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

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EMT Course Fundamentals Unit

Lesson 5 EMT Assessment / History and Physical Exam

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Overview

• Lesson is 7 hours total
• 3 hours online / independent preparation
• 4 hour face-to-face lab session (Lab 2)

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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

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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.

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Primary Survey

• This is CVO
• Assess Airway & Breathing
• Assess Circulation
• Done simultaneously
• Done RAPIDLY

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Emergent Tx

• Airway Control
• Ventilation
• Oxygen Therapy
• Bleeding Control / Urgent Injury Care

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Decision Point

• Additional Resource Needs?
• Rescue, HazMat
• Law Enforcement
• Air Transport
• More than one Ambulance
• Paramedics

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Decision Point

• Critical Trauma = Rapid Trauma Exam
• Otherwise = Focused History AND Physical

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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

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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

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As Time Allows…

• Vitals—recorded and reported in the order:
• BP-HR-RR-SpO2-other (like T or GCS
• r Pain or EtCO2)
• History—pertinent elements of SAMPLE

with OPQRST added for pain

• Detailed Physical Exam—check

EVERYTHING (but this takes a while)

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Vitals

• “Full set of vitals”
• Recorded and Reported in this order:
• BP-HR-RR-SpO2-other (like T or GCS
• r Pain or EtCO2)

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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

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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?)

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History-Clues

• Med bottles / med list
• File of Life, Phone
• Medic Alert bracelet / necklace
• Scars / Clues during physical exam

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Alert Needed?

• Time Critical Diagnosis Alert
• Trauma
• Stroke
• STEMI
• Other (Sepsis in some systems)

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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….

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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

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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)