How to evaluate a sick patient: treat first what kills first:
First start with gloves on:
A: Airway
- Immobilize the cervical spine with your hands
- Then speak to the patient: “Hello mister/miss, do you hear me?”
- Assess if a Headblock is needed to secure the cervical spine
- Assess the airway with the ‘Look, listen, feel’ method:
- Look at the thorax for symmetric excursions
- Listen to the sounds patients make.
- Stridor (anafylaxis)
- Snoring (tongue obstruction)
- Or other sounds
- Feel the air coming against your cheek
If there is no sign of breathing, you have to start Advanced Life Support!
- Look and feel the face for signs of trauma or fractures
- Look inside the mouth for signs of blood, vomit, angio-edeme or teeth
B: Breathing
- Start with giving the patient a non-rebreathing mask with 15L oxygen
- Then inspect and palpate the neck for:
- Inspect for signs of distended neck veins or trauma
- Feel if the Trachea is in the midline and if there is subcuteaneous emphysema
- Then Inspect the thorax:
- Breathing frequency, symmetry and depth
- Signs of trauma, cyanosis or usage of accessory breathing muscles
- Auscultate
- Listen for signs of pneumonia, heart failure or pneumothorax/hematothorax
- Percussion
- Listen for signs of pneumothorax/hematothorax
- Palpate
- Is the thorax painful and is the skeletal bones intact? Flail chest can be deadly
- End with measuring the saturation of the hemoglobin
C: Circulation:
- Start with the three C’s: Carotid Artery, Capillary refill time and Color
- Carotid artery: palpate and feel for frequency, rhythm and how powerful the pulsations are
- Capillary Refill Time: Firmly press your thumb on the Sternum for 5 seconds. Then assess the refill
- Color of the patient: is the patient white? Red? Blue? Sweaty?
- Assess possibility of bleeding: Blood on the floor, Four places more:
- Look if there is blood on the floor
- 1. Are there signs of Hematothorax (already assessed in the B)
- 2. Are there signs of abdominal bleeding? Inspect and Feel
- 3. Are there signs of bleeding in pelvis?
- Assess pelvis integrity. Painful? Signs of instable fracture? Only test once! And if there is instability, use proper stabilizing materials
- 4. Are there signs of bleeding in the lower extrimities? Inspect and feel the legs
- Now give the patient two needles for infusion:
- Give either saline infusion 500 ml/30 minutes or Packed Cells in case of trauma. The saline has to be warm in case of trauma!
- Take some blood for tests
- Assess the vital signs: Pulse and Blood pressure
D: Disabiliy
- Determine EMV score
- Assess pupillary reactions
- Check lateralisation signs (ask patient if she can move fingers and toes)
- Determine bedside glucose
E: Environment:
- Completely undress patient and check for skin changes
- Measure temperature (hypothermia? Fever?)
- Completely warm patient with blanket
- Ask if the patient has pain
Summary:
A: 4 things
- CWK
- Breathing sounds
- Facial trauma
- Mouth
B: 2 things with NRM and SpO2
- Inspect and palpate neck
- Inspect, palpate, percussion and ausculation lungs
- Inspect 6x things (3x breathing 3x thorax)
C: 4 things
- Three C’s
- Assess bleeding
- Start treatment
- Monitor patient vital sigsn
D: 4 things
E: 4 things
A writing place. 