Chapter 10

Five main parts of patient assessment

Scene size up

Primary assessment

History taking

Secondary assessment

Reassessment

Symptom/Subjective

What the patient tells you

Sign/Objective

What you see

Scene size up combines

Understanding conditions prior to responding

Dispatchers information

Observation of scene

Mechanism of injury (MOI)

(How?) the injury occurred (blunt trauma, penetrating trauma, compression/crush injury)

Nature of illness (NOI)

(What?) the injury is (fracture)

Chief complaint

The reason the patient called/what the person says is wrong

Chief concern

What the patient is worried about

Be aware of scenes with multiple patients who are exhibiting similar signs as it could indicate an ___

Unsafe scene

When there are multiple patients

Use the incident command system, identify number of patients and begin triage

If patient has obvious life threatening external bleeding use

XABC

XABC

Massive bleeding

Airway

Breathing

Circulation

LOC

Level of consciousness scaled by AVPU

AVPU

Awake and alert

Responsive to verbal stimuli

Responsive to pain

Unresponsive

Orientation mental status test

Evaluate patients ability to remember

Person

Place

Time

Event

Primary assessment

ABC, LOC, immediate danger, XABC(if massive bleeding)

Secondary assessment

Medical or traumatic evaluation

Reassessment

Constantly re assessing checking for errors

Hypoxia signs

Low oxygen in tissue

Rapid breathing

Rapid heart rate

Cyanosis

After airway is treated check for

Rate, rhythm and quality

Oxygen saturation should be greater than

94%

Stridor

High pitched noisy sound while breathing often indicates upper airway obstruction

Respiratory failure

Breathing is inadequate/low oxygen saturation

Respiratory distress

Difficulty breathing

Respiratory arrest

No breathing

Assess circulating by evaluating

Mental status

Pulse

Skin condition

If you cannot find pulse

Being cpr

Poor circulation will cause skin to appear

Pale, white, ashen, gray

Skin appears blue when it is not saturated with

Oxygen

Liver disease and dysfunction can result in

Yellowing of the skin and sclera

Abnormal skin temps

Hot

Cold

Clammy

Capillary refill

how long blood takes to refill the area pressed

Used to check circulation

• Normal: usually ≤ 2 seconds

• Delayed: may suggest poor perfusion

Bleeding from an artery characterized by

Spurting of blood

Bright red blood

Arterial bleeds are serious

Severe blessings on extremities that pressure does not resolve need

A tourniquet

PAT

Pediatric Assessment Traingle

Appearance

Work of Breathing

Circulation

TICLS

Tone

Interactiveness

Consolability

Look or gaze

Speech or cry

Mottling

Blotchy, patchy, marbled like skin

Circulation assessment

Pulse? bleeding? shock? Skin temp? Capillary refill time?

Airway assessment

Can they speak? Noisy breathing? Obstructions? Head position? Secretions?

👉 Snoring =
👉 Gurgling =
👉 Stridor =
👉 Silence =

👉 Snoring = tongue obstruction
👉 Gurgling = fluid/secretions
👉 Stridor = upper-airway narrowing
👉 Silence in a patient who should be breathing = potentially complete obstruction

Assessing breathing in children and infant , you want to ___ the chest

Expose

____ the airway when there are secretions or fluids that are obstructing or threatening to obstruct the airway.

Suction

Gurgling sounds → ________ → ______

Gurgling sounds → suspect fluid in the airway → suction

Suction quickly______ ventilating if fluids are blocking the airway.

Before

High priority patients include

Unresponsive

Difficulty breathing

Uncontrolled bleeding

Altered level of consciousness

Severe chest pain

Pale skin or sign of poor perfusion

Complicated childbirth

Severe pain

The golden hour (period)

Time from injury to definitive care

SAMPLE history stands for

Signs and symptoms

Allergies

Medications

Pertinent past medical history

Last known

Event leading up to injury or illness

OPQRST stands for

Onset

Provocation/palliation

Quality

Region/radiation

Severity

Timing

Wong baker pain scale

pain assessment tool that uses faces showing different levels of pain.

• Used especially for children, but can also be used for patients who have difficulty using a 0–10 numeric scale.

• The patient chooses the face that best represents how they feel.

• It typically ranges from 0 = no pain to 10 = worst pain.

Vial of Life / File of Life

Usually contains:

• Medical conditions

• Medications

• Allergies

• Emergency contacts

• Physician information

• Other important medical history

Vial of Life: Often kept on or inside the refrigerator, commonly with a sticker indicating EMS should look there.

File of Life: A similar form, often kept in a designated location such as the refrigerator or on the refrigerator door.

For diabetics check when their

Last meal was had

Pertinent negatives

important symptoms or findings that the patient specifically does NOT have.

* “Are you short of breath?” → No

* “Do you have nausea?” → No

* “Have you passed out?” → No

Consider all female patients of childbearing age who report lower abdominal pain to be

Pregnant unless ruled out by history etc (period, birth control)

Head-to-Toe Secondary Assessment

systematic physical examination where you examine the patient from the head down to the feet to find injuries or abnormalities.

