patient assessment during influenza epidemics patient assessment during influenza epidemics an...
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Patient Assessmentduring Influenza Epidemics
Patient Assessmentduring Influenza Epidemics
An Outline of theApproach to Patients
An Outline of theApproach to Patients
Raymond L. Fowler, M.D., FACEPRaymond L. Fowler, M.D., FACEP
Associate Professor of Emergency MedicineAssociate Professor of Emergency Medicineandand
Co-Chair of the Section onCo-Chair of the Section onEMS, Disaster Medicine, and Homeland SecurityEMS, Disaster Medicine, and Homeland Security
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Chief of Medical OperationsChief of Medical OperationsThe Dallas Metropolitan BioTel SystemThe Dallas Metropolitan BioTel System
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Associate Professor of Emergency MedicineAssociate Professor of Emergency Medicineandand
Co-Chair of the Section onCo-Chair of the Section onEMS, Disaster Medicine, and Homeland SecurityEMS, Disaster Medicine, and Homeland Security
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Chief of Medical OperationsChief of Medical OperationsThe Dallas Metropolitan BioTel SystemThe Dallas Metropolitan BioTel System
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An immediate responseis requiredto problems foundduring patientassessment
An immediate responseis requiredto problems foundduring patientassessment
For example,an obstructed
airway can bringdeath in a matter
of a coupleof minutes
For example,an obstructed
airway can bringdeath in a matter
of a coupleof minutes
As we assess patients,we must quickly determine
fundamental parametersof their respiratory
and circulatory status.
As we assess patients,we must quickly determine
fundamental parametersof their respiratory
and circulatory status.
Copyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEPCopyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEP
Approaching thePatient
Approaching thePatient
Copyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEPCopyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEP
“See what you see!”“See what you see!”
““People look, but theyPeople look, but theydon’t see”don’t see”
……A. Fowler, Jr.A. Fowler, Jr.
““People look, but theyPeople look, but theydon’t see”don’t see”
……A. Fowler, Jr.A. Fowler, Jr.
Copyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEPCopyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEP
Alertness? Level of distress?Noises?Respirations?The pulse rate?Skin?Obvious things (bleeding)
Alertness? Level of distress?Noises?Respirations?The pulse rate?Skin?Obvious things (bleeding)
Copyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEPCopyright 2006 Ray Fowler MD, FACEPRay Fowler MD, FACEP
History Taking:This seems to be a “lost black art” for
so many medical providers
What happened?When?LOC?
Major system symptoms?Co-morbid conditions?
Above all: RISK???Above all: RISK???
History Taking:This seems to be a “lost black art” for
so many medical providers
What happened?When?LOC?
Major system symptoms?Co-morbid conditions?
Above all: RISK???Above all: RISK???
Techniques ofPatient Assessment
Techniques ofPatient Assessment
Primary SurveySecondary Survey
Third Survey
Primary SurveySecondary Survey
Third Survey
Scene Survey/Mechanism/# pts.Scene Survey/Mechanism/# pts.
LOC/Airway/CspineLOC/Airway/Cspine
Respiratory Rate and LaborRespiratory Rate and Labor
Pulses R & Q, N & WSkin CMT/CRT/External Bleeding
Pulses R & Q, N & WSkin CMT/CRT/External Bleeding
Neck appearance, JVD, TracheaNeck appearance, JVD, Trachea
Chest appearance, BS, HTChest appearance, BS, HT
Quick survey of abdomen, pelvis,extremities, and back
Quick survey of abdomen, pelvis,extremities, and back
The Primary SurveyThe Primary Survey
Abbreviations:
R & Q – Rate and Quality
N & W – Neck and Wrist
CMT – Color, Moisture, Temperature
CRT – Capillary Refill Time
JVD – Jugular Venous Distension
BS – Breath Sounds
HT – Heart Tones
Abbreviations:
R & Q – Rate and Quality
N & W – Neck and Wrist
CMT – Color, Moisture, Temperature
CRT – Capillary Refill Time
JVD – Jugular Venous Distension
BS – Breath Sounds
HT – Heart Tones
Scene Survey/Mechanism/# pts.
LOC/Airway/Cspine
Respiratory Rate and Labor
Pulses R & Q, N & WSkin CMT/CRT/External Bleeding
Neck appearance, JVD, Trachea
Chest appearance, BS, HT
Quick survey of abdomen, pelvis,and extremities
Scene Survey/Mechanism/# pts.
LOC/Airway/Cspine
Respiratory Rate and Labor
Pulses R & Q, N & WSkin CMT/CRT/External Bleeding
Neck appearance, JVD, Trachea
Chest appearance, BS, HT
Quick survey of abdomen, pelvis,and extremities Reveals threats to
Basic PhysiologyReveals threats toBasic Physiology
. . .the vital elements of the Primary Survey. . .the vital elements of the Primary Survey
The Order of the SurveyThe Order of the Survey
11
22
33
44
55
…flows in an orderly way from head to toe…flows in an orderly way from head to toe
HeadHead
NeckNeck
Upper ExtremitiesUpper Extremities
ChestChest
AbdomenAbdomen
PelvisPelvis
Lower ExtremitiesLower Extremities
The Secondary SurveyThe Secondary Survey
LOCLOC
AirwayAirway
BreathingBreathing
CirculationCirculation
Any other pertinent positive or negative
found in the primary or
secondary surveys
Any other pertinent positive or negative
found in the primary or
secondary surveys
The Third SurveyThe Third Survey
For example, if wheezing was found
and treated in theprimary survey,is the wheezing
still there?
If external bleedingwas found and a
dressing put on it,is the bleedingstill stopped?
For example, if wheezing was found
and treated in theprimary survey,is the wheezing
still there?
