2 chapter 38 assessment-based management 3 objectives there are no 1985 objectives for this chapter
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Assessment-Based Management
• You may have to provide care for patients who can’t answer questions for themselves.
• You must be able to assess the patient and the scene.• Draw clues from the environment.
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Effective Patient Assessment(1 of 3)
• Gathering Information – Critical to decision making
• The importance of history– 80% of patient’s diagnosis is attributed to the history
• The EMT-I’s knowledge will help guide in asking appropriate questions
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Effective Patient Assessment(2 of 3)
• Physical Assessment– Effectiveness may be compromised by some field
situations.• Patterns and Field Impression
– Compare information gathered with what you know about similar conditions.
– Look for patterns.– Patterns allow the EMT-I to formulate a plan of
action.
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Effective Patient Assessment(3 of 3)
• BLS/ALS Treatment– Standing orders/protocols– Correct impression essential to choosing appropriate
protocol– Adapt treatment plan to problem
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Choreographing Assessment and Management
• EMS teams need a plan for roles• Team leader
– Manages patient care• Patient Care Person(s)
– Gather scene information– Talk to relatives/bystanders
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The Right Stuff
• Getting the right equipment to a patient’s side is an important component of care.– Hope for the best, prepare
for the worst.– Incorrect equipment
compromises patient care.• Optional “Take In” equipment
– Medications, IV equipment
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Airway • Oral airways• Nasal airways• Suction (electric or manual)• Rigid Yankauer and flexible suction catheters
Breathing • Mouth-powered ventilation devices (pocket mask)• Manual ventilation bag-valve-mask• Spare masks• Oxygen tank and regulator• Oxygen masks, cannulas, and extension tubing• Occlusive dressings• Large-bore IV catheter for thoracic decompression
EMT-I Management (1 of 2)
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Circulation • Dressings• Bandages and tape• Infection control supplies: gloves, eye shields• Sphygmomanometer, stethoscope
Disability and dysrhythmia
• Rigid collars• Flashlight• AED
Exposure • Scissors• Space blanket or something to cover the patient
EMT-I Management (2 of 2)
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Aspects of Assessment/ Decision Making (1 of 2)
• Ensure nonjudgmental attitude.• Consider causes of uncooperative, restless, and
belligerent behavior.– Hypoxia– Hypovolemia– Hypoglycemia– Head injury
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Aspects of Assessment/ Decision Making (2 of 2)
• Distracting Injuries– Obvious injuries that look bad can divert your
attention from more serious injuries.• Environment may be distracting.
• Move patient to controlled area (ie, ambulance).
• Be organized to avoid confusion.
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General Approach (1 of 3)
• Calm, orderly demeanor– Have “preplan” before entering scene
• Initial assessment– Sets tone for patient encounter– Critical patients
• ABCs• Perform necessary interventions
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General Approach (2 of 3)
• Life-threatening problems– Cardiac/respiratory arrest– Respiratory distress/failure– Unstable dysrhythmias– Seizures– Coma/altered mental status– Shock/hypotension– Major trauma– Possible cervical spine injury
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General Approach (3 of 3)
• Noncritical patients– More contemplative approach– Immediate interventions not needed– Time for history and exam
• The role of experience: the more knowledge the EMT-I has, the more productive he or she will be in knowing what to look for and what questions to ask.
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Transferring the Patient (1 of 2)
• Effective communication and transfer of patient information is a vital component of care.– The way a patient is transferred is often the weak link
in care.– Methods
• Face to face• Telephone• Radio• In writing
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Transferring the Patient (2 of 2)
• Good presentation suggests effective assessment and care.
• Popular formats– SOAP
• Subjective information, Objective information, Assessment, Plan
– CHART• Chief complaint, History, Assessment, Rx/ treatment,
Transport
• Preprinted sheets help to organize.