Close the Loops

   The ongoing assessment should focus on two distinct areas: reassessing the ABCs and revisiting the patient's chief complaint(s). First and foremost, the ongoing assessment needs to confirm that the patient's airway is open and remains patent, that breathing is adequate, and that there is no circulatory compromise. Any problem(s) noted with airway, breathing or circulation require immediate attention. The second half of the ongoing assessment is going back and revisiting the elements of the chief complaint. These are the items that can easily become loose ends during the time the patient is under your care. In the case above, the loose end of pain management remained just that: a loose end that went unaddressed.

   By closing the loops on any loose ends, you make certain that whatever patient care therapies you have put into play have actually been effective and that you've met your patient's needs. Had a thorough ongoing assessment been completed on our patient, it's likely that one or two more rounds of nitro would have been administered, and possibly morphine sulfate or fentanyl to take the patient as close to pain-free as possible.

   In our case, the loose end of pain management did not result in a horrible outcome for the patient, but as a result, he stayed in pain and misery far longer than was necessary. Take time to do a thorough ongoing assessment with every patient, and you can drastically reduce the number of loose ends in your practice. Just close the loops.

   Until next month...

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.