Chapter 16 Focused History and Physical Examination of the Medical Patient.
Transcript of 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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Overview
Assessment of the Medical Patient The Responsive Medical Patient The Unresponsive Medical Patient
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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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Assessment of the Medical Patient
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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Assessment of the Medical Patient
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
The Responsive Medical Patient
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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
The Responsive Medical Patient
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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
The Responsive Medical Patient
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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
The Responsive Medical Patient
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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
The Responsive Medical Patient
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Baseline vital signs– Assess
• Respiration• Pulse• Blood pressure• Skin temperature and condition• Pupils, pulse oximetry, and capillary refill in children
The Responsive Medical Patient
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Baseline vital signs– Abnormal vital signs
• Patient is high priority• Initiate immediate transport
The Responsive Medical Patient
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Treatment and transport– High priority
• Treatment for life threats provided during initial assessment
• Further treatment and assessment administered during transport
The Responsive Medical Patient
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Treatment and transport– Low priority: complete focused history and
physical with baseline vital signs on the scene before transport
The Responsive Medical Patient
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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
The Responsive Medical Patient
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Ongoing assessment– Continuously monitor for any changes in
patient condition
The Responsive Medical Patient
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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
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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Head and neck– Abnormalities– Eyes, ears, nose, mouth– Pupils– Drainage from the nose– Scars or venous distension on neck
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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History– Quickly ask the family and bystanders
about the patient history– Look for clues on the scene
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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Medical control and ALS– Consider ALS backup if patient requires
advanced-level evaluation and treatment
The Unresponsive Medical Patient
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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
The Unresponsive Medical Patient
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Stop and Review
What is the first step of the assessment of the unresponsive medical patient?