Patient Assessment Marking Sheet

PARAMEDIC – PATIENT CARE THEORY I Name:

Start Time:

PRIMARY ASSESSMENT

SECONDARY ASSESSMENT

Personal Protective Equipment EMCA Intro/LOC (AVPU) Airway – open & inspect Suction as needed Size & insert airway as needed C-spine – rule in / out (manage with airway) Breathing Respiratory distress Select O2 delivery device BVM – O2 flow rate • vol. delivery (5-7ml/Kg) • absence of gastric distension • chest rise/fall • compliance – O2 flow rate JVD/trach dev/subcu emph 4 point auscultation Circulation – carotid and radial Gross bleed/med alert check Cardiac monitor

     in / out yes / no yes / no  L/min ml    L/min

Finish Time:

Skull lobes (frontal, occipital, left & right parietal) Face (orbitals, zygoma, nasal, maxilla, mandible, mouth) Ears (behind and inside ears) C-spine (palpate & visualize C-spine) Thorax (Rclv, Lclv, Rscp, Lscp, Ster, Symm, Exp 6 point auscultation Clear breath sounds Equal air entry Abdomen (RUQ, LUQ, RLQ, LLQ, Flk, Palp and Exp) Pelvis (Ant, Let, Post) Left Leg (U, K, L, F, Circ, Sen, Mvmt, Str, Symm, ROM) Right Leg (U, K, L, F, Circ, Sen, Mvmt, Str, Symm, ROM) Left Arm (U, E, L, H, Circ, Sen, Mvmt, Str, Symm, ROM) Right Arm (U, E, L, H, Circ, Sen, Mvmt, Str, Symm, ROM) Spine (C, T, L, S/C, Palpate and Expose)

      yes / no yes / no       

VITALS / ASSESSMENT FINDINGS Pulse

Rate1: Rate2:

Rhythm1: Rhythm2:

Volume1: Volume2:

Respirations

Rate1: Rate2:

Rhythm1: Rhythm2:

Volume1: Volume2:

HISTORY

BP

1:

Name: Age Sex CC: OPQRST AEIOU TIPS SAMPLE

Skin

Colr1: Colr2:

Temp1: Temp2:

Moisture1: Moisture2:

Pupils

Size1: Size2:

Equal1: Equal2:

Reactivity1: Reactivity2:

GCS Temp SP O2 Blood Glucose

1: 1: 1: 1:

2: 2: 2: 2:

    yes / no

M/F   

TREATMENT Oxygen on @ Appropriate transport decision Transport @ Symptom Relief Drug: Good protocol use Contraindications Defibrillation Protocol: Good protocol use Contraindications



   

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2:

Trauma Management Immobilization Sager KED Splints Dressings

    

Verbalization throughout



COMMENTS

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