Patient Assessment Patient Assessment Model (PAM)Model (PAM)

NCDCCNCDCC

Learning ObjectiveLearning ObjectiveThe cadets will be able to understand:The cadets will be able to understand: The basic principles of a single The basic principles of a single

casualtycasualty

The procedure of Rapid Body SurveyThe procedure of Rapid Body Survey

Decide the situation of the casualtyDecide the situation of the casualty

ScopeScope IntroductionIntroduction Rescue Scene EvaluationRescue Scene Evaluation Primary surveyPrimary survey Decision pointDecision point EvaluationEvaluation ConclusionConclusion

RSERSERescue Scene EvaluationRescue Scene Evaluation

What is the environment?What is the environment?

Is there any hazard?Is there any hazard?

What is the mechanism of What is the mechanism of Injury Injury

Primary SurveyPrimary SurveyAimAim : : To discover and treat life or limb - To discover and treat life or limb -

threatening threatening conditions conditions LOC (Level of consciousness – using AVPU)LOC (Level of consciousness – using AVPU) Delicate SpineDelicate Spine Airway (Head tilt Chin lift)Airway (Head tilt Chin lift) Breathing (Look Listen and feel)Breathing (Look Listen and feel) Circulation (check for radial & carotid pulse)Circulation (check for radial & carotid pulse) RAPID BODY SURVEY (no more than 30s)RAPID BODY SURVEY (no more than 30s) Look for life & limb threatening injuriesLook for life & limb threatening injuries SkinSkin

Primary SurveyPrimary Survey LOC - Level of LOC - Level of

Consciousness (AVPU) Consciousness (AVPU) AwakeAwake – – the patient respond to you, the patient respond to you, able to maintain his or her own airway.able to maintain his or her own airway.

VerbalVerbal – – the patient respond to speech.the patient respond to speech.

PainPain – – the person make some kind of the person make some kind of response to a painful stimulus.response to a painful stimulus.

UnresponsiveUnresponsive – – there is no response there is no response to verbal and painful stimuli.to verbal and painful stimuli.

Primary surveyPrimary survey

D D - - Delicate spineDelicate spine

- Immediately stabilize the head - Immediately stabilize the head and neck if you cannot rule out and neck if you cannot rule out the possibility of spinal injurythe possibility of spinal injury

Primary SurveyPrimary Survey

AA – – AirwayAirway

Check for Obstructed AirwayCheck for Obstructed Airway

- - push chin down (No Spinal Injuries)push chin down (No Spinal Injuries)

- modified jaw thrust (Spinal Injuries)- modified jaw thrust (Spinal Injuries)

Primary SurveyPrimary Survey BB - - BreathingBreathing

Determine casualty’s breathing using Determine casualty’s breathing using the 3 senses: LOOK, LISTEN AND FEELthe 3 senses: LOOK, LISTEN AND FEEL

LOOKLOOK the rise and fall of the chestthe rise and fall of the chest LISTENLISTEN place ear over the casualty’s place ear over the casualty’s

mouth then listen/feel on cheeksmouth then listen/feel on cheeks FEELFEEL feel the breathing from the feel the breathing from the

nose/mouthnose/mouth

NO BREATHINGNO BREATHING

GIVE 2 BREATHS THEN CHECK FOR GIVE 2 BREATHS THEN CHECK FOR PULSE. PULSE.

IF PULSE PRESENT GIVE RESCUE IF PULSE PRESENT GIVE RESCUE BREATHING (12 TIMES PER MINUTE).BREATHING (12 TIMES PER MINUTE).

IF PULSE ABSENT. START IF PULSE ABSENT. START CPRCPR

Primary SurveyPrimary Survey

Primary SurveyPrimary Survey

CIRCULATIONCIRCULATION

CPR No CPR

•30:2 = 1 cycle

•5 cycles

•Control haemorrhage

•Control haemorrhage

•Perform RBS

Note: - check for rate and characteristic- NO radial pulse, check carotid pulse- NO carotid pulse, perform CPR

Primary SurveyPrimary Survey RBSRBS - - Rapid Body Survey (max. Rapid Body Survey (max.

30secs)30secs)

check for external bleeding and check for external bleeding and

deformities deformities expose and examine injury siteexpose and examine injury site provide appropriate emergency provide appropriate emergency

treatmenttreatment PracticalPractical

Primary SurveyPrimary Survey SkinSkin

- check for colour and condition - check for colour and condition

to project any sign of shock.to project any sign of shock.

