ITLS Patient assessment Training the FIX-IT way as · PDF fileITLS Patient assessment Training...
Transcript of ITLS Patient assessment Training the FIX-IT way as · PDF fileITLS Patient assessment Training...
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ITLS Patient assessment Training the
FIX-IT way as shown in the ITLS 7th edition
Presented By: Leon and Alexandra Charpentier in Vancouver,
BC November 2013
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History of FIX-IT
• Four years studying the outcome of student
training
• The systematic training of FIX-IT led into
better on scene patient care
• Introduced to my Co-authors of the Trauma
Assessment Chapter, JT Stevens and Dr.
Campbell.
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Training Students Using FIX-IT
• Students are easily side tracked by the sight
of visible injuries
• This is a good training tool to keep the
student on track
• It’s similar to using mnemonics
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In order to ensure an uninterrupted/organized
patient assessment, the patient assessor must rely on their partners treatment
steps while patient assessment is conducted
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“Your Treatment is Only as
Good as Your Patient
Assessment.”
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Patient Assessment Introducing
FIX-IT Process
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PATIENT ASSESSMENT
MEDICAL Vs. TRAUMA
The SAME? Yes or No.*
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What’s the Difference?
• Scene Size-up
• Medical O.P.Q.R.S.T.
• Trauma Rapid Trauma Survey/Focused Exam.*
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Trauma Assessment
• Let’s Talk about Trauma
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The Patient Assessment Process
Includes:
• Primary Survey
• Secondary Survey
• Ongoing Exam
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Primary Survey Includes:
• Scene size up
• Initial Assessment
• Focused Exam or Rapid Trauma Survey
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Secondary Survey Includes:
• Baseline, Vital signs, SAMPLE History
• Head to Toe detailed exam
• Identify Load-n-Go’s that have not already been
identified.
• Assign duties to other team members
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Ongoing Exam Includes
Reassessment of:
• LOC (Level of Consciousness)
• ABC’s (Airway Breathing Circulation)
• Any Changes (From Previous Assessment)
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Each patient assessment step requires the
thought of resolving the issues of that step as
the next step is reached.
The FIX-IT Process (Remember your partner does the FIX-IT)
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All Patient Assessment
Must Start With…….
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Scene Size-Up
Standard Precautions
You must ask yourself these questions:
1. Is the scene safe?
2. What’s the mechanism of injury?
3. How many patients do I have?
4. Do I need more help or equipment?
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Essential Equipment (FIX-IT Tools)
• Personal protective equipment
• Backboard, straps, and head motion-restrictor
• Cervical collar
• Oxygen and airway equipment
• Trauma box
Bring essential equipment with you when you make your patient contact
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Initial Assessment Includes…
– Cervical Spine control
– L.O.C.
– AVPU (Alert, Verbal, Pain, Unresponsive)
– Airway – patent yes or no?
– Breathing – rate & quality
– Circulation – rate & quality
– Skin color, condition
– Control bleeding
Did you find a load & go?
(What’s Your General Impression)
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It is Important that
you use the:
“FIX-IT” Process
The FIX-IT is done by your partner
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FIX-IT Process For General Impression
• LOC: Altered Mental Status – “Think” D stick/medical alert tags and medication patches (Fentanyl patch)
• As soon as you say: Airway/breathing – tell your partner to “FIX-IT” without stopping your patient assessment (O2, NRB, 15 LPM)
• As soon as you say: Circulation – Think “FIX-IT” (Is your IV equipment ready? Treat for SHOCK in route)
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Do Not Interrupt Initial
Assessment
Except for:
• Airway obstruction
• Cardiac arrest
• The scene becomes
unsafe
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Remember what is a Load and Go?
•Altered mental status
•Abnormal respiration
•Abnormal circulation
•Major chest trauma
•Tender abdomen
•Pelvic instability
•Bilateral femur fractures
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When the Initial Assessment
Is Completed,
IT’S…
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Time To Make A
Decision!
Rapid Trauma Survey
or
Focused Exam.
Which way to go?
