NREMT Patient Assessment - Medical

Patient Assessment

• BSI/PPE

• Scene size-up

• Primary assessment

• History taking

• Secondary assessment

• Reassessment

Scene Size-up

• BSI - Scene is safe

• MOI/NOI

• # of Patients

• Requests Additional Assistance

• C-Spine Considerations

Primary Assessment

• Verbalize general impression of patient

• Determine level of consciousness (AVPU)

• Determine chief complaint/life threats

• Assess ABC

• Stay & Play vs Load & Go

Airway Assessment

• Open and Access airway

• insert adjunct as indicated

• Verbalize oxygen

• suction needed?

Breathing Assessment

• Assess breathing

• Assure adequate ventilation

• verbalize oxygen

• manage injures that compromise breathing

Circulation Assessment

• Bleeding?

• Pulse

• Skin assessment (color, temp, condition)

History Taking

* History of Present Illness (OPQRST)

* Past medical history (SAMPLE)

History of Present Illness (OPQRST)

• Onset

• Provocation

• Quality

• Radiation

• Severity

• Time

• Additional Qs regarding present illness

Past Medical History (SAMPLE)

• Signs/Symptoms

• Allergies

• Medications

• Past Medical History

• Last Oral Intake

• Events leading up to illness

Secondary Assessment

• assess affected body part and/or system

vital signs

• baseline vitals

• state field impression of patient

• interventions

Vital Signs

• Pulse

• Blood Pressure

• Respirations (rate & quality)

• Skin

• Pupils

• Pulse Oximetry

• blood glucose

• States field impression of patient

• verbalize interventions/treatment

Cardiac treatment

• Drug (ASA)

• Dose

• Route

• Indicates standing order or contacts medical control

Respiratory treatment

• Drug (albuterol)

• Dose

• Route

• Indicates standing order or contacts medical control

Reassessment

• LOC

• ABC

• Repeats vital signs (5-15 min)

• Monitor interventions

• Transfer of care