“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

F                F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

As a part of your Secondary Decision (2°D) you are asked to decide ‘How sick is your patient’?  I use four simple terms to classify and communicate this:  Not Sick, Sick, Very Sick and Dead.

In order to understand how to use these terms, you need to learn about what I call the ‘critical signs’.  You’ve already learned about the vitals signs, well, these are the critical signs, and there are three (plus one more).  These are signs and symptoms we look for that indicate to us that our patient is very ill.  I have taught these a lot, and have heard them sometimes referred to as the ‘Four P’s’ by my students, because each one starts with the letter P. 

If a patient has no complaints at all, then they are classified as ‘Not Sick’.  If a patient doesn’t have a pulse, they’re ‘dead’.  Those are the two extremes, and they’re pretty easy to understand.  So that leaves the terms ‘Sick’ and ‘Very Sick’ to define.

If the patient has one or more of the critical signs, and they are ‘new onset’ (they haven’t had them for weeks or years) then we consider them to be ‘Very Sick’. 

However, if their complaints aren’t any of the critical signs, or if it’s a critical sign that has lasted for weeks or years (for example, shortness of breath for two weeks), then we would consider them to be just ‘Sick’.

Perfusion

First we look to see how well the patient is perfusing.  In this case, we are interested specifically in how well they are perfusing their brain.  There are a few clues we can use.  The most sensitive indicator of brain perfusion is the patients level of awareness.  If they are alert and oriented times three (to person, place and time) then they are probably perfusing their brains quite well.  We can look too at their colour, their blood pressure, and their heart rate.

Pain

Specifically, ischemic chest pain.  If your patient is complaining of crushing, mid-sternal chest pressure or tightness radiating to their left arm or jaw, then that is a critical sign.  Look to for Levine’s sign - the patient clenching a fist over their chest when they describe their discomfort.  It’s indicative of acute coronary syndrome.

Pleuritic

Shortness of breath, difficulty breathing and/or pulmonary adventitia all indicate difficulty breathing - and that’s a critical sign.

Panic

In and of itself panic isn’t a critical sign.  If a patient is panicked, that’s not critical.  But panic lends credence and gives weight to the other critical signs.  Decreased perfusion + panic = even more critical decreased perfusion.  Similarly, ischemic chest pain + panic = even more critical chest pain. 

Search for the critical signs, find out how long your patient has had them (acute vs. chronic) and use that information to determine if your patient is Not sick, Sick, Very sick or Dead.

Back to 2° Decision