MEDICAL ASSESSMENT - BLS Care Asthma Scenario
1. Scene Safety/ BSI
2. Determine the nature of the illness
3. Determine the number of patients
4. Request additional resources if needed: ALS, police, fire, and/or utilities
5. What is my general impression?
6. Determine the level of consciousness: AVPU
Alert, verbal, pain, unresponsive
7. Airway
Open, the patient can open and close their mouth
Patent, clear nothing blocking the airway
Secure, patient able to maintain airway on own
8. Breathing: rate, rhythm, and quality - Listen to Lung Sounds
If under 10 or over 30 strongly consider a BVM
If between 10 and 30 use non-re-breather or nasal cannula
Testing - Everyone gets high flow oxygen
9. Circulation:
Pulse: Rate and Quality - Check a radial pulse
Skin: Color, condition, and temperature
10. MAKE TRANSPORT DECISIONS!
High priority patient, ALS needed. Transport to the closest appropriate facility - Emergency Department
11. Focused History and Physical Examination: OPQRST
Onset:
What were you doing when this started?
Provokes/Palliates:
Does anything make it better or worse?
Quality:
Can you describe the Chief Complaint? (Pain, Shortness of breath, etc.). Tearing pain, dull pain, ache pain, can’t get air in/out, etc.
Radiate:
Does the pain go anywhere?
Do you have a cough? Do you have any pain or discomfort?
Pain moves to another area (radiates to my back)
Severity:
On a scale of 1 -10, how bad is the chief complaint?
1-10 (pain is a 9 out of 10)
Time:
How long has this been going on? Has anything like this ever happened before? Every been hospitalized. Every been intubated (needed a breathing tube?)
12. SAMPLE
Signs and Symptoms in addition to the OPQRST
Allergies: Not asking about allergies is a critical fail
Medications:
Past medical history
Last meal:
Events leading to illness:
13. Focused Physical Examination
Do a physical exam - listen to lung sounds, check the skin for rashes, look for bee stings, swelling, angioedema, palpate for abdominal pain, etc.
14. Base line vitals
Pulse
Respiratory rate
Lung Sounds
Blood Pressure
Skin condition
Pupils
SPo2
Blood Glucose
15. Interventions:
(High flow o2 should have been administered during the breathing assessment)
Medication administration: Five Rights
Right: Patient
Right: Medication
Right: Dose
Right: Route
Right: Time
State if it is a standing order or you need to contact medical control
16. Administer Medication explaining any side effects
17. Reassess patient every 5 minutes
18. Transport patient to the nearest appropriate facility
19. Transfer care to an equal or higher-level healthcare professional
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