Assessment Based Management

Assessment-Based Management : 

Assessment-Based Management

Inverted Pyramid Reasoning : 

Inverted Pyramid Reasoning

Effective Assessment : 

Effective Assessment The Foundation for Patient Care You can’t treat what you don’t find You can’t find if you can’t gather, synthesize, evaluate information

Effective Assessment : 

Effective Assessment Good information makes good decisions!

Effective Assessment : 

Effective Assessment History 80% of diagnosis Particularly important with medical patients Do not let your suspicions or patient past history affect your questioning

Effective Assessment : 

Effective Assessment Physical Exam Particularly important in trauma Also very important in unresponsive medical patients Focused vs. Detailed

Effective Assessment : 

Effective Assessment Pattern Recognition Look for “pictures” that characterize specific types of patients or situations Expand your knowledge base Build direct and indirect experience

Field Diagnosis : 

Field Diagnosis Diagnosis = Combination of pattern recognition, intuition Base treatment plan on your: Field diagnosis Protocols/standing orders Professional judgment

Factors Influencing Assessment/Decision Making : 

Factors Influencing Assessment/Decision Making Personal Attitudes Uncooperative Patients Patient Compliance Distracting Injuries Environmental Considerations Personnel Considerations

Personal Attitudes : 

Personal Attitudes Preconceived notions can “short circuit” data collection and pattern recognition

Uncooperative Patients : 

Uncooperative Patients “Just another drunk” “Frequent flyers” What are the other possibilities? Hypoxia Hypovolemia Hypoglycemia Head injury How would you want a member of your family treated?

Patient Compliance : 

Patient Compliance Prior negative experiences Cultural differences Language barriers

Distracting Injuries : 

Distracting Injuries The most obvious problem usually isn’t what’s killing the patient Be systematic in your assessment Avoid making a diagnosis before you have all the information you need

Environmental Considerations : 

Environmental Considerations Scene chaos Violence Dangerous situations High noise levels Crowds of bystanders

Personnel Considerations : 

Personnel Considerations Too many helpers are as much of a problem as too few Stage personnel, bring them into the scene as needed Assign specific tasks Do NOT do assessment, management by committee!

Scene Choreography : 

Scene Choreography Have a plan Team Leader Patient contact History Physical exam Presents patient Handles documentation EMS Command Patient Care Provider Scene cover Scene information Talks with bystanders Vital signs Performs interventions Triage Officer

The Right Equipment : 

The Right Equipment Infection Control Gloves Goggles Airway Control Oral airways Nasal airways Suction/catheters Laryngoscope ET tubes, stylettes, syringes, tape Breathing Pocket mask BVM, masks Oxygen tank, regulator Oxygen masks, tubing Occlusive dressings Chest decompression kit Circulation Dressings Bandages, tape BP Cuff, stethoscope Note pad, pen, pencil

The Right Equipment : 

The Right Equipment Disability Rigid collars Flashlight Dysrhythmia ECG monitor Defibrillator Exposure Scissors Blankets to cover patient

The Right Equipment : 

The Right Equipment IV kit Drug box

Approach to Patient : 

Approach to Patient Scene Size-Up Initial Assessment Focused or Detailed History and Physical Exam Ongoing Assessment

Scene Size-Up : 

Scene Size-Up Body substance isolation Scene safety How many patients? Mechanism of injury/Nature of illness? Additional equipment or support?

Initial Assessment : 

Initial Assessment General impression Appearance Work of breathing Circulation to skin Mental status (AVPU) Airway Breathing Circulation

Initial Assessment : 

Initial Assessment If you find a life threat, fix it! If you can’t fix it, try to make it someone else’s problem ASAP! Load & Go vs. Stay & Play

History and Physical Exam : 

History and Physical Exam Focused vs. Detailed? Trauma patient, AMS or significant mechanism Trauma patient, isolated injury Medical patient, responsive Medical patient, unresponsive

Ongoing Assessment : 

Ongoing Assessment Unstable patient: Every 5 minutes Stable patient: Every 15 minutes Mental status ABCs Transport priority Vital signs Assessment of problem areas Effectiveness of interventions Management plan

Key Principles : 

Key Principles Continuously check for potential life threats Maintain a high index of suspicion When in doubt, treat for the worst case scenario

Effective Patient Presentation : 

Effective Patient Presentation Establish credibility, trust Efficiently transfers critical information Ensures on-line orders for needed procedures Poor Presentations Compromise Care

Effective Patient Presentation : 

Effective Patient Presentation Less than one minute Concise, clear Little jargon Consistent format Include pertinent positives, negatives Conclude with specific actions, requests, questions

Effective Patient Presentation : 

Effective Patient Presentation Plan ahead Know what information will be needed Use pre-set formats Use pre-printed forms