Chapter 9

Patient Assessment Overview

• Effective patient assessment is crucial for EMTs and involves various components that guide emergency management.

Key Components of Patient Assessment

• Scene Size-up: Assess scene safety, mechanism of injury (MOI), need for additional resources, and determine number of patients.

• Primary Assessment: Quickly identify potential life threats, assess ABCs (airway, breathing, circulation), and begin necessary interventions.

• History Taking: Gather information about the patient's chief complaint and past medical history to guide treatment.

• Secondary Assessment: Perform a complete physical examination and gather additional details beyond the primary assessment.

• Reassessment: Regularly monitor the patient's condition to identify changes and adjust treatment as necessary.

Scene Size-up (Pages 1-3)

• Ensure Scene Safety:

  • Assess environment for hazards and ensure personal safety.

  • Establish safety protocols for hazardous situations including traffic and physical dangers.

• Assess Mechanism of Injury/Nature of Illness:

  • Differentiate between medical and traumatic cases to inform assessment processes.

  • Identify factors influencing patient condition, such as blunt vs. penetrating trauma.

• Consider Additional/Specialized Resources:

  • Request ALS for severe cases based on patient's condition and local protocols.

Primary Assessment (Pages 4-6)

• Form General Impression:

  • Note age, sex, race, and overall distress level.

• Levels of Consciousness (LOC):

  • Use AVPU scale to assess responsiveness (Alert, respond to Verbal stimuli, respond to Painful stimuli, Unresponsive).

• Assess Airway, Breathing, Circulation (ABCs):

  • Airway: Keep patent and manage obstructions.

  • Breathing: Assess adequacy and provide ventilation if necessary.

  • Circulation: Monitor heart rate, skin condition, and check for severe bleeding. Control external bleeding via direct pressure.

• Access Vital Functions: Assess vitals to determine stability and need for immediate transport.

History Taking (Page 2-3)

• Obtain Chief Complaint: Determine the most pressing medical issue.

• Investigate Past Medical History: Use SAMPLE mnemonic (Signs/Symptoms, Allergies, Medications, Past Medical History, Last oral intake, Events leading up to illness/injury).

• Identify Pertinent Negatives: Document absent symptoms that may clarify diagnosis.

Secondary Assessment (Pages 4-7)

• Perform Full-Body Scan: Check for injuries using the DCAP-BTLS mnemonic (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling).

• Focused Assessment Techniques: Based on chief complaint, assess key body systems using systematic methods.

• Assess Vital Signs: Accurate measurement of pulse, blood pressure, respiratory rate, and temperature.

Monitoring Devices (Page 8-9)

• Pulse Oximetry: Important for assessing oxygenation, but consider limitations such as peripheral circulation.

• Blood Pressure Measurement: Use manual or electronic techniques depending on situation.

• Capnography: Measure CO2 levels for insight into ventilation and metabolic function.

• Blood Glucometry: Assess blood sugar, particularly for patients with altered mental status.

Reassessment (Page 10-16)

• Importance of Reassessment: Required to monitor changes and evaluate effectiveness of interventions.

• Frequency of Reassessment: Every 5 minutes for unstable patients; every 15 minutes for stable patients.

• Components of Reassessment:

  • Repeat primary assessment, recheck vitals, confirm treatment is effective, and identify any changes in the condition.

Skills Objectives (Page 17-38)

• Demonstrate Assessment Techniques: Use AVPU scale, check pulse, assess airway and breathing.

• Understand Vital Sign Measurements: Accurately assess and interpret vital signs under various conditions.

• Perform Rapid Exam: Identify life threats and assess the patient's physical condition efficiently.

Conclusion

• Overall proficiency in patient assessment is vital to delivering effective emergency medical care and improving patient outcomes.