5 parts of the run
1. scene survey/ ABCDE’s
A. scene survey
b. clues at scene
d. time of day
e. patient position
f. determine MOI or nature of illness
g. consider back up
h. Anything about the patient that jumps out at you!
i. Age, sex/Wt.
Walk up to patient introduce yourself and check for pulse. Determine the C/C B. ABCDE’s C-spine if any suspected trauma or injuries r/o later if not needed a. Airway-determine if the airway is open if closed open with head tilt chin lift or in trauma jaw trust maneuver. If the patient is alert and responsive the airway is patent. Assess, intervene, reassess b. Breathing- determines if breathing is adequate or inadequate (lung sounds, O2 sat). Asses breathing by looking listening and feeling for amount of air in/out (tidal volume, place hand on chest) and the rate of breathing.
Look for any obvious signs such as JVD, apnea, nasal flaring, trachea tugging, outside the rate 8-24 adult and unequal movement. If adequate o2 therapy if not BVM. Assess, intervene, reassess. c. Circulation-pulse; assess if there is a pulse or no pulse if no pulse in wrist (80mmHg) go to brachial (70mmHg) then carotid (60mmHg) determine the regularity and strength(EKG), possible major bleeding; control any arterial bleeding or venous bleeding by placing gloved hand and then getting pressure dressing, skin color: assessing color, temperature and condition, capillary refill (immediate2sec).assess, intervene, reassess d. Disability- alert and orientation use AVPU or BRIM or Glasgow coma scale.
What, where, when, how it occurred, recall event (AOX4), events leading to injury. Causes of ALOC AEIOUTIPS, e. Expose, Examine, Environment- expose any life threating injuries or pertinent negatives (chest pain expose chest, abdominal pain expose abdomen etc…) examine for pertinent negatives (intercostals muscle use, abdominal rigidity, guarding, JVD etc…) consider environment affecting patient( cold dangerous etc..)
Consider status of patient: Mild (0to1 sign and symptom, moderate 2to3 signs and symptoms, acute 3 or more signs and symptoms) General impression and transport decision split with partner here.
2. Investigation of C/C chief complaint:
Medical Trauma or ALOC, language barrier
OnsetBreathing tidal volume, effectiveness
ProvokedResponse (person, place, time, event)
QualityI eyes (PERL)
Radiation, relief, reoccurrence, regionMotor sensation (MAEX4) SeverityChest (pertinent negatives)
TimeAbdomen (pertinent negatives)
Cap Refill (immediate or delayed)
May have to do Y/N questions.
Follow up with bystanders
Special questions when find pertinent negatives (physical findings)
3. Paramedic Vitals/signs
Respirations Lungs Sounds
Marry vitals to C/C (lung sounds, respirations, O2 Sat)
Always do first set
If done in initial assessment do again!
Act on abnormal vitals
Consider specialize vitals Orthostatic (lying flat, sitting up, standing)
4. Focused history and physical exam, special questions( narrow down C/C): Complete Head to toe (secondary) or a rapid trauma assessment (for patients with ALOC or significant MOI, or critical findings in Initial assessment and for unknown injuries suspected) Focused trauma assessment(focused on injury site, for No MOI, no multiple injuries, No ALOC, No critical findings on initial assessment) same for medical either focused or rapid medical(head to toe) Obtain Sample (use team effort radio person can obtain) special questions with pertinent negatives (JVD, intercostal muscle use are you have chest pain with SOB etc…)