emt 14

2 components of medical history

history of the present illness (HPI) and past medical history (PMH)

Past medical history (PMH)

information gathered regarding the patients health problems in the past

The best way to develop a good patient rapport

get down to the patients level, show empathy, and listen carefully

Open ended questions

question that can't be answered w yes or no, best to start with, and then follow up with additional questions for more detail

Close ended questions

only require a yes or no, best when patient may pass out

Patient diagnosis

can be difficult since many problems share symptoms, focus more on what the patient needs rather than what's wrong with them 

Chief complaint

patient statement describing what's wrong (why EMS was called)

History of the present illness

the events/mechanism leading to the patients current problem

O

onset: what were you doing when this began

P

provocation: does anything make the pain worse/better

Q

quality: can you describe the pain

R

radiation: where is the pain, does it spread anywhere else

S

severity: how bad is the pain, 0 = no pain, 10 = worst pain imaginable 

T

time: when did the pain start, has it changed since, was it sudden or gradual

Beta blockers

treat high BP by limiting increased HR and effect compensation 

SAMPLE

used as a check list for patient assessment, makes sure the most meaningful components have been addressed, used AFTER HPI 

Interviewing school aged children

include parents/teachers/caregivers (valuable info, may boost child's confidence), keep language simple, do not joke

Regression

when some children are stressed, they will act like younger children

Physical examination

vital for 2ndary assessment, helps find problems not recognised in primary assessment, used to help verify certain assumptions

3 parts of physical examination

observe, auscultate, and palpate, the approach to this depends on the patients complaint and presentation 

Observe

getting a sense of the patient's condition and evaluating the chief complaint, (ex. finding deformities, pained expressions, or difficulty moving)

Auscultate

listening for signs of abnormal conditions (ex. lung sounds/wheezing)

Palpate

feeling an area for deformities/abnormal findings (ex. abdomen) 

Physical examination order adults vs kids

adults get examined head-to-toe, alert infants and young children are examined toe-to-head (lets the child get used to you before you touch their heads/face)

Children ages five to eight

may be more modest/reserved, explain why you must remove certain clothing or touch them, do not rush them 

Respiratory system assessment

onset, dyspnea or exertion, weight gain (fluid build up), orthopnea (dyspnea when laying down), do they sleep on pillows, cough, chronic respiratory illnesses?

Most important parts of RS assessment

mental status (oxygen delivery to the brain) and level of R distress/breathing

RS 2ndary assessment

chest rise/fall, lung sounds, pulse ox, edema in the lungs, fever

Cardiovascular system assessment

focuses on the heart and blood vessels

2 types of Cvascular patients

cardiac patients and patients in shock or with a vascular problem

Cvascular patient history

obtain info on any past cardiac conditions and meds, see if current signs/symptoms match prior med conditions, look for any specific characteristics (ex. discomfort when breathing/position changes) 

Gastrointestinal patient physical exam

observes patients position, assess the abdomen (palpate), inspect any available vomit/feces

Immune system assessment

look for signs of allergic reactions and the severity (anaphylaxis)

Immune system patient history

any allergies/exposure? usual reaction to allergens? history of asthma? chest/throat tightness? dyspnea/edema? GI distress? 

Immune system physical examination

observe contact point with the allergen

hives

edema in face/lips/mouth

patients voice (raspy or stridor)

lung sounds

Musculoskeletal system history assessment

done for trauma, after physical exam

• any prior injuries in the wound spot?

• blood thinner meds/diseases w common fractures?

• med problems caused by the trauma?

Musculoskeletal physical assessment

signs of injury (ex. deformities), palpate potential injury areas, compare body symmetry, look for capitation, palpate all major body areas/extremities esp if patient is unconscious

Capitation

the feeling of  broken bones rubbing together

Diagnosis

a description/label for a patient's condition that helps clinics further evaluate treatment

Representativeness

using pattern recognition to assume the patient has a condition

• difficult when presented w abnormal symptoms, may result in misdiagnosis

Availability

the urge to think something because it's more easily recalled (ex. bc of recent exposure), can be reduced by thinking of how common the condition is

Confirmation bias

looking for evidence that supports the diagnosis you already have in mind, leads to overlooking other evidence

Illusory correlation

believing two things correlate when they actually don’t

Anchoring and adjustment

thinking a condition is likely and staying set on that 

Search satisfying

finding a potential cause to the patients problem and then no longer looking for other potential causes