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Scene Size Up
Primary Survey
Initial Assessment
Multi Trauma Isolated Trauma
Rapid Trauma Survey Focus Exam
Now Is It
Detailed Exam/Secondary Survey
On Going Exam
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Focused Exam
Isolated Injury:
- Hand closed in car door
- Shot self in foot
(The Focused Exam is used when there is no
chance for multi-trauma)
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Rapid Trauma Survey (Priority Patients)
Dangerous mechanism of injury
History reveals
• Loss of consciousness
• Difficulty breathing
• Abnormal initial assessment
Poor general impression
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Rapid Trauma Survey Begins
Check the Head
Deformities Burns
Contusions Tenderness
Abrasions Lacerations
Penetration Swelling
DCAP /BTLS
(Partner “THINK” FIX-IT)
Your partner’s FIX-IT at this point would possibly be control head bleeding
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Check the Neck (DCAP /BTLS)
• Trachea deviation
• Yes or no
• Jugular Vein Distention (JVD)?
- Yes or no
If YES, “Think” chest trauma (Partner “THINK” FIX-IT)
The FIX-IT here is when you apply C-collar
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Check the Chest (DCAP / BTLS /
TIC-Tenderness, Instability, Crepitation)
• Breath sounds – 2 fields only
• Heart sounds
Your partner’s FIX-IT here could
be to fix the:
- Stab wound
- Flail chest
- Sucking chest wound
Did you find a load & go?
(Partner “THINK” FIX-IT)
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Check the
Abdomen (DCAP / BTLS)
- Is it tender?
- Is it distended?
Your partner (s) FIX-IT here would be:
Are the IV’s ready?
Treat for SHOCK in route
(Partner “THINK” FIX-IT)
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Check the Pelvis
(DCAP /BTLS )
• Check the pubis
If unstable do not check
again
Your partner’s FIX-IT would
be:
If unstable secure the
pelvis and use scoop
stretcher
Did you find a load & go?
(Partner “THINK” FIX-IT)
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Stabilize the Pelvis; FIX-IT Tools
With a Sheet Styles of scoop
stretchers
Sam Splint
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Check the
Lower Extremities (DCAP /BTLS )
P.M.S. - (Pulse/ Motor/Sensory)
Bilateral femurs
- Load & go
Your partner’s FIX-IT here may be:
Think traction splint and/or
P.A.S.G. for stabilization (Partner “THINK” FIX-IT)
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Check the
Upper Extremities
(DCAP /BTLS )
P.M.S. (Pulse / Motor / Sensory)
If any fractures, “Think FIX-IT” after you are in the ambulance.
(Partner “THINK” FIX-IT)
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Move to Backboard
• Once pelvic is stabilized:
• Scoop
• Log roll stable pelvics only
• Check the back
• S.M.R.D.(Spinal Motion
Restriction Device)
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Interventions / FIX-ITs That May
Be Done On-Scene
• Initial airway management
• Oxygen/breathing assistance
• CPR
• Control major bleeding
• Seal sucking chest wounds
• Chest decompression
All interventions could possibly be done by your partner during the team leader’s assessment
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Move to
Ambulance
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Baseline
Vital Signs (Includes LOC, Airway, Breathing,
Circulation)
(Consider P.A.S.G.)
(Consider D-Stick)
1st Thing Inside:
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Sample History • S ymptoms
• A llergies
• M edications
• P ast medical problems
• L ast oral intake
• E vents preceding the emergency
2nd Thing Inside:
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Assign Duties To Other
Team Members
•IV monitor
•Pulse ox
•Bandaging/splinting, etc.
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Secondary Survey Begins in ambulance unless
circumstances apply for
instance, awaiting helicopter.
Ect.
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Scenario Using the FIX-IT
process
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Practice, Practice, Practice
Remember, your patient is not
your practice
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Remember: “Your Treatment of
Your Patient is Only as Good as Your Assessment”.
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Any Questions?
Thanks for being a great audience!
Leon Charpentier, EMT-P
Alexandra Charpentier, EMT-P