REGION XI EMS Patient Assessment Module Part 3uicems.uic.edu/rxi/pdfs/PtAssmt3of3.pdf ·  ·...

1

REGION XI EMS

Patient Assessment

Module Part 3

SITE CODE 11-1325-E-1213-C 1 hour CE

2

Monitoring Devices and Medical Devices

3

Monitoring and Medical devices

Pulse oximetry

Blood pressure

Glucose monitor

Cardiac monitor/ AED

12 lead EKG

Capnography

Airway adjuncts

Broselow tape

4

Pulse Oximetry

5

Blood Pressure

Don’t take over bulky clothing

Avoid reporting BP as 130/ Palp

Case scenario

6

Blood Glucose

Who checks a blood sugar?

When do you check a blood sugar?

Treatment

Case scenario

7

12 Lead EKG

Who gets an EKG

Where do we

transport patient

SMO

EKG Lead Placement

8

STEMI CENTERS

Advocate Christ Medical Center Advocate Illinois Masonic Medical

Center Advocate Lutheran General

Hospital Advocate Trinity Hospital John H. Stroger, Jr. Hospital of

Cook County Little Company of Mary Hospital Loyola University Medical Center Mercy Hospital and Medical

Center MetroSouth Medical Center Mt Sinai Hospital Northwestern Memorial Hospital Norwegian American Hospital Our Lady of the Resurrection

Medical Center

Resurrection Medical Center Rush University Medical Center St. Francis Hospital (Evanston) St. Joseph Hospital - Chicago St. Margaret (Indiana) St. Mary Medical Center Swedish Covenant Hospital University of Chicago Medical

Center University of Illinois Hospital &

Health Sciences System Vanguard MacNeal Hospital Vanguard Weiss Memorial

Hospital Vanguard West Suburban Medical

Center

9

Cardiac Monitor

Case scenario

10

AED 500

BLS engine

BLS ambulance

Other brand AED’s on ALL Private Provider BLS ambulances

11

AED 1000

CFD ALS ambulance

Brought into ALL EMS responses except for known respiratory or cardiac arrest

Transfer onto monitor once in the ambulance

12

Capnography

When do we use

Documents CPR effectiveness

Documents return of spontaneous circulation

Normal value: 35-45

13

Airway Adjuncts

14

Broselow tape

Tool for determining correct dosage of medications and equipment sizes

Eliminates need to estimate child weight

Red to head

Patient heel identifies the patient color zone

15

Alternate Vascular Sites

Patients in extremis

16

Alternate Vascular Sites

Consider use of EZ IO

Patients in extremis

Cardiac arrest

Severely unstable patient

Contraindications

No blood return on access

Known infection in line

17

Hemodialysis

Graft

Synthetic tube connecting an artery and vein

Usually placed in upper extremities

Fistula

Artery and vein are connected

18

19

Dialysis catheters

Semi - permanent

Placed using the IJ, subclavian or femoral vein

Tip is usually in the right atrium

20

Triple Lumen catheter

Short term nontunneled catheter

Placement in either the internal jugular, subclavian, or femoral

Tip placement into the central circulation either the Superior vena cava (SVC) or Inferior vena cava (IVC)

20

21

Hickman Catheter

Long term catheter

Surgically placed

Tunneled and cuffed

Tip place usually SVC

Aseptic technique when using catheter

7/8/2013 21

22

PICC

Inserted in forearm

Tip lies in SVC/right atrial junction

22

23

Implantable Port

Surgically placed line

Place under skin

Need a special needle to access it (non-coring)

24

Reassessment

25

Reassessment

Repeat the initial and focused assessments

Performed throughout the patient encounter

26

Unstable patients

Every 5 minutes

More often or continuously if needed

Stable patients

Every 15 minutes

After interventions

When there is a change

How often do you reassess?

27

What do you reassess?

Mental Status/Level of Consciousness Behavior change

Facial expression

Mood, affect

Memory, attention

Airway

Patency

Positioning

Suctioning

28

What do you reassess? Cont.

Breathing - Respirations

Rate

Quality - depth, accessory muscles, posture

Lung sounds

Pulse oximeter - saturation of red cells with oxygen

ETCO2- exhaled carbon dioxide

29

What do you reassess? Cont.

Circulation

Pulse – rate and quality, central and peripheral

Capillary refill

Skin - color, moisture, temperature

Other Vitals signs

BP - systolic and diastolic

30

Reassess the response to treatments or interventions

Objective findings

Subjective findings

Case scenario

31

Reassess the Chief Complaint

Are there any changes in what they called 911 for?

Better? Worse? Same?

Are there any new complaints?

32

Reassess the Interventions

Reassess the effectiveness of medications, treatments, splinting, dressings

Consider the need for adjustment or modification of treatment

33

Reassess Pain

Rating

Remains the same

Getting worse

Getting better

Pain scale

Vital signs Observe for trends

34

If there are negative changes…

Re-contact medical control/base station

Request additional direction

Case scenario

35

Documentation

Document all findings, including no change because that can be equally significant.

Document all treatments and assessments even if the patient is not transported.

Case scenario

36

Important Documentation Points….

Use objective words and descriptions of the scene and patient.

Use quotation marks if documenting something someone said.

Describe the patient’s actions that lead to your assessment of LOC.

Document all interventions, the results, and any issues or difficulties while performing the intervention.

37

More Important Documentation Points….

Document any patient belongings that you bring with the patient on transport.

Document your contacts with Medical Control

If you are taking over care from another provider, document your own assessment of the patient.

Patient Assessment Part 3

Patient Assessment Part 2 is completed. Please complete the quiz, then the completion certificate. Submit a copy of the certificate to your Resource Hospital, your employer and keep a copy for your records

39

References

AAOS Emergency Care and Transportation of the Sick and Injured. Editor Andrew Pollak, 2011.

Brady Emergency Care 12th edition, Daniel Limmer & Michael O’Keefe, 2011.

EMS REGION XI CHICAGO PARAMEDIC STANDING MEDICAL ORDERS & POLICIES AND PROCEDURES

2012 Chicago EMS Medical Directors Consortium National EMS Education Standards and Instructional

Guidelines NHTSA website www.nhtsa.gov http://www.ems.gov/pdf/811077e.pdf and

http://www.ems.gov/pdf/811077c.pdf Sanders, M. J., Mosby’s Paramedic Textbook, Revised 2nd

Edition TNCC Provider Manual, Emergency Nurses Association,

2007.