PATIENT ASSESSMENT AND VITAL FUNCTIONS

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Optimal patient care requires that the EMT-I accurately assess patients. The following topics will be discussed during this lesson:

· Initial assessment

· Focused History and Detailed Physical Examination

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

1. State the goal of the initial assessment.

2. Identify the elements and important observations that are included in an initial assessment.

3. Demonstrate an initial assessment.

4. State the goals of a focused history and detailed physical examination.

5. Identify the elements and important observations that are included in a focused history.

6. Understand the Glasgow Coma Scale.

7. Discuss the EMT-1 responsibility in reporting assessment findings.

8. Demonstrate taking vital signs and performing a focused history and detailed physical examination.

SKILLS

Temperature

Pulse

Blood Pressure

Initial Assessment – Conscious and Unconscious

Focused History and Detailed Physical Examination – Conscious and Unconscious

KEY VOCABULARY

The following terms will be used during this lesson:

• Sign – an objective assessment finding observation by the EMT

• Symptom – a subjective complaint voiced by the patient

• Inspection – visually examining a patient

• Palpation – examining a patient by touch

• Auscultation – using a stethoscope to listen for the sounds made by the internal organs

• Bradycardia – a heart rate of less than 60/minute

• Tachycardia – a heart rate of greater than 100/minute

• Hypertension – blood pressure that is elevated above normal (acute or chronic)

• Hypotension – blood pressure that is too low to adequately perfuse the body

• Symptomatic – an illness or injury causing the patient to be in distress

• Asymptomatic – an illness or injury not resulting in signs/symptoms of distress

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

INITIAL PATIENT ASSESSMENT

Goal: to detect serious and life threatening problems

Elements and Important Observations:

The Initial Patient Assessment: Conscious

1). Assess environment: (may need to manipulate the environment)

· Safety of rescuers and environment

• Environmental factors
• Patient location (home, street, convalescent, etc.)
• Weapons (may indicate trauma mechanism)
• Medications (may offer clues to past medical history)
• Witnesses (may help to explain circumstances)
• Mechanism of injury
• Number of patients

2). Airway (determine responsiveness and patency of airway)

(Patient is awake)

• Initiate spinal precautions if indicated
• Introduce self to patient
• Obtain patient’s name and age
• Determine LOC: day/time/place

5). Skin signs: assess color, temperature and moisture

• Pale, cool, moist skin and delayed capillary refill are due to peripheral vasoconstriction
• If signs of poor perfusion, consider placing patient supine

6). Assess neurological status: assess level of consciousness

(Glasgow Coma Score) and neuro deficits

• Restlessness, agitation, and lethargy may be due to hypoxia and decreased cerebral perfusion.

Complete GCS:

• Eye Opening

4. Spontaneous

3. Verbal

2. Painful

1. None

• Motor Response

6. Obedient

5. Purposeful

4. Withdraws

3. Flexion

2. Extension

1. None

• Verbal Response

5. Oriented

4. Disoriented

3. Inappropriate

2. Incomprehensible

1. None

7. Determine chief complaint

When to perform an initial patient assessment:

• On arrival
• Patient condition changes
• After each intervention

Focused History and Detailed Physical Examination: Conscious

Focused History and Detailed Physical Examination: Conscious

Goal: a systematic assessment of all the body systems to determine the patient’s

medical or traumatic problems

1). Elicit history of chief complaint or problem (PQRST)

• P provoking factor- “What were you doing?”

• Q Quality- “What does the pain feel like?”

• R Region- “Where does it hurt?”

Radiation- “Does the pain go anywhere else?”

Reoccurrence-“Has this happened before?”

• S Severity- “How bad is the pain?”

• T Time- “When did it start?”

2). Elicit personal history (HAM)

• H medical history/under a doctors care
• A allergies/age
• M medications-current over the counter and prescription

3). Vital Signs

• Blood pressure—not a reliable early indicator of shock; assess for more subtle signs (capillary refill, heart rate, altered LOC)
• Orthostatic vital signs if indicated
• Pulse—rate and quality (pulses present and equal in all extremities)
• Heart rhythm (dysrhythmias may be an indication of poor perfusion or a result of poor perfusion)
• Respirations—rate, depth, tidal volume, and lung sounds (present, absent, or abnormal)
• Pupils—(pupillary size and reaction to light)

4). Special Questions

Ask questions specific to chief complaint:

• Seizure – recent change in medication
• SOB – orthopnea, dyspnea on exertion, last attack
• Trauma – any loss of consciousness

5). Pertinent Body Check:

• Medical or minor trauma—perform body check pertinent to chief complaint
• Major trauma—perform total body check

TOTAL BODY CHECK

Conscious Patient

1). HEAD:

· Visualize: any signs of trauma

-Lacerations -Hematomas

-Abrasions -Avulsions

-Penetrations -Contusions

-Deformities

-Facial symmetry

-Drainage from nose/ears/mouth

-Injury to teeth or tongue

-Injury to eyes

-Singed nasal hair/soot

· Palpate for any:

-Tenderness/Instability/Crepitus

2). NECK AND C-SPINE:

• Visualize the neck and c-spine area:

-accessory muscle use

-neck vein distention

-any signs of trauma- lacerations/abrasions/penetrations

deformities/hematomas/avulsions/contusions

-tracheal deviation

-medical alert tags

• Palpate for:

- Tenderness/Instability/Crepitus

3). CHEST:

• Visualize the chest area looking for:

-accessory muscle use

-signs of trauma - lacerations/abrasions/penetrations

deformities/hematomas/avulsions/contusions

• Palpate (chest, clavicles, sternum, and rib cage)

- Tenderness/Instability/Crepitus

• Auscultate (normal, noisy, or absent)

-presence of lung sounds

-equality of breath sounds

4). ABDOMEN:

• Visualize the abdominal region looking for signs of trauma:

-penetrations/lacerations/contusions/hematomas

-abrasions/avulsions/contusions

• Palpate:

-pulsating mass

-tenderness

-distention

-rigidity

5). PELVIS:

• Visualize:

-incontinence

-signs of trauma- lacerations/abrasions/penetrations

deformities/hematomas/avulsions/contusions

• Palpate for:

- Tenderness/Instability/Crepitus

-equality of femoral pulses

6). LOWER EXTREMITIES:

• Visualize:

-signs of trauma- lacerations/abrasions/penetrations

deformities/hematomas/avulsions/contusions

-medical alert tags

-tracks

-capillary refill

• Palpate:

- Tenderness/Instability/Crepitus

-circulation (equality of pulses)

-motor (equality of movement)

-sensation (equality of feeling)

7). UPPER EXTREMITIES:

• Visualize:

-signs of trauma- lacerations/abrasions/penetrations

deformities/hematomas/avulsions/contusions

-medical alert tags

-tracks

-capillary refill

• Palpate:

- Tenderness/Instability/Crepitus

-circulation (equality of pulses)

-motor (equality of movement)

-sensation (equality of feeling)