KEMBAR78
Patient Assessment Checklist | PDF | Breathing | Pain
Scribd
Upload
1K views2 pages

Patient Assessment Checklist

This document is a checklist for assessing a patient after an injury. It includes checks of the patient's airway, breathing, circulation, disability level, and exposure to examine for injuries. It then has a secondary full-body assessment checking the head, neck, chest, abdomen, pelvis, extremities, and posterior areas for soft tissue injuries, deformities, pain, or other issues. The responder completes the checklist and records their signature, the patient's name, and the date and time.

Uploaded by

Daintm Adi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
1K views2 pages

Patient Assessment Checklist

This document is a checklist for assessing a patient after an injury. It includes checks of the patient's airway, breathing, circulation, disability level, and exposure to examine for injuries. It then has a secondary full-body assessment checking the head, neck, chest, abdomen, pelvis, extremities, and posterior areas for soft tissue injuries, deformities, pain, or other issues. The responder completes the checklist and records their signature, the patient's name, and the date and time.

Uploaded by

Daintm Adi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

PATIENT ASSESSMENT CHECKLIST

(To be completed by the attending school nurse or designee)

NAME OF VICITM: ____________________________________________

DATE: ______________________ TIME: ________________

SIGNATURE & TITLE OF RESPONDER: ____________________________

Primary Survey Yes No


Airway / Cervical Spine Stabilization ✔

Open airway (jaw thrust / chin lift) ✔

Remove debris ✔

Airway adjuncts ✔

Stabilize cervical spine (manual alignment) ✔

Breathing ✔

Look, listen, feel ✔

Rate, symmetry ✔

Auscultate breath sounds ✔

Circulation ✔

Palpate carotid ✔

Palpate radial (second responder) ✔

Jugular vein distention ✔

Skin temperature and color ✔

Disability / Limited Neuro Exam ✔

Level of consciousness ✔

AVPU ✔

Alert ✔

Verbal response ✔

Pain response ✔

Unresponsive ✔

Expose / Examine ✔

Expose / undress patient as needed ✔

Fahrenheit / Keep Patient Warm ✔

Vital Signs ✔

FRONT
Secondary Assessment (Head to Toe) YES NO

Head and Face ✔

Soft tissue injury ✔

Bone deformity / loose teeth ✔

Exposed bone or tissue ✔

Eye movement / pupillary response / PERRLAEOM ✔

Ear drainage / avulsion / bruise ✔

Nasal drainage ✔

Tenderness / pain ✔

Neck ✔

Soft tissue injury ✔

Impaled objects ✔

Tenderness / pain ✔

Tracheal deviation ✔

Jugular vein distention ✔

Chest / Thorax ✔

Soft tissue injury ✔

Rise and fall during respirations/ symmetry ✔

Auscultate breath sounds ✔

Auscultate apical heart rate ✔

Tenderness / pain ✔

Impaled objects ✔

Abdomen / Flank ✔

Soft tissue injury ✔

Impaled objects ✔

Tenderness / pain ✔

Pelvis / Genitalia ✔

Soft tissue injury ✔

Impaled objects ✔

Bony deformities ✔

Urge to void ✔

Tenderness / pain ✔

Extremities ✔

Soft tissue injury ✔

Deformity ✔

Color ✔

Sensation ✔

Range of motion ✔

Tenderness / pain ✔

Pulse ✔

Posterior ✔

Log roll with manual cervical spine alignment ✔

Deformities ✔

Soft tissue injury ✔

Tenderness / pain ✔

Vital Signs ✔

VICTIM RELEASED TO: AT: BY:

You might also like