Neurology: Altered Mental Status 17. The complete decision scheme can be found in Figure 1. Breathing: Is the patient breathing? Visit for more information and stay tuned for new topic previews throughout the year! Is the patient bleeding severely? Stable patients will be assessed, fully immobilized, and transported routinely to the hospital. Issues in Airway Management, Oxygenation, and Ventilation Assessment 13. He is a teacher of medical students in the College of Medicine and the residency training program in Emergency Medicine at The Ohio State University Medical Center. Lightning Strike Injuries Special Patient Populations 49. Neurology: Altered Mental Status 17.
If so, the patient should be transported to a trauma center. Now, although mechanism of injury is still part of the puzzle, it is considered of less prognostic value than in prior years. Trauma in Special Populations: Pediatrics 45. The only area with a change to the science is mechanism of injury. Obtaining an occasional manual blood pressure will help reduce the impact of the erroneous readings, especially in hypotensive patients. Trauma in Special Populations: Pregnancy 47. Interventions: Positioning Oral or nasal airway Suction.
These include penetrating injuries to the head and torso, flail chest, multiple long bone fractures, and other significant injuries. Those who have an altered mental status or injury to any part of the face, neck, or chest will need further evaluation see Figure 2. He has more than 25 years of experience as an educator in emergency medical services. If a patient appears to have a minor, isolated injury such as an ankle injury , it is acceptable to assess and treat only that one injury or location. This initial step helps to determine whether the patient appears responsive or not and provides a first glance at patient positioning e. Vital Signs Vital signs--or, more important, trends in vital signs see Table 3 --are crucial in determining the severity and progression of your patient's condition. Unstable trauma patients and any patient suspected of being hypovolemic will still receive high-concentration oxygen via nonrebreather mask when breathing adequately, and positive pressure ventilation with oxygen when necessary for inadequate or absent breathing.
If the patient is in shock, you should know that now rather than waiting until later in the assessment. Missing from the standards is the detailed information on executing the subsequent hands-on assessments. The fact that a patient is responsive does not eliminate the need for further assessment in this step. Issues in Airway Management, Oxygenation, and Ventilation Assessment 13. Respiratory Emergencies: Airway Resistance Disorders 29. Head and Traumatic Brain Injury 43.
Interventions: Control of severe bleeding Treatment for shock. Is the patient breathing enough to support life? The standards do include a scene size-up, which is very similar to the existing size-up, and a primary assessment, which is similar to the existing initial assessment. Cardiovascular Emergencies: Hypertensive and Vascular Emergencies 27. Endocrine Emergencies: Diabetes Mellitus and Hypoglycemia 22. Table of Contents Preparatory 1.
This is not to say there is no value in the history; it is just that a hands-on exam is likely to produce more finite and applicable results. Trauma in Special Populations: Pregnancy 47. Neurology: Altered Mental Status 17. Abdominal Injuries and Gastrointestinal Bleeding 20. Abdominal Injuries and Gastrointestinal Bleeding 20. The primary assessment will differ among patients, based on their needs. Diving Emergencies: Decompression Sickness and Arterial Embolism 48.
Bleeding and Bleeding Control 38. Immunology: Anaphylactic and Anaphylactoid Reactions 21. Multiple Casualty Incident and Incident Management. You will later learn that the opposite is true for medical patients. Reassessment should be performed approximately every 15 minutes for stable patients and every 5 minutes for unstable patients when time and priorities permit Figure 4. Pulse oximetry will likely have a greater role in patient assessment and care, as more protocols specify oxygen delivery amounts and devices based on oximetry readings. Endocrine Emergencies: Hyperglycemic Disorders 23.
Blood, Cardiac Function, and Vascular System Lifespan Development 9. Emergencies Involving the Eyes, Ears, Nose, and Throat Shock and Resuscitation 35. Immunology: Anaphylactic and Anaphylactoid Reactions 21. Mechanism of injury still has a primary role in initially determining whether cervical spine stabilization should be maintained. The hemoglobin in the blood may be 100% saturated, but this is of minimal value diagnostically when the patient is severely hypovolemic. Head and Traumatic Brain Injury 43.
Endocrine Emergencies: Hyperglycemic Disorders 23. Research has yet to show a definitive correlation between mechanism of injury and actual injury. Issues in Cardiac Arrest and Resuscitation 36. Trauma in Special Populations: Geriatrics 46. Endocrine Emergencies: Diabetes Mellitus and Hypoglycemia 22. Trauma in Special Populations: Geriatrics 46. Lifespan Development Public Health 10.
Soft Tissue Injuries: Crush Injury and Compartment Syndrome 41. Issues in Cardiac Arrest and Resuscitation 36. Patients who are unstable will receive this head-to-toe exam more quickly, whereas those who appear to be more stable some of whom are potentially unstable will receive the secondary exam proportionally more slowly see Table 2. Cardiovascular Emergencies: Chest Pain and Acute Coronary Syndrome 25. In the absence of higher priorities e. Ambient Air, Airway, and Mechanics of Ventilation 7.