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REGION XI EMS
Patient Assessment
Module Part 3
SITE CODE 11-1325-E-1213-C 1 hour CE
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Monitoring Devices and Medical Devices
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Monitoring and Medical devices
Pulse oximetry
Blood pressure
Glucose monitor
Cardiac monitor/ AED
12 lead EKG
Capnography
Airway adjuncts
Broselow tape
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Pulse Oximetry
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Blood Pressure
Don’t take over bulky clothing
Avoid reporting BP as 130/ Palp
Case scenario
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Blood Glucose
Who checks a blood sugar?
When do you check a blood sugar?
Treatment
Case scenario
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12 Lead EKG
Who gets an EKG
Where do we
transport patient
SMO
EKG Lead Placement
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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
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Cardiac Monitor
Case scenario
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AED 500
BLS engine
BLS ambulance
Other brand AED’s on ALL Private Provider BLS ambulances
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AED 1000
CFD ALS ambulance
Brought into ALL EMS responses except for known respiratory or cardiac arrest
Transfer onto monitor once in the ambulance
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Capnography
When do we use
Documents CPR effectiveness
Documents return of spontaneous circulation
Normal value: 35-45
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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
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Alternate Vascular Sites
Patients in extremis
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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
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Hemodialysis
Graft
Synthetic tube connecting an artery and vein
Usually placed in upper extremities
Fistula
Artery and vein are connected
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Dialysis catheters
Semi - permanent
Placed using the IJ, subclavian or femoral vein
Tip is usually in the right atrium
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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)
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Hickman Catheter
Long term catheter
Surgically placed
Tunneled and cuffed
Tip place usually SVC
Aseptic technique when using catheter
7/8/2013 21
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PICC
Inserted in forearm
Tip lies in SVC/right atrial junction
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Implantable Port
Surgically placed line
Place under skin
Need a special needle to access it (non-coring)
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Reassessment
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Reassessment
Repeat the initial and focused assessments
Performed throughout the patient encounter
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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?
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What do you reassess?
Mental Status/Level of Consciousness Behavior change
Facial expression
Mood, affect
Memory, attention
Airway
Patency
Positioning
Suctioning
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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
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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
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Reassess the response to treatments or interventions
Objective findings
Subjective findings
Case scenario
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Reassess the Chief Complaint
Are there any changes in what they called 911 for?
Better? Worse? Same?
Are there any new complaints?
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Reassess the Interventions
Reassess the effectiveness of medications, treatments, splinting, dressings
Consider the need for adjustment or modification of treatment
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Reassess Pain
Rating
Remains the same
Getting worse
Getting better
Pain scale
Vital signs Observe for trends
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If there are negative changes…
Re-contact medical control/base station
Request additional direction
Case scenario
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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
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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.
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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
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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.
