Chapter 16 Focused History and Physical Examination of the Medical Patient.

Chapter 16Focused History and Physical Examination of the Medical Patient

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Assessment of the Medical Patient The Responsive Medical Patient The Unresponsive Medical Patient

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Assessment of the Medical Patient

Patient priorities – Differ somewhat between patient with a medical

illness and patient with trauma– Depend on whether the medical patient is awake

and responsive or unresponsive

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History– No mechanism of injury– An illness resulting in a call for emergency care– Obtain necessary information to prioritize care of

the medical patient

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Physical examination– Use the history to guide the physical exam– Physical examination findings often confirm the

suspicions formed from the history

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The Responsive Medical Patient

A very common type of patient Has a medical illness and usually can

communicate its details

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History of the present illness– Organize questions to get information quickly– Avoid long-winded accounts– Filter irrelevant history


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Chief complaint– First and most important part of the history– Main reason why patient called for help– Approach: introduce yourself and ask politely

about the problem


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OPQRST– Specific questions to better define problem

and determine treatment• Onset of symptoms• Provocation, or provoking factors• Quality of symptoms • Radiation of discomfort from primary location• Severity of symptoms• Time: length of time symptoms have been present


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OPQRST History

Watch this video demonstrating obtaining the history using OPQRST

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SAMPLE history– Important elements of medical history to help further define

the current problem• Signs and symptoms• Allergies to medications • Medications • Past medical history• Last oral intake• Events leading up to the current event


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SAMPLE History

Watch this video as a demonstration of obtaining a patient history using SAMPLE

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Focused physical examination– Focus on the body area that seems affected by

the current problem– Look for DCAP-BTLS when examining the specific

body part in question


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Baseline vital signs– Assess

• Respiration• Pulse• Blood pressure• Skin temperature and condition• Pupils, pulse oximetry, and capillary refill in children


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Baseline vital signs– Abnormal vital signs

• Patient is high priority• Initiate immediate transport


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Treatment and transport– High priority

• Treatment for life threats provided during initial assessment

• Further treatment and assessment administered during transport


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Treatment and transport– Low priority: complete focused history and

physical with baseline vital signs on the scene before transport


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Online medical control– Necessary for permission to assist a patient

with previously prescribed medications

Consider ALS– Necessary for treatment beyond EMT’s

scope of practice


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Ongoing assessment– Continuously monitor for any changes in

patient condition


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Stop and Review

What is the focus during the assessment of the conscious and alert medical patient?

What acronym assists the EMT in determining the conscious medical patient’s response to pain?

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The Unresponsive Medical Patient

Unresponsive patient cannot give history Perform rapid physical exam to determine

sources of unresponsiveness

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Measure vitals Try to obtain a history from the

“family or bystanders


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Rapid physical examination– Similar to head-to-toe rapid exam for

trauma patients– Perform a systematic assessment for

DCAP-BTLS– Consider cervical spinal immobilization

for unresponsive medical patients who may have fallen


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Head and neck– Abnormalities– Eyes, ears, nose, mouth– Pupils– Drainage from the nose– Scars or venous distension on neck


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Abdomen and pelvis– Expose and check for abnormalities– Palpate all four quadrants– Assess pelvis by compression of the iliac wings,

hips, and pubis


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Extremities – Assess for abnormalities

as for the trauma patient– Look for edema– Note pulses, motor, and

sensory function – Check for MedicAlert

emblems


Courtesy of the MedicAlert Foundation, Turlock, CA

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Back and buttocks– Assess for abnormalities– Listen to the lungs from the back if possible


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Vital signs– After the rapid physical assessment, a complete

set of vital signs should be obtained– Carefully record and refer to this set as a baseline


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History– Quickly ask the family and bystanders

about the patient history– Look for clues on the scene


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Treatment and transport– Life-threatening problems:

• Treatments provided during initial assessment• Transport should directly ensue

– If transport not initiated by the completion of the physical exam, then it should be addressed after the patient history


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Medical control and ALS– Consider ALS backup if patient requires

advanced-level evaluation and treatment


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Ongoing assessment– Repeatedly assess patient during transport for

any changes– Contact receiving hospital and advise of the

nature of the patient’s illness or injury


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Stop and Review

What is the first step of the assessment of the unresponsive medical patient?

Chapter 16 Focused History and Physical Examination of the Medical Patient.

Documents

Transcript of Chapter 16 Focused History and Physical Examination of the Medical Patient.