21 medical assessments
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ASSESSMENT OF THE MEDICAL PATIENT
Institute for Emergency Medical Services
MEDICAL ASSESSMENTMEDICAL ASSESSMENT
Trau m a A ssessm en t
D ete rm in eM .O .I.
Y es
M ed ica l A ssessm en t
N o
Trau m a C om p on en t?
M ed ica l
Is th is a m ed ica l o r a trau m a p a tien t?
Institute for Emergency Medical Services
MECHANISM OF INJURYMECHANISM OF INJURY
YESYES NONO
TRAUMA SURVEYTRAUMA SURVEY MEDICAL ASSESSMENTMEDICAL ASSESSMENT
&&
PHYSICAL EXAMPHYSICAL EXAM
MEDICAL ASSESSMENT
PRIMARY SURVEYResponsive Medical PatientResponsive Medical Patient
Institute for Emergency Medical Services
BODY SUBSTANCE ISOLATION
BODY SUBSTANCE ISOLATION
GlovesGloves
GlassesGlasses
MaskMask
ApronApron
OverallsOveralls
(As appropriate)(As appropriate)
Institute for Emergency Medical Services
SCENE SIZE-UPSCENE SIZE-UP
SScene safecene safe
UUniversal precautionsniversal precautions
NNumber of patientsumber of patients
MMechanism of injuryechanism of injury
DDo I need Additional helpo I need Additional help
Institute for Emergency Medical Services
INITIAL ASSESSMENTINITIAL ASSESSMENT
General impression of patientGeneral impression of patientSkin colour, rate and depth of respirations, Skin colour, rate and depth of respirations, effort, patients position, age, sex, weight, heighteffort, patients position, age, sex, weight, height
Considers C-spine stabilisationConsiders C-spine stabilisation
Determine level of consciousnessDetermine level of consciousnessShake and shout / “hello can you hear me?”Shake and shout / “hello can you hear me?”
Determine chief complaint/apparent life Determine chief complaint/apparent life threatsthreats
Institute for Emergency Medical Services
AIRWAYAIRWAY
Assessment of the airwayAssessment of the airway
““Can you open your mouth for me?”Can you open your mouth for me?”
Establishes and maintains a patent Establishes and maintains a patent airwayairway
Institute for Emergency Medical Services
BREATHINGBREATHING
Assessment of breathingAssessment of breathing
Initiate appropriate Initiate appropriate oxygen therapyoxygen therapy
Assure adequate ventilationAssure adequate ventilation
Institute for Emergency Medical Services
CIRCULATIONCIRCULATION
Assessment of pulseAssessment of pulse
Assess and control any major bleedingAssess and control any major bleeding
Assess skin (colour, temperature, Assess skin (colour, temperature, condition)condition)
Assess capillary re-fillAssess capillary re-fill
Institute for Emergency Medical Services
DISABILITYDISABILITY
AA = Alert= Alert
VV = Verbal= Verbal
PP = Pain= Pain
UU = Unresponsive= Unresponsive
PP = Pupils= PupilsEE = Equal= EqualAA = And = And RR = Round= RoundRR = React= ReactLL = Light= Light
Institute for Emergency Medical Services
CUPS DECISION CUPS DECISION
Institute for Emergency Medical Services
CUPS DECISIONCUPS DECISION
CC CCriticalritical
UU UUnstablenstable
PP PPotentially unstableotentially unstable
SS SStabletable
Institute for Emergency Medical Services
CUPS DECISIONCUPS DECISION
CC CCriticalritical
UU UUnstablenstable
PP PPotentially unstableotentially unstable
SS SStabletable
Load & go adult
Load & go infant/child
Institute for Emergency Medical Services
Why gather the history before physical exam or vital signs ?
