What is the initial workup for a patient found on the ground?

Initial Workup for a Patient Found on the Ground

The initial workup for a patient found on the ground should prioritize assessment of airway, breathing, and circulation (ABCs), followed by a rapid neurological evaluation and systematic search for injuries or medical causes, while ensuring patient safety and stabilization. 1

Immediate Assessment and Stabilization

1. Scene Safety Assessment

• Ensure the area is safe for both rescuer and patient before approaching 1
• If the area is unsafe, move the patient to a safe location only if necessary 1

2. Primary Survey (ABCs)

• Airway: Assess patency; clear visible obstructions; consider head tilt-chin lift if no trauma suspected 1
• Breathing: Look for chest movements, listen for breath sounds, feel for air movement 1
• Circulation: Check carotid pulse for 5 seconds; assess for major bleeding 1

3. Responsiveness Assessment

• Check level of consciousness using verbal and tactile stimuli 1
• If unresponsive but breathing normally, consider placing in recovery position unless trauma is suspected 1
• If unresponsive and not breathing normally, begin CPR per current guidelines 1

Secondary Assessment

1. Vital Signs Monitoring

• Complete set of vital signs: blood pressure, heart rate, respiratory rate, temperature, oxygen saturation 1, 2, 3
• Blood glucose measurement (point-of-care testing) 1

2. Focused Neurological Assessment

• Perform stroke screening using a validated tool like FAST (Face, Arm, Speech, Time) 1
• Assess pupillary response, motor function, and Glasgow Coma Scale 4
• Consider second screening tool for stroke severity if FAST is positive 1

3. Trauma Assessment

• Examine for signs of head, neck, or spine injury before moving patient 1
• If trauma is suspected, maintain cervical spine immobilization 1
• Assess for other injuries: fractures, lacerations, contusions 1

Diagnostic Workup

1. Laboratory Tests

• Complete blood count with differential and platelets 2
• Comprehensive metabolic panel (electrolytes, BUN, creatinine, glucose, liver function) 2
• Coagulation studies (PT, PTT, INR) if bleeding concerns or anticoagulant use 1, 2
• Cardiac markers if cardiac etiology suspected 1
• Toxicology screen if intoxication suspected 5

2. Imaging Studies

• 12-lead ECG for all patients with unexplained unresponsiveness 1, 2
• Chest X-ray (PA and lateral) 2
• CT head without contrast for patients with altered mental status, focal neurological findings, or suspected head trauma 1
• Consider CT angiography for suspected stroke patients who are potential candidates for endovascular therapy 1

3. Additional Considerations

• Obtain information about time of onset, witnessed events, and medical history from bystanders or family 1
• Document current medications, especially anticoagulants 1
• Assess for signs of shock; if present, place patient supine 1
• Consider raising feet 6-12 inches if shock present without trauma 1

Special Circumstances

1. Suspected Stroke

• Rapid transport to appropriate stroke center if stroke is suspected 1
• Document last known well time 1
• Consider thrombolysis eligibility (within 4.5 hours) and endovascular treatment (up to 24 hours in selected cases) 1

2. Suspected Cardiac Event

• Administer aspirin if chest pain is present and no contraindications 1
• Consider pain relief with morphine and nitrates for suspected cardiac ischemia 1

3. Suspected Seizure

• Treat prolonged seizures with short-acting benzodiazepines 1
• Single self-limiting seizures may not require long-term anticonvulsant therapy 1

Common Pitfalls to Avoid

1. Delayed recognition of life-threatening conditions: Always prioritize assessment of ABCs and immediate threats to life 1

2. Premature movement of trauma patients: Do not roll patients with suspected neck, back, hip, or pelvic injuries unless necessary to open airway or reach safety 1

3. Incomplete history gathering: Attempt to obtain information about the circumstances from witnesses, which is crucial for diagnosis 1

4. Overlooking non-traumatic causes: Consider medical causes (stroke, hypoglycemia, seizure, cardiac event) even when trauma is apparent 5

5. Inadequate monitoring: Continue frequent reassessment of vital signs and neurological status during the initial workup period 1, 3