic?
Listen – Are they complaining about feeling hot or cold?
Feel – Is their skin dry, moist, clammy, hot, or cold?

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III. Patient Assessment System – Primary Survey

Part 3 of 9: Patient Assessment System – Primary Survey

STOP – PRIMARY SURVEY: Are they alive, and are they going to stay alive?

A: Approach and Assess – Are they conscious and can they speak?
A: Airway – Do they have an open airway?
B: Breathing – Are they breathing?
B: Breathing – How well are they breathing? 
C: Circulation – Do they have a pulse? 
C: Circulation – Are they bleeding?
D: Deformity – Are there any obvious deformities?
D: Disability – Is their neck or back at risk of injury?
E: Environment – Can they stay where they are?
E: Everyone Else – How is everyone else in the group doing?

A: Approach and Assess – status of the central nervous system
Are they conscious and can they speak?
Look – Are they awake; are their eyes open; what position are they lying in?
Listen – Speak to them. Do they speak back?
Feel – What is your general impression of the situation?

A: Airway – status of the respiratory system
Do they have an open airway?
Look – Is there anything in their airway?
Listen – Can you hear air moving in and out of the airway?
Feel – Can you feel air moving in and out of the airway?

B: Breathing – status of the respiratory system
Are they breathing?
Look – Is their chest wall moving as they breathe?
Listen – Can you hear any adventitious breath sounds indicating a partially occluded airway, such as wheezing, gurgling, or snoring?
Feel – Is the chest wall moving appropriately with respirations?

B: Breathing – status of the respiratory system
How well are they breathing?
Look – Is their chest wall moving as they breathe?
Listen – Can you hear any adventitious breath sounds indicating a partially occluded airway, such as wheezing, gurgling, or snoring?
Feel – Is the chest wall moving appropriately with respirations?

C: Circulation – status of the circulatory system
Do they have a pulse?
Look – Is there any bleeding?
Listen – Can you hear a heartbeat?
Feel – Can you feel a carotid pulse?

C: Circulation – status of the circulatory system
Are they bleeding?
Look – Is there any bleeding?
Listen – Can you hear a heartbeat?
Feel – Can you feel a carotid pulse?

D: Deformity
Do they have any obvious injuries or deformities?
Look – Do you see any obvious injuries or deformities?
Listen – Where are they complaining of pain?
Feel – Where does it hurt? As you touch them, where can you cause pain?

D: Disability
Is their neck or back at risk of injury?
Look – What was the mechanism of injury (MOI)? Can they move their extremities?
Listen – Are they complaining of any neck or back pain?
Feel – Do they have normal sensation in their extremities?

E: Environment
Can they stay where they are?
Look – Where are they lying?
Listen – Are they complaining about being hot, cold, or wet?
Feel – Is their skin warm, dry, cold, or wet?

E: Everyone Else
How is everyone else in the group doing?
Look – How does the rest of the group look?
Listen – Is anyone complaining of being cold, wet, hungry, or thirsty?
Feel – What is the emotional status of the group?

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II. Patient Assessment System — Scene Survey

Part 2 of 9: Patient Assessment System – Scene Survey

To survey something is to examine it closely and ascertain the condition. In this system of STOP and Survey, the intent is to take the time to STOP and take a deep breath before closely examining and ascertain the patient’s condition.  A survey is organized in a logical step-by-step process that allows you to gather the information and respond in an orderly manner. 

STOP – SCENE SURVEY: Is the Scene Safe?
 Am I OK, and am I going to stay OK?
 Are the others OK, and are they going to stay OK?
 Is the victim of this crisis OK, and are they going to stay OK?
 What happened? What was the mechanism of injury (MOI)?
 How do I safely approach the victim?
 What is my general impression of how serious this is?

To accomplish all this Scene Survey:
 
1. STOP! Stand still, take a deep breath, and ask yourself, “Am I OK?” If not, do something about it! Go

2. STOP! Tell everyone else to STOP, stand still, take a deep breath and ask themselves, “Am I OK?” If not, do something about it! Don’t allow anyone to run off to check the victim or to get help. Go

3. STOP! Is the victim OK? First speak or call out to them, even if you cannot see them or get to them. Ask them if they are alright. Hopefully, they will answer; even if they say that they are not alright, at least you know they are alive, have an open airway, are breathing, and have a pulse. Go

4. STOP! Ask yourself, “What happened?” “What was the mechanism of injury?” Go

5. STOP! Survey the victim’s situation. While figuring out how to safely get to them, keep talking to them, be positive, keep encouraging them, tell them to lie still, that help is on the way. Go

6. STOP! As you approach the victim, survey their position. Ask yourself, “Can they stay where they are, or are they in eminent danger and need to be moved?” Go

7. STOP! What is your impression of the victim. As you approach the victim (they do not become your patient until you lay your hands on them), develop a general impression of how serious the situation seems to be, based on the position they are lying in, how they look, whether they are conscious, bleeding, etc. Go

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I. THE PATIENT ASSESSMENT SYSTEM — Overview

Part 1 of 9: THE PATIENT ASSESSMENT SYSTEM — The First Five Minutes

STOP – SCENE SURVEY: Is the scene safe?Am I safe?
Is everyone else safe?
Is the patient safe?
What happened? (Mechanism of Injury – MOI)
How do you safely approach the victim?
What is your general impression of the situations seriousness?STOP – PRIMARY SURVEY: Are they alive?
A: Approach and Assess – Are they conscious and can they speak?
A: Airway – Do they have an open airway?
B: Breathing – Are they breathing?
B: Breathing – How well are they breathing? 
C: Circulation – Do they have a pulse? 
C: Circulation – Are they bleeding?
D: Deformity – Are they any obvious deformities?
D: Disability – Is their neck or back at risk of injury?
E: Environment – Can they stay where they are?
E: Everyone Else – Is everyone else high and dry and safe?

STOP – SECONDARY SURVEY: How Are They? 
How well are they doing? Vital Signs
What are their injuries? Patient Exam
What is their past medical history? AMPLE History
What is your patient care plan?  SOAPnote

STOP – RESCUE SURVEY: Do we need help?
What is our plan to get help?
Who is going to go to get help?
What do we need to do to protect the patient while waiting for help to arrive?
What do we need to do to protect ourselves while waiting for help to arrive?
Is the scene safe for the group?

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