Paramedic Assessment Questions

Assessment 1. 2. 3. 4. 5. 6. P - PPE / BSI / Scene Safety E – Environmental Hazards: Violence, Weather / Temperature, Unstable Scene, etc. N – Number of Patients M – Mechanism of injury or Nature of illness A – Additional Resources N – Need for extrication / C-spine General Impression: 1. What do I see, hear, smell when I approach the scene? 1. Orientation: Hello, my name is __________, what seems to be bothering you today? AVPU: Determine if the patient acknowledges you via tracking you, verbal stimuli, painful stimuli, unresponsive to stimuli. Alert & Oriented Status (A&O) 1. 2. 3. 4. What is your first and last name? How old are you and when is your birthday? What is going on right now? If they cannot answer any of the above then ask them specifically: o - Person o - Place o - Time o - Situation Primary Survey Airway: Is the airway open and patent? If not, what do I need to do to fix it? A. Head tilt chin lift / modified jaw thrust B. Suctioning C. Airway adjunct – OPA / NPA Breathing: Is my patient suffering from Dyspnea (Shortness of Breath)? What is the: A. Rate: how many breaths per minute (12-20 normal rate). B. Quality (Tidal Volume): Do they have normal chest rise and fall? Shallow, Deep? C. Rhythm: Are they regular or irregular? If the rate, quality, or rhythm is inadequate fix it by bagging the patient with a BVM with high flow O2 at the appropriate rate and tidal volume. **All patients will be placed on O2 therapy via canula (2-4 lpm), NRB (10-15 lpm)** ** If the chief complaint is respiratory related, we would also auscultate Lung sounds ** Circulation: How is my patient perfusing? A. What is the patient’s pulse? Is it regular, irregular, weak, bounding, or absent? B. What do my patients skins look like? Pale / cool / clammy, Normal / Normal / Warm, Hot / Red / Diaphoretic? C. What is my patients capillary refill? < 2sec or > 2sec? D. Do I see any major immediate life-threatening bleeding? E. Do I need to treat for shock? If so (based on skin signs) put a blanket on them and place them in Trendelenburg position. Transport Decision: Load and Go / Stay and Play? Secondary Survey: For altered level of consciousness patients, they may or may not be able to answer questions appropriately. You will need to attempt to identify the root cause behind their ALOC. You will use AEIOU TIPS A – Alcohol: Do you suspect the patient was drinking? Ask if they have been or look for signs / ask bystanders. E – Epilepsy: Does the patient have a known history of epilepsy or did the witnesses see any signs / symptoms the patient had a seizure? I – Insulin: Does the patient have a known or suspected history of Diabetes? Check the patient’s blood sugar. ***EVERY ALOC PATIENT SHOULD HAVE THEIR BLOOD SUGAR CHECKED*** O – Overdose: Look for clues the patient may have overdosed on either elicit drugs or possibly prescription medications including toxins / poisons in their environment. U – Uraemia (Remal Failure): Look for signs of urinary tract infections, lack of urination, fever, signs of septic shock. T – Trauma: Look for obvious signs of trauma through rapid trauma assessment I – Infection: Look for signs of infection including fever and signs of septic shock P – Psychosis: Some patients may be having a behavioral emergency. Look to bystanders, family members, or possibly medications to assist in making this diagnosis. S – Stroke: Look for signs and symptoms of stroke via Cincinnati Stroke Scale / LA Stroke Scale or Bystander / Family history. Try to determine when the patient was last seen with normal mentation. **If you were able to correct any of these situations ie; administration of oral glucose, you will then continue trying to gather assessment finding through OPQRST / SAMPLE form either the patient or family. 1. Pertinent Questions 1. Onset: What were you doing when the symptoms started? 2. Provoked / Palliate: Did the symptoms come on gradually or all at once? 3. Quality: Are you having a hard time speaking or moving? 4. Radiates: This question doesn’t pertain to Stroke 5. Severity: If this has happened before, what was the outcome? 6. Time: How long ago did the symptoms start? 10m, 1hr, 2 days etc. 2. Pertinent Secondary 1. Slurred Speech (CSS) 2. Facial Droop (CSS) 3. Arm Drift (CSS) 4. Pupils 5. Check perfusion, motor, sensory for all extremities 3. History: HAM 1. History: Do you have any other medical problems? 2. Allergies: Do you have any allergies to medications? 3. Medications: Are you taking any medications? 4. Treatment Plan: 1. Vital Signs – BP, Lung Sounds, Pupils, Pulse Ox, Pulse, RR / Quality 2. Medication – Assist when protocol allows 3. Treatment: O2, 12 Lead, Glucose, etc. 4. Transport: ALS or BLS 5. Position Patient 6. Transport Destination Decision 7. Reassessment