TreatmentTreatment

Cut & expose woundCut & expose wound

Arresting HaemorrhageArresting Haemorrhage

Immobilise FractureImmobilise Fracture

Primary SurveyPrimary Survey

Decision pointDecision point

- - UNSTABLEUNSTABLE

> transport > transport IMMEDIATELYIMMEDIATELY

- - STABLE STABLE

> provide necessary treatment before > provide necessary treatment before

transportationtransportation

Secondary SurveySecondary Survey(optional to teach)(optional to teach)

AIM : To identify problems that do not pose

an immediate threat to survival. However,

it may threaten survival if undetected

Consists of

o History

o Vital Signs

o Head to Toe Examination

History History chief complaint chief complaint

history of chief complainthistory of chief complaint

medical history - past andmedical history - past and

presentpresent

medicationsmedications

allergiesallergies

identifying dataidentifying data

PAM1-10PAM1-10

Vital Signs Vital Signs level of consciousness level of consciousness pulse, respiration (30sec*2)pulse, respiration (30sec*2) skin color & conditionskin color & condition temperature (if appropriate)temperature (if appropriate)

NOTE : if NOTE : if UNSTABLEUNSTABLE transport transport

IMMEDIATELYIMMEDIATELY( Complete secondary survey enroute( Complete secondary survey enroute

to hospital )to hospital )

PAM1-11PAM1-11

Rapid Body SurveyRapid Body Survey (Practical) (Practical)

HeadHead EyesEyes

EarEar Nose Nose Mouth Mouth SkinSkin SpineSpine

PAM1-12PAM1-12

Head to Toe Examination (inspection & palpation)

ChestChest ShoulderShoulder Upper ExtremitiesUpper Extremities AbdomenAbdomen Pelvis Pelvis Lower Extremities Lower Extremities

Head to Toe ExaminationHead to Toe Examination1. 1. HeadHead

Run your hands carefully over the Run your hands carefully over the scalp to feel for bleeding, swelling scalp to feel for bleeding, swelling or depression, which may indicate a or depression, which may indicate a possible fracturepossible fracture

note: note: Be careful not to move the Be careful not to move the casualty if you suspect that she may casualty if you suspect that she may have injured her neckhave injured her neck

Head to Toe ExaminationHead to Toe Examination2. 2. EarEar

Look for blood or clear fluid (or Look for blood or clear fluid (or both) coming from either ear. These both) coming from either ear. These discharges may be signs of damage discharges may be signs of damage inside the skullinside the skull

Head to Toe ExaminationHead to Toe Examination3. 3. EyesEyes

Examine both eyesExamine both eyes Note whether the eyes are openNote whether the eyes are open Check the size of the pupils, whether Check the size of the pupils, whether

the pupils are equal in size the pupils are equal in size (as they (as they should be)should be)

whether they react to light (the pupils whether they react to light (the pupils should shrink when light falls on them)should shrink when light falls on them)

Look for any foreign object, blood, or Look for any foreign object, blood, or bruising in the whites of the eyesbruising in the whites of the eyes

Head to Toe ExaminationHead to Toe Examination4. 4. NoseNose

Check the nose for discharges as Check the nose for discharges as you did for the ears you did for the ears

Look for the blood or clear fluid Look for the blood or clear fluid

(or a mixture of both) coming from (or a mixture of both) coming from either nostril either nostril

Note: Any of these discharges might indicate Note: Any of these discharges might indicate damages inside the skulldamages inside the skull

Head to Toe ExaminationHead to Toe Examination5. 5. MouthMouth

Note the rate, depth, and nature (easy or Note the rate, depth, and nature (easy or difficult, noisy or quiet) of the breathing difficult, noisy or quiet) of the breathing

Note any odor on the breathNote any odor on the breath Look for anything that might obstruct the Look for anything that might obstruct the

airway.airway. If the denture is firm and in place, leave If the denture is firm and in place, leave

them alonethem alone Look for any wound in the mouth or Look for any wound in the mouth or

irregularity in the line of the teethirregularity in the line of the teeth Check the lips for burns Check the lips for burns

Head to Toe ExaminationHead to Toe Examination6. 6. SkinSkin

Note the colour, temperature, and state of the Note the colour, temperature, and state of the skin: skin:

Is it pale, flushed, or grey-blue Is it pale, flushed, or grey-blue (cyanosis)(cyanosis)

Is it hot or cold, dry or damp? Is it hot or cold, dry or damp? E.g. pale, cold, sweaty skin suggest shockE.g. pale, cold, sweaty skin suggest shock

A flushed, hot face suggests fever or A flushed, hot face suggests fever or heat strokeheat stroke

A blue tinge indicates lack of oxygen; A blue tinge indicates lack of oxygen; Look for the sign especially in the lips, Look for the sign especially in the lips,

ears, and faceears, and face

Head to Toe ExaminationHead to Toe Examination7. 7. SpineSpine

Run your fingers gently along the spine Run your fingers gently along the spine from the base of the skull downwards as from the base of the skull downwards as far as possible, without disturbing the far as possible, without disturbing the casualty’s position; casualty’s position;

