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Clinical Foundations

Clinical Foundations. Priority Setting and Patient Assessment. Primary Survey. Assessment of Airway/Cervical Spine, Breathing, Circulation, and Disability Subjective Data-Chief Complaint, precipitating event/onset of symptoms, mechanism of injury, time factor, source of data

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Clinical Foundations

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  1. Clinical Foundations Priority Setting and Patient Assessment

  2. Primary Survey • Assessment of Airway/Cervical Spine, Breathing, Circulation, and Disability • Subjective Data-Chief Complaint, precipitating event/onset of symptoms, mechanism of injury, time factor, source of data • Objective Data-physical signs and symptoms

  3. Airway • Airway/Cervical Spine – open/clear or Obstructed • Is it patent? Position the airway, maintain cervical immobilization, remove debris, possibly inert NP/OP airway

  4. Breathing • Is it acceptable or compromised • Position, provide supplemental oxygen, auscultate breath sounds, provide PPV or intubate if necessary

  5. Circulation • Pulse, Bleeding, Perfusion • Iv access, auscultate heart sounds, CPR, control bleeding, IVF or blood products

  6. Disability • Brief Neuro exam

  7. Secondary Survey • 90 second head to toe examination • The goal is to discover abnormalities and injuries

  8. Focused Assessment • System specific related to complaint • Contains subjective and objective data • Intervention performed

  9. Vital Signs • Temp-abnormally high or low should be confirmed with rectal • Pule-rate, quality, cap refill, compared to each side of the body • Respirations, rate and work of breathing • Oxygen Saturation-essential for respiratory complaints, altered LOC, serious illness, or any abnormal vital sign • Blood Pressure-Systolic is a component of cardiac output, Diastolic is a component of vasculature • Orthostatic Vital Signs-syncope, dizzy, dehydration-Lying, Sitting, Standing. Positive if an increase in heart rate greater than 20-30 bpm or if dizziness or syncope develops during

  10. Prioritization with Individual Patients • Assess BEFORE acting • Prioritization Principles • Acute before Chronic • Life before Limb • Systemic before Local

  11. Trends • Any symptoms associated with other definitive changes (e.g. not feeling well and a fever and feeling short of breath) • Any minor symptoms that tend to recur repeatedly or intensify in severity (nagging cough that won’t go away) • Steady progressive decline

  12. Patient Demographics • Presence of other risk factors increase the patient’s priority • Elderly • Very Young • Altered Immunity • Transplant Patients • Multiple Comorbidities • Pregnancy • Reactions that have the potential to worsen (overdose, allergic response)

  13. Remember • A “known” patient can develop a new problem • Avoid WHO rather than what • Just because someone is more demanding or “ranked” higher should not distract from a more urgent patient need • Express your limit…”I understand you need me. I have to take care of this urgent need first and then a I can work with you”

  14. And finally… • Remember, prioritization does not mean a person’s need is not met. It is first things first so the right care is given to the right person at the right time for the right reason.

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