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Rocket clouds

1. Scene Size-up

1.1. Scene safe? BSI? MOI/NOI? Number of patients; additional resources? C-spine? What is your field impression?

1.1.1. Is my scene safe? Do I have the correct body substance isolation on? How many patients do I have? Do I need additional resources for this patient? What is the problem/what happened? Do I need to take c-spine to protect patient's spine?

2. Primary Assessment

2.1. LOC? ABCDE or CAD? Shock or airway management? Chief complaint; your general impression; patient priority, transport decision.

2.1.1. Is patient sick or not sick? Qualify and quantify how sick the patient is. Is patients airway patent? Is patient conscious? Does the patient have a pulse? Do you need to insert an airway? Do they need O2? Is patient bleeding dangerously? What is patient's skin like? Is patient alert or unconscious? If alert use APVU scale. Do you note a disability or exposure? Are lung sounds clear and equal bilaterally?

3. History Taking


3.1.1. Signs and symptoms? Is patient allergic to anything? What is patient's medical history? Are they currently taking any medications? Has this happened before? Last time they ate or drank; event that caused MOI or NOI. Is the patient in pain? What is the patients blood glucose levels? When did this happen? What was patient doing, what does it feel like? If in pain, does the pain move; how bad is the pain or feeling; what does the pain feel like? Is anything making the pain better or worse? What time did this happen? Take notes; be empathetic. Consider risk factors.

4. Secondary Assessment

4.1. Medical or trauma? Baseline vitals; focused or rapid body exam?

4.1.1. What is patient's blood pressure, heart rate, respiratory rate, temperature, pain rating, GSC, co2 reading, pulse oximetry reading, capnography reading, blood glucose reading? Search for DCAP/BTLS. If medical: carefully asses SAMPLE and priorities of current condition. If trauma: check for all injuries head to toe scan and exam. Can you stabilize patient, make patient as comfortable as possible? Is the trauma caused by medical condition?

5. Reassessment

5.1. Repeat primary assessment, obtain vitals again, reassess chief complaint, recheck interventions, identify any changes in patients condition,

5.1.1. Is patient's airway, breathing and circulation still stable or has it become worse and does it need a different intervention? Has the patient's vitals changed for the good or bad? Have you managed the chief complaint and is the intervention working? Do this every 5 minutes with unstable patients and every 15 with stable patients.

6. Questions to ask yourself and your patient:

7. Decisions to make, actions to take.

8. key terms:

8.1. LOC: level of consciousness

8.2. ABCDE: airway, breathing, circulation, disabilities, exposure

8.3. CAD: circulation, airway, breathing

8.4. SAMPLE: signs and symptoms, allergies, medications and medical history, pertinent past medical history, last oral intake, event leading to the NOI or MOI

8.5. NOI: nature of illness

8.6. MOI: mechanism of injury

8.7. OPQRST: onset of pain or symptoms, provocation (does anything make it better or worse), quality of the pain, does the pain radiate, severity of pain, time of onset

8.8. DCAP-BTLS: deformities, contusions, abrasions, punctures / penetrations. Burns, tenderness, lacerations and swelling.

8.9. Chief complaint: the primary symptom that a patient states as the reason for seeking medical care.

8.10. Trauma: a physical or mental injury. With trauma patients, it's important to do a total body back and front, head to toe assessment. Always remember that trauma can be caused by underlying medical condition.

8.11. Medical: relating to an illness either ongoing or sudden.

8.12. C-spine: short for cervical spine. Taking c-spine means holding the patient's head on either side of the face, supporting the neck and disabling movement of the cervical spine.

8.13. Signs: objective observations or measurements that you make

8.14. Symptoms: subjective information that the patient tells you.

9. Note: history taking and secondary assessment can be done simultaneously.

10. Medical vs Trauma

10.1. Medical Patients:

10.1.1. Monitor current NOI. Dig into pertinent past medical history and medications.

10.2. Trauma Patients

10.2.1. Ensure you take c-spine or rule it out based on MOI. Make sure to do a head to toe rapid scan (checking for bleeding and major injuries) during primary assessment and a more in depth head to toe in secondary body scan. If patient has multiple injuries, manage life threats first.

11. Conscious vs Unconscious Patients

11.1. Conscious: proceed with patient assessment pathways

11.2. Unconscious: check for pulse, Check for breathing. Protect spine based on NOI or MOI. Consider oral or nasal adjunct to protect airway. Check with bystanders for patient information. Check for medical jewelry. Make sure to do a full body scan. If no pulse start CPR immediately, yell for help and an AED. Check blood glucose.