Principles of Patient Assessment in EMS By Bob

Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

Chapter 9 – Focused History and Physical Exam of the Medical Patient © 2003

Objectives n n n Describe the approach for obtaining a focused history from a responsive medical patient. Explain how the EMS provider might obtain a focused history from an unresponsive patient. Provide examples of positive findings and pertinent negatives for a medical patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) n n Describe how the two acronyms OPQRST and SAMPLE are used to obtain essential medical history information. List the components of the focused physical exam (PE) for the medical patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) n Describe how the approach to the PE of a responsive medical patient differs from the approach to the unresponsive patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Introduction n n In the absence of trauma it is most likely a medical complaint Determine the chief complaint Responsive patients – begin SAMPLE & FH, get the history of present illness Positive findings Pertinent negatives © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

FH & PE Medical Patient n n Determine if the patient is responsive Reasonable response Can interview patient if they are responsive Establish rapport and obtain consent © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

The Responsive Medical Patient n n CC OPQRST SAMPLE Focus PE on specific body system: Respiratory or cardiac n Neurological or behavioral n Abdominal or obstetrical n Geriatric or pediatric n © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Questions to Ask n n n n CC – Why was EMS called? O – When did symptoms/ CC begin? P – What seems to provoke it (ie: exercise, fever)? Q – How do you describe the sensation (ie: crushing, stabbing, pressure…)? R – Where is the pain & where does it go? Does anything relieve it? S – How would you rate this experience on a scale of 1 to 10? T – When did it start? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Responsive Medical Patient: SAMPLE Examples n n n S – nausea, vomiting, blurred vision A – drugs, insects, plants, environmental M – lasix, potassium, insulin, penicillin P – recent surgery, CABG, pacemaker, diabetes L – meal, drinks, meds E – stress or emotional event © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Responsive Medical Patient: Additional Steps n Focused PE (guided by the CC): Respiratory n Cardiac n Neurological n Behavioral n Abdominal n Geriatric n Pediatric n n Multiple body systems evaluated as needed (skin, muscles, circulatory, GI…) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

The Unresponsive Medical Patient n n Begin with the PE, then talk Perform a rapid physical exam (RPE) Get baseline VS Consider other tests: Et. CO 2 n Pulse oximetry n Temperature n ECG n Blood sugar n © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Speak to The Family & Bystanders n n n Ask about SAMPLE history Ask about patient’s general health status Ask for list of meds Ask about advanced directives Take one family member along to the hospital © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Look for Clues! n n n Vial of Life Medic alert bracelet, necklace, or anklet Global Med-Net service Look in the refrigerator for meds Have the police look for a wallet card Look for meds and check them in your pocket reference © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion n The FH & PE follows one of two pathways depending if the patient is responsive or not responsive. The order of steps in the FH & PE of the medical patient depends on the patients responsiveness. The exam is either rapid, in the patient who is not responsive, or focused in the responsive patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.