If external bleedingwas found and a
dressing put on it,is the bleedingstill stopped?
InfluenzaInfluenza
A viral illness producing primarilyA viral illness producing primarilya respiratory illness with fever, a respiratory illness with fever,
coughing, headache, muscle coughing, headache, muscle aches, and sometimes GI Sxaches, and sometimes GI Sx
A viral illness producing primarilyA viral illness producing primarilya respiratory illness with fever, a respiratory illness with fever,
coughing, headache, muscle coughing, headache, muscle aches, and sometimes GI Sxaches, and sometimes GI Sx
Influenza usuallyInfluenza usuallyproduces a mild toproduces a mild to
moderate illnessmoderate illness
Influenza usuallyInfluenza usuallyproduces a mild toproduces a mild to
moderate illnessmoderate illnessEitherEither......EitherEither......
•Cough and feverCough and fever•Severe myalgias & HASevere myalgias & HA•GI SymptomsGI Symptoms
•Cough and feverCough and fever•Severe myalgias & HASevere myalgias & HA•GI SymptomsGI Symptoms
Or a combinationOr a combinationof any of theseof any of these
Or a combinationOr a combinationof any of theseof any of these
Pandemic InfluenzaPandemic Influenza
A small percent of patientsdevelop much more
severe signs and symptoms
A small percent of patientsdevelop much more
severe signs and symptoms
Pandemic InfluenzaPandemic Influenza
•Hemorrhagic pneumonia•Encephalitis
•Severe GI symptoms
•Hemorrhagic pneumonia•Encephalitis
•Severe GI symptoms
Hemorrhagic PneumoniaHemorrhagic Pneumonia
•Profound shortness of breath•Cyanosis and low pulse ox
•Severe coughing•Bloody cough
•Respiratory failure
•Profound shortness of breath•Cyanosis and low pulse ox
•Severe coughing•Bloody cough
•Respiratory failure
EncephalitisEncephalitis
•Fever•Headache
•Altered mental status, confusion•Delirium
•Fever•Headache
•Altered mental status, confusion•Delirium
GastrointestinalGastrointestinal
•Nausea and vomiting•Diarrhea
•Bloody diarrhea•Abdominal pain
•Nausea and vomiting•Diarrhea
•Bloody diarrhea•Abdominal pain
Evaluating theInfluenza PatientEvaluating the
Influenza Patient
FIRSTPROTECT
YOURSELF
FIRSTPROTECT
YOURSELF
Evaluating theInfluenza PatientEvaluating the
Influenza Patient
Primary SurveySecondary Survey
Third Survey
Primary SurveySecondary Survey
Third Survey
Evaluating theInfluenza PatientEvaluating the
Influenza PatientAltered LOC?
Respiratory distress?Nature of sputum?Blood pressure?
Nature of any vomitus?Nature of any diarrhea?
Altered LOC?Respiratory distress?Nature of sputum?Blood pressure?
Nature of any vomitus?Nature of any diarrhea?
Evaluating theInfluenza PatientEvaluating the
Influenza Patient
- Altered LOC? *Possible encephalitis*Possible encephalitis- Respiratory distress? *Viral pneumonia or*Viral pneumonia or secondary infectionsecondary infection- Nature of sputum? *Hemoptysis?*Hemoptysis?- Blood pressure? *Shock?*Shock?- Nature of any vomitus? *Bloody?*Bloody?- Nature of any diarrhea? *Bloody?*Bloody?
- Altered LOC? *Possible encephalitis*Possible encephalitis- Respiratory distress? *Viral pneumonia or*Viral pneumonia or secondary infectionsecondary infection- Nature of sputum? *Hemoptysis?*Hemoptysis?- Blood pressure? *Shock?*Shock?- Nature of any vomitus? *Bloody?*Bloody?- Nature of any diarrhea? *Bloody?*Bloody?
Managing theInfluenza Patient
Managing theInfluenza Patient
- Altered LOC? *Sedation, ?airway, *Sedation, ?airway, treat infection?treat infection?- Respiratory distress *Respiratory support,*Respiratory support, treat infections?treat infections?- Shock *Circulatory support*Circulatory support- Vomiting and diarrhea *Volume support*Volume support
- Altered LOC? *Sedation, ?airway, *Sedation, ?airway, treat infection?treat infection?- Respiratory distress *Respiratory support,*Respiratory support, treat infections?treat infections?- Shock *Circulatory support*Circulatory support- Vomiting and diarrhea *Volume support*Volume support
Signs of ShockSigns of ShockWeak, thirsty, lightheaded
Pale, then sweatyTachycardiaTachypnea
Diminished urinary output
Weak, thirsty, lightheadedPale, then sweaty
TachycardiaTachypnea
Diminished urinary output
HypotensionAltered LOC
Cardiac arrestDeath
HypotensionAltered LOC
Cardiac arrestDeath
EarlyEarly
LateLate
Synthesis
Synthesis
A influenzapandemic will
present one of thegreatest challenges
to social andmedical
infrastructureever seen
A influenzapandemic will
present one of thegreatest challenges
to social andmedical
infrastructureever seen
Local, State, andNational Preparedness
are Essential…
Local, State, andNational Preparedness
are Essential…
……if we are to be ableif we are to be ableto make a difference…to make a difference………if we are to be ableif we are to be ableto make a difference…to make a difference…
Drop a lineif you haveany questionsor comments
Drop a lineif you haveany questionsor comments
[email protected]@doctorfowler.com
www.utsw.wswww.utsw.ws““the emergency medicine education website”the emergency medicine education website”
www.utsw.wswww.utsw.ws““the emergency medicine education website”the emergency medicine education website”