Check for any irregularity, swelling, or Check for any irregularity, swelling, or tendernesstenderness`̀

Note: Loosen clothing around the neck, and Note: Loosen clothing around the neck, and look for signs such as a medical look for signs such as a medical warning warning medallion or a hole (stoma) in the medallion or a hole (stoma) in the windpipe left by surgical operationwindpipe left by surgical operation

Head to Toe ExaminationHead to Toe Examination8. 8. ChestChest

Ask the casualty to breathe deeply, and Ask the casualty to breathe deeply, and note whether the chest expands evenly, note whether the chest expands evenly, easily, and equal on both sides easily, and equal on both sides

Feel the ribcage to check for deformities, Feel the ribcage to check for deformities, irregularity, or tendernessirregularity, or tenderness

listen for unusual sounds when the victim listen for unusual sounds when the victim is breathingis breathing

Observe whether breathing causes any Observe whether breathing causes any painpain

Look for bleedingLook for bleeding

Head to Toe ExaminationHead to Toe Examination9. 9. ShouldersShoulders

Gently feel for any deformity, Gently feel for any deformity, irregularity or tenderness on:irregularity or tenderness on:

Collar bonesCollar bones

ShouldersShoulders

Head to Toe ExaminationHead to Toe Examination10. 10. Upper extremitiesUpper extremities

Check the movement of the Check the movement of the elbows, wrists, and fingers by elbows, wrists, and fingers by asking the casualty to bend and asking the casualty to bend and straighten the arm and hand at straighten the arm and hand at each of the jointseach of the joints

Check that the casualty can feel Check that the casualty can feel normally with her fingers and that normally with her fingers and that there are no abnormal sensations there are no abnormal sensations in the limbsin the limbs

Head to Toe ExaminationHead to Toe Examination10. 10. Upper extremitiesUpper extremities

Note the colour in the fingers: if the Note the colour in the fingers: if the fingertips are pale or grey-blue, this fingertips are pale or grey-blue, this may indicate a problem with the may indicate a problem with the circulation circulation

Look for any marks on the forearm, Look for any marks on the forearm, and for a medical warning braceletand for a medical warning bracelet

Take the pulse at the wrist or neckTake the pulse at the wrist or neck

Head to Toe ExaminationHead to Toe Examination 10. 10. Upper extremitiesUpper extremities

Note:Note: Do not move the casualty to examine Do not move the casualty to examine

the spine when you notice any the spine when you notice any impairment or loss of movement, impairment or loss of movement, these signs suggest spine injury these signs suggest spine injury

Otherwise, gently pass your hand Otherwise, gently pass your hand under the hollow of the back and feel under the hollow of the back and feel along the spine, checking for swelling along the spine, checking for swelling and tendernessand tenderness

Head to Toe ExaminationHead to Toe Examination 12. 12. AbdomenAbdomen

Gently feel the casualty’s abdomen Gently feel the casualty’s abdomen to detect any evidence of bleedingto detect any evidence of bleeding

Identify any rigidity or tenderness Identify any rigidity or tenderness of the abdomen’s muscular wallof the abdomen’s muscular wall

Head to Toe ExaminationHead to Toe Examination13. 13. PelvisPelvis

Feel both sides of the hips, and Feel both sides of the hips, and gently move the pelvis to look for gently move the pelvis to look for signs of fracture signs of fracture

Check the clothing for any evidence Check the clothing for any evidence of incontinence or bleeding from of incontinence or bleeding from orificesorifices

Head to Toe ExaminationHead to Toe Examination14. 14. Lower ExtremitiesLower Extremities

Ask the casualty to raise each leg in Ask the casualty to raise each leg in turn, and to move his/her ankles and turn, and to move his/her ankles and kneesknees

Look and feel for bleeding, swelling, Look and feel for bleeding, swelling, deformity, or tendernessdeformity, or tenderness

Check the movement and feeling in the Check the movement and feeling in the toes toes

Look at their skin colour: grey-blue skin Look at their skin colour: grey-blue skin indicate a circulatory disorder or injuries due indicate a circulatory disorder or injuries due to coldto cold

PROTOCOLS OF PAMPROTOCOLS OF PAM

LOCDABC

RBSSKIN

DECISION POINT

TREATMENT

LOAD & TRANSPORT

RECORD & REPORT

RSE

HISTORY VITAL SIGNS HEAD TO TOE

Stable

Pri

mar

y su

rvey

Unstable

Transport Immediately

Sec

onda

ry S

urve

y

Protocol

ConclusionConclusion What are the 3 information that you need

to find out for RSE

What are the aims in Primary Survey What are the aims of Secondary Survey

What should you do if the casualty is

unstable

What should you do if the casualty is stable