For a medical patient the history usually For a medical patient the history usually provides the most important informationprovides the most important information
Institute for Emergency Medical Services
Respiratory & CardiacRespiratory & Cardiac
Altered Mental StatusAltered Mental Status
Allergic ReactionAllergic Reaction
Piosoning/OverdosePiosoning/Overdose
Environmental EmergencyEnvironmental Emergency
Obstetrics*Obstetrics*
BehaviouralBehavioural
DIFFERENT “FOCUSED MEDICAL” QUESTIONS
Institute for Emergency Medical Services
FOCUSED MEDICAL HISTORY QUESTIONS
O = OnsetO = Onset P = ProvocationP = Provocation Q = QualityQ = Quality R = RadiationR = Radiation S = SeverityS = Severity T = TimeT = Time
CARDIAC AND RESPIRATORYCARDIAC AND RESPIRATORY
Institute for Emergency Medical Services
ONSET
What were you doing when it started?What were you doing when it started?
Do you think it was caused by anything Do you think it was caused by anything in particular ?in particular ?
Institute for Emergency Medical Services
PROVOKES
Can you think of anything that might Can you think of anything that might have triggered this pain?have triggered this pain?
Does anything make the pain better or Does anything make the pain better or worse?worse?
Can you make the pain happen ?Can you make the pain happen ?
Institute for Emergency Medical Services
Can you describe the pain for me?Can you describe the pain for me?
Dull ache.Dull ache. // TearingTearing
SharpSharp // GrippingGripping
ThrobbingThrobbing // StabbingStabbing
ShootingShooting / Worst headache of my life/ Worst headache of my life
QUALITY
Institute for Emergency Medical Services
Where exactly is the pain?Where exactly is the pain?
Does it spread anywhere?Does it spread anywhere?
Gallbladder pain in R shoulderGallbladder pain in R shoulder
Cardiac pain in Jaw.Cardiac pain in Jaw.
RADIATION
Institute for Emergency Medical Services
SEVERITY
How bad is the pain?How bad is the pain?
On a scale of 1 to 10, with 10 being the On a scale of 1 to 10, with 10 being the worst you could possibly imagine, how worst you could possibly imagine, how would you rate your pain?would you rate your pain?
Institute for Emergency Medical Services
TIME
When did the pain start?When did the pain start?
Has it changed at all since it started?Has it changed at all since it started?
Institute for Emergency Medical Services
QUESTIONING TECHNIQUES
Open QuestionsOpen Questions
Closed QuestionsClosed Questions
Leading QuestionsLeading Questions
Comparative QuestionsComparative Questions
Institute for Emergency Medical Services
RESPIRATORY & CARDIACRESPIRATORY & CARDIAC
O = Onset?O = Onset? P = Provocation?P = Provocation? Q = Quality?Q = Quality? R = Radiation?R = Radiation? S = Severity?S = Severity? T = Time?T = Time?
Interventions: Interventions: Has anything helped or Has anything helped or made the problem worsemade the problem worse
Institute for Emergency Medical Services
ALTERED LEVEL OF CONSCIOUSNESS
ALTERED LEVEL OF CONSCIOUSNESS
Description of episodeDescription of episodeOnset?Onset?Duration?Duration?Associated symptoms?Associated symptoms?Evidence of trauma?Evidence of trauma?Seizures?Seizures?Fever?Fever?
Interventions: Interventions: Has anything helped or Has anything helped or made the problem worsemade the problem worse
Institute for Emergency Medical Services
ALLERGIC REACTION
History of allergies?History of allergies?
What were you exposed to?What were you exposed to?
Duration of exposure?Duration of exposure?
Effects?Effects?
Progression?Progression?
Interventions: Interventions: Has anything helped or made Has anything helped or made the problem worsethe problem worse
Institute for Emergency Medical Services
SubstanceSubstanceWhen was substance injested when did the When was substance injested when did the exposure occur?exposure occur?How much did you injest?How much did you injest?Over what time period?Over what time period?Estimated weight?Estimated weight?
Interventions: Interventions: Has anything helped or made Has anything helped or made the problem worsethe problem worse
POISONING
Institute for Emergency Medical Services
ENVIRONMENTAL EMERGENCIES
Source?Source?
Environment?Environment?
Duration?Duration?
Loss of consciousness?Loss of consciousness?
Effects- general/local?Effects- general/local?
Institute for Emergency Medical Services
OBSTETRICS
Are you pregnant?Are you pregnant?
How long have you been pregnant?How long have you been pregnant?
Pain or contractions?Pain or contractions?
Bleeding or discharge?Bleeding or discharge?
Do you feel the need to push?Do you feel the need to push?