You look, listen, and feel for things such as:

• Bleeding

• Swelling

• Tenderness

• Deformities

• Bruising

• Burns

• Medical ID jewelry

• Abnormal sensations or movement

Palpation

Touch the patient for abnormalities and pain

Auscultation

Listen to the sounds in the body using a stethoscope

DCAP-BTLS

EMT trauma-assessment mnemonic for finding signs of injury during your physical exam.

D – Deformities

• C – Contusions (bruising)

• A – Abrasions (scrapes)

• P – Punctures/Penetrations

• B – Burns

• T – Tenderness

• L – Lacerations

• S – Swelling

Infants and young children secondary assessment begins at the

Feet

Newborn pulse rate

100-205

Infant pulse rate

100-180

Toddler pulse rate

98-140

Preschool pulse rate

97-118

school age pulse rate

75-118

Bounding

Stronger than normal pulse

Untreated abnormally high BP may lead to

Stroke

Heart attack

Heart failure

And damage to organs

Hypotension

Low BP

Hypertension

High BP

Systolic newborn BP range

67-84

Systolic infant BP range

72-104

Systolic toddler BP range

86-106

Systolic pre school BP range

89-112

Systolic school age BP range

97-115

Systolic adolescent BP range

110- >120

Systolic adult BP range

90-120

Formula used to determine appropriate systolic BP in children 1-10

70 + (2 x age) = systolic blood pressure

Stupor

severely decreased level of consciousness where the patient is difficult to arouse.

They may:

* Not respond to normal talking

* Respond only to vigorous/repeated stimulation, such as a painful stimulus

* Quickly become unresponsive again when stimulation stops

A patient in stupor has an altered mental status (AMS) and needs

assessment for causes such as hypoxia, low blood sugar, trauma, stroke, overdose, or shock.

Syncope

Syncope = temporary loss of consciousness (fainting) caused by a brief decrease in blood flow to the brain.

Typically:

• Happens suddenly

• Patient becomes unresponsive briefly

• They usually recover spontaneously

Often returns to their normal mental status afterward

Syncope is a symptom, not a diagnosis. Look for the underlying cause

Glasgow Coma Scale (GCS)

The Glasgow Coma Scale measures a patient’s level of consciousness using 3 categories:

E = Eye opening (4 points)

• 4 — Spontaneous

• 3 — To voice

• 2 — To pain

• 1 — None

V = Verbal response (5 points)

• 5 — Oriented

• 4 — Confused

• 3 — Inappropriate words

• 2 — Incomprehensible sounds

• 1 — None

M = Motor response (6 points)

• 6 — Obeys commands

• 5 — Localizes pain

• 4 — Withdraws from pain

• 3 — Abnormal flexion (decorticate)

• 2 — Abnormal extension (decerebrate)

• 1 — None

⭐ Total:

3–15

15 = fully alert/normal GCS
3 = deepest level of unconsciousness

E + V + M = GCS

PERRL

Pupils

Equal

Round

Regular in size

React to light

Newborn rr

30-60

infant

30-53

toddler rr

22-27

preschool rr

20-28

school aged rr

18-25

Blood pressure is usually not assessed for patients younger than

3

Adults and older children rr

12-20

Check ______ to ensure circulation through the body

Extremity Pulses

Capnography

CO₂ + waveform

measuring and monitoring the amount of carbon dioxide (CO₂) in exhaled air.

🚑 For EMT/NREMT:

• It helps assess ventilation—how well the patient is moving air in and out.

• The main number is ETCO₂ (end-tidal carbon dioxide).

• Normal ETCO₂ is generally 35–45 mmHg.

• A waveform shows CO₂ throughout the breathing cycle.

Pulse oximetry

oxygen saturation (SpO₂)

Blood glucometry

measuring a patient’s blood glucose (blood sugar) using a glucometer. 🩸

🚑 For EMT/NREMT:

• Usually obtained from a finger-stick.

• Helps identify hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

• A low glucose level can cause altered mental status, weakness, seizures, or unconsciousness.

GEMS-DIAMOND

• G — Geriatric considerations → age-related changes

• E — Environmental → home/surroundings, hazards, living conditions

• M — Medical → medical history and current conditions

• S — Social → family, caregivers, isolation, ability to care for themselves

• D — Drugs → medications, interactions, compliance

• I — Insulin → diabetes and glucose problems

• A — Alcohol → alcohol use

• M — Mental status → confusion, dementia, depression, altered mental status

• O — Other → other relevant factors

• N — Nutrition → diet, dehydration, malnutrition

• D — Disease → chronic and acute illnesses

How often should re assessment be done on an unstable patient

Every 5 minutes

How often should re assessment be done on a stable patient

Every 15 minutes

Start with the Most _____ symptoms

Start with Most serious symptoms→ least serious