Lesson 5 EMT Assessment / History and Physical Exam Boone County - PowerPoint PPT Presentation

EMT Course Fundamentals Unit Lesson 5 EMT Assessment / History and Physical Exam Boone County Fire Protec/on District EMS Educa/on

Overview • Lesson is 7 hours total • 3 hours online / independent preparation • 4 hour face-to-face lab session (Lab 2) Boone County Fire Protec/on District EMS Educa/on

Content • Integration of Safety, Circulation, Ventilation and Oxygenation Lessons • Definition of the parts of patient assessment • Introductory scenarios to practice the fundamental assessment / treatment steps Boone County Fire Protec/on District EMS Educa/on

General Impression • "Across the room...sick or not sick?" • Could be "not sure yet" • This is your "gut feeling"--the "little voice" or that unexplainable but usually right uneasy feeling that you get. Boone County Fire Protec/on District EMS Educa/on

Primary Survey • This is CVO • Assess Airway & Breathing • Assess Circulation • Done simultaneously • Done RAPIDLY Boone County Fire Protec/on District EMS Educa/on

Emergent Tx • Airway Control • Ventilation • Oxygen Therapy • Bleeding Control / Urgent Injury Care Boone County Fire Protec/on District EMS Educa/on

Decision Point • Additional Resource Needs? • Rescue, HazMat • Law Enforcement • Air Transport • More than one Ambulance • Paramedics Boone County Fire Protec/on District EMS Educa/on

Decision Point • Critical Trauma = Rapid Trauma Exam • Otherwise = Focused History AND Physical Boone County Fire Protec/on District EMS Educa/on

If Critical Trauma.. • Direct your team to prep for rapid transport • Do a Rapid Trauma Exam (no longer than 60 second full body sweep / squeeze to find major bleeds and major injuries) • Transmit a Trauma Alert Boone County Fire Protec/on District EMS Educa/on

Otherwise... • Do a Focused History AND Physical • Both…History AND Physical • Focused—on what is the main problem or main body system(s) involved • Vitals are an important part of this phase Boone County Fire Protec/on District EMS Educa/on

As Time Allows… • Vitals—recorded and reported in the order: • BP-HR-RR-SpO2-other (like T or GCS or Pain or EtCO2) • History—pertinent elements of SAMPLE with OPQRST added for pain • Detailed Physical Exam—check EVERYTHING (but this takes a while) Boone County Fire Protec/on District EMS Educa/on

Vitals • “Full set of vitals” • Recorded and Reported in this order: • BP-HR-RR-SpO2-other (like T or GCS or Pain or EtCO2) Boone County Fire Protec/on District EMS Educa/on

History-SAMPLE • Signs and Symptoms besides chief complaint • Allergies to foods or medications • Medications prescribed and whether taken • Pertinent past medical history • Last ______ (meal, med, episode of this, BM, LMP…whatever makes sense) • Events leading up to this Boone County Fire Protec/on District EMS Educa/on

History-OPQRST • Onset of symptoms (what were you doing when it started?) • Provocative / Palliative (what makes it better or worse?) • Quality (what does it feel like?) • Radiation (does the pain go to other places?) • Severity (scale of 0-10) • Time(what Time did it start?) Boone County Fire Protec/on District EMS Educa/on

History-Clues • Med bottles / med list • File of Life, Phone • Medic Alert bracelet / necklace • Scars / Clues during physical exam Boone County Fire Protec/on District EMS Educa/on

Alert Needed? • Time Critical Diagnosis Alert • Trauma • Stroke • STEMI • Other (Sepsis in some systems) Boone County Fire Protec/on District EMS Educa/on

Detailed Exam • Time consuming • Rapid exam allowed 5 seconds on head… detailed exam takes as long as needed to look in / around / behind ears and eyes and scalp and teeth and mouth and…. Boone County Fire Protec/on District EMS Educa/on

Ongoing Assessment • You ALWAYS have time for this—even the most critical patients get an ongoing assessment—maybe that is all there is time for but there is always time for it. • Repeat big things including Vitals • Maybe LS, Maybe check for bleeding control, Maybe pupil size • Check on treatments you have done Boone County Fire Protec/on District EMS Educa/on

Summary • Initial Assessment (CVO) • Emergent Interventions • Decision Point (Resources? Critical Trauma?) • Rapid Exam or Focused H&P (Alerts?) • Ongoing Assessment • Secondary Exam (Detailed H&P) Boone County Fire Protec/on District EMS Educa/on