Last menstrual period?Last menstrual period?
Institute for Emergency Medical Services
BEHAVIOURAL
How do you feel?How do you feel?
Determine suicidal tendenciesDetermine suicidal tendencies
Is the patient a threat to self or others?Is the patient a threat to self or others?
Is there a medical problem?Is there a medical problem?
Interventions: Interventions: Has anything helped or Has anything helped or made the problem worsemade the problem worse
Institute for Emergency Medical Services
HISTORY OF PRESENT ILLNESS (HPI)
SS = Signs and Symptoms= Signs and Symptoms
AA = Allergies= Allergies
MM = Medications= Medications
P P = Pertinent past history= Pertinent past history
LL = Last oral intake= Last oral intake
EE = Events leading to problem= Events leading to problem
Institute for Emergency Medical Services
SIGNS & SYMPTOMS
Can you describe Can you describe what is wrong?what is wrong? Chief complaint Chief complaint (C.C)(C.C)
Have you any Have you any other symptoms?other symptoms?
Institute for Emergency Medical Services
ALLERGIES
Are you allergic to Are you allergic to anything?anything?
Institute for Emergency Medical Services
MEDICATIONS
Do you take any Do you take any medication?medication?
What do you take What do you take those for?those for?
Institute for Emergency Medical Services
MEDICATIONS
PrescriptionsPrescriptions
CurrentCurrent
RecentRecent
Birth Control PillsBirth Control Pills
Institute for Emergency Medical Services
MEDICATIONS
Non-PrescriptionNon-Prescription
CurrentCurrent
RecentRecent
Vitamin supplements Vitamin supplements
Institute for Emergency Medical Services
PERTINENT MEDICAL HISTORY
Do you have any Do you have any medical conditions medical conditions that we should that we should know about?know about?
Have you ever had Have you ever had a problem like this a problem like this before?before?
Institute for Emergency Medical Services
LAST ORAL INTAKE
When was the last When was the last time you ate or time you ate or drank?drank?
What did you eat What did you eat or drink?or drink?
Institute for Emergency Medical Services
EVENTS
Sequence of events leading up to the Sequence of events leading up to the illnessillness
How have you felt today?How have you felt today?
Anything out of the ordinary Anything out of the ordinary happen?happen?
Institute for Emergency Medical Services
RE-CAP SO FARRE-CAP SO FAR
Scene size up ( SUNMD )Scene size up ( SUNMD )
Initial assessment ( general impressions etc.. )Initial assessment ( general impressions etc.. )
AirwayAirway
BreathingBreathing
CirculationCirculation
DisabilityDisability
CUPS decisionCUPS decision
Focused medical questions / SAMPLEFocused medical questions / SAMPLE
Institute for Emergency Medical Services
BASELINE VITAL SIGNS
PulsePulse
RespirationsRespirations
Blood PressureBlood Pressure
Breath soundsBreath sounds
SpOSpO22
Skin colour, temperature, conditionSkin colour, temperature, condition
Capillary refill Capillary refill
PupilsPupils
Institute for Emergency Medical Services
INTERVENTIONS
Obtain medical directionObtain medical direction
Employ Dublin Fire Brigade Employ Dublin Fire Brigade ProtocolProtocol
PHECC C.P.G’sPHECC C.P.G’s
Institute for Emergency Medical Services
INTERVENTIONS
Cardiac monitorCardiac monitor
Glucose measurementGlucose measurement
OO2 , 2 , GTN , ASA , Glucose gel , SalbutomolGTN , ASA , Glucose gel , Salbutomol
Patient Positioning Patient Positioning (e g : trendellenburg for hypovolaemia) (e g : trendellenburg for hypovolaemia)
Institute for Emergency Medical Services
RE-EVALUATES CUPS
Re-evaluate transport decisionRe-evaluate transport decision
It’s now Time to goIt’s now Time to go
Institute for Emergency Medical Services
REPEATS FOCUSED EXAM
Based on patients Based on patients Chief ComplaintChief Complaint
Institute for Emergency Medical Services
REPEATS FOCUSED EXAM
Re-evaluate patient for obvious Re-evaluate patient for obvious indications of illness that may have been indications of illness that may have been missedmissed
Look for less obvious evidence of Look for less obvious evidence of illness/injuryillness/injury
Institute for Emergency Medical Services
REPEATS FOCUSED EXAM
As appropriate, As appropriate, assess:assess:
HeadHead
NeckNeck
ChestChest
AbdomenAbdomen
PelvisPelvis
ExtremitiesExtremities
PosteriorPosterior
Institute for Emergency Medical Services
RE-CHECKS INTERVENTIONS
Cardiac monitor Cardiac monitor
OO22
PositioningPositioning
Institute for Emergency Medical Services
COMMUNICATIONS
It is imperitave that you strive to It is imperitave that you strive to communicate well with your patient communicate well with your patient
TrustTrust
RespectRespect
Professionalism Professionalism
Institute for Emergency Medical Services
REPEAT VITAL SIGNS
PulsePulse
RespirationsRespirations
Blood PressureBlood Pressure
Breath soundsBreath sounds
SpOSpO22
Skin colour, temperature, conditionSkin colour, temperature, condition
Capillary refill Capillary refill
PupilsPupils
Institute for Emergency Medical Services
FROM THE TOPFROM THE TOP
Scene size up ( SUNMD )Scene size up ( SUNMD )
Initial assessment ( general impressions etc.. )Initial assessment ( general impressions etc.. )
AirwayAirway
BreathingBreathing
CirculationCirculation
DisabilityDisability
CUPS decisionCUPS decision
Focused medical questions / SAMPLEFocused medical questions / SAMPLE
Institute for Emergency Medical Services
FROM THE TOPFROM THE TOP
Baseline vital signsBaseline vital signs
InterventionsInterventions
Re-evaluates CUPS decisionRe-evaluates CUPS decision
Repeats focused examRepeats focused exam
Re-checks interventionsRe-checks interventions
CommunicationsCommunications
Repeats vital signsRepeats vital signs
MEDICAL ASSESSMENT
PRIMARY SURVEYUnresponsive Medical PatientUnresponsive Medical Patient
Institute for Emergency Medical Services
UNRESPONSIVE PATIENT
ABCD / consider C spine controlABCD / consider C spine control
CUPSCUPS
Rapid assessment Rapid assessment
History of present illness (bystanders)History of present illness (bystanders)
S.A.M.P.L.E. history (bystanders)S.A.M.P.L.E. history (bystanders)
Baseline Vital Signs Baseline Vital Signs
Make relevant interventionsMake relevant interventions
Institute for Emergency Medical Services
Position patient to correct airway
Institute for Emergency Medical Services
INITIAL ASSESSMENTPrimary Survey
AA BB CC DD
Institute for Emergency Medical Services
CUPS DECISION CUPS DECISION
Institute for Emergency Medical Services
CUPS DECISIONCUPS DECISION
CC CCriticalritical
UU UUnstablenstable
PP PPotentially unstableotentially unstable
SS SStabletable
Institute for Emergency Medical Services
CUPS DECISIONCUPS DECISION
CC CCriticalritical
UU UUnstablenstable
PP PPotentially unstableotentially unstable
SS SStabletable
Load & go adult
Load & go infant/child
Institute for Emergency Medical Services
RAPID ASSESSMENT
Start with rapid Start with rapid assessmentassessment
HeadHead
NeckNeck
ChestChest
AbdomenAbdomen
PelvisPelvis
ExtremitiesExtremities
PosteriorPosterior
Institute for Emergency Medical Services
RESPIRATORY & CARDIACRESPIRATORY & CARDIAC
O = Onset?O = Onset? P = Provocation?P = Provocation? Q = Quality?Q = Quality? R = Radiation?R = Radiation? S = Severity?S = Severity? T = Time?T = Time?
Interventions: Interventions: Has anything helped or Has anything helped or made the problem worsemade the problem worse
Institute for Emergency Medical Services
HISTORY OF PRESENT ILLNESS (HPI)
SS = Signs and Symptoms= Signs and Symptoms
AA = Allergies= Allergies
MM = Medications= Medications
P P = Pertinent past history= Pertinent past history
LL = Last oral intake= Last oral intake
EE = Events leading to problem= Events leading to problem
Institute for Emergency