Patient assessment is the most important skill that you must master!
When it you are dealing with Critical Care Transport (CCT) you will be tasked with transporting some of the sickest patient populations. These patients will present many unique challenges to you as a Critical Care Transport Provider: from logistical issues of time and distance to hemodynamic derangements that you must address.
Hence if you are new paramedic that just graduated and been mostly trained in 911 scene response and you may be feeling pretty cocky:
The moment that you will have a patient in your care on 4 infusions, who is intubated, sedated and is on mechanical ventilation. All of a a sudden becomes agitated and is actively trying to pull his ET tube out and your are only 22 minutes into your 1 hour transport, plus you have a family member asking you all kinds of questions meanwhile all of the alarms, bells, and whistles going off from your equipment will be a very humbling perhaps even an underwear staining moment in your medic career.
This is the moment that you will realize the importance of proper patient assessment, it’s won’t come from reading a book or watching a youtube video, it will come from direct experience when you least expect it. Hopefully this humbling experience will teach you the importance of addressing all of your patient care needs in the sending facility prior to departure and having everything ready on standby to have an uneventful safe trip.
When starting out try to keep things basic and systematic. KISS Principle (Keep it simple stupid) is certainly applicable when you are rookie.
What are we doing? CRITICAL CARE INTER FACILITY TRANSPORT or simply C C I F T
Hence in accordance with KISS principle when you arrive at the sending facility ICU floor and you can see that your patient is intubated and on mechanical ventilation support, ask yourself:
Ask: “What am I doing here?” Answer: CRITICAL CARE INTER FACILITY TRANSPORT
1) Get the patients chart from the clerk or the nurse and familiarize yourself with patients condition: HPI, PMH, Allergies, Medications, Lab Data, Diagnostics etc.
2) Remember this mnemonic (C C I F T)
C-(Capnography) Place ETCO2 Adaptor between ETT and hospital ventilator circuit (Record data)
C- (Cardiac Monitor) Place Pulse Oximetry (SPO2) Sensor on the patient and connect the 12 Lead EKG (Print and record data)
I- (Inspect) Write down IV drip dosages, Ventilator Settings, Vital Sings (MAP, BP, HR, RR, SPO2, ETCO2, Temp) (Record data)
F- (Feel) For warm distal extremities with good radial pulses and MAP of 65mmHG or greater (Record data)
T- (Transition) Transition drips first, then connect vent circuit while the patient is still on hospital bed recheck your vitals (Record data), move the patient last to your stretcher.
3) All recorded data must have at least 3 values:
First set of diagnostic vital signs gives you a Snap Shot (on hospital ventilator and equipment)
Second set a Comparison
Third and there after Trending (on your equipment prior to leaving the facility)
Basics of Critical Care Patient Assessment