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Principles of Patient Assessment in EMS PowerPoint PPT Presentation


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Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 11 – Detailed Physical Examination. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. . Objectives.

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Principles of Patient Assessment in EMS

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Principles of patient assessment in ems l.jpg

Principles of Patient Assessment in EMS

By:

Bob Elling, MPA, EMT-P

&

Kirsten Elling, BS, EMT-P


Chapter 11 detailed physical examination l.jpg

Chapter 11 – Detailed Physical Examination

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Objectives

  • Describe the patients on whom the EMS provider should perform a detailed physical examination (DPE).

  • Explain when the EMS provider would perform a DPE.

  • Describe how and why the approach to the DPE is modified for children.

  • List the three general types of closed soft tissue injuries that the EMS provider may discover during an examination.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Objectives (continued)

  • Describe the various types of open soft tissue injuries that the EMS provider may discover during an examination.

  • List the body areas and specific assessment points for each.

  • Explain how the acronym DCAP-BTLS may be useful during the DPE.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Objectives (continued)

  • Provide an example of when the DPE would not be performed by the EMS provider.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Introduction

  • The detailed physical exam (DPE) is a complete head-to-toe exam for the non-life or limb-threatening conditions.

  • The DPE is performed on trauma patients with a significant MOI.

  • The DPE is usually completed during transport unless there is a delay.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Detailed Physical Exam

  • For most patients assess in a head-to-toe direction.

  • For young children the toe-to-head approach is used to decrease fear and anxiety.

  • Soft tissue injuries discovered are classified as “opened” or “closed.”

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Closed Soft Tissue Injuries

  • Contusion

  • Hematoma

  • Crush injuries

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Open Soft Tissue Injuries

  • Abrasion

  • Avulsions

  • Incisions

  • Lacerations

  • Punctures/penetrations

  • Amputations

  • Impaled objects

  • Major artery lacerations

  • Crush injuries

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Head

    • Assess for DCAP-BTLS and crepitus

    • Common injuries are contusions and lacerations, which bleed profusely

  • Face

    • Assess for DCAP-BTLS, crepitation and symmetry

    • Palpate facial bones for stability

    • Vision problems can result from instability

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Eyes

    • Assess for DCAP-BTLS, pupil response, and eye movement

    • Note any discoloration in the anterior chamber and around the eye (Raccoon’s eye)

  • Nose

    • Assess for DCAP-BTLS, and fluid drainage

    • Drainage may include blood or CSF

    • For patients that are immobilized, drainage may become an airway obstruction

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Ears

    • Assess for DCAP-BTLS and fluid drainage

    • Allow fluids to drain

  • Mouth

    • Assess for DCAP-BTLS, crepitation, loose or broken teeth, swelling or laceration of the tongue or throat, unusual odors, discoloration, and drainage

    • Assess need for suction or airway adjuncts

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Neck

    • Assess for DCAP-BTLS, crepitation and JVD

    • May be necessary to open c-collar to assess, maintain manual stabilization

  • Chest

    • Assess for DCAP-BTLS, crepitation, symmetry and paradoxical motion

    • Listen to breath sounds

    • Note any scars

    • Apply chest compression to reveal rib fractures

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Abdomen

    • Assess for DCAP-BTLS, guarding, rigidity, masses/bulging (pulsing or firm) or distension

    • Prior to palpation, listen for absence of bowel sounds (if feasible)

    • Ask the patient about distension or bloating

    • Do not touch any masses

    • Note any scars

    • Consider females of child bearing age to be pregnant

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Pelvis

    • Assess for DCAP-BTLS, crepitus, and stability

    • Apply pressure on pelvic ring and pubic synthesis

    • Reconsider the MOI for possible pelvic injury

  • Posterior

    • Assess back and buttocks for DCAP-BTLS and crepitation

    • When patient is on a long board prior to the exam, use fingers to reach under

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Examine the Following Areas:

  • Extremities

    • Assess for DCAP-BTLS and distal PMS

    • Compare side to side and assess for strength and reflexes

    • Assess the range of motion (ROM)

    • With major degloving injury or amputation assess for bleeding

    • Crush injuries have the potential for immediate complications when crush is a lengthy time

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Priority Determines Care

  • The DPE is conducted:

    • Only if time permits

    • Usually enroute to the hospital

  • When the patient’s condition is critical the priority should be:

    • Necessary interventions

    • Serial initial assessments

    • Transport

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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Conclusion

  • The DPE is a thorough head-to-toe exam of the trauma patient who has significant MOI.

  • The approach differs for children (toe-to-head).

  • The DPE is completed enroute to the hospital if time and personnel permit.

  • Report all findings to the next care giver and carefully document your findings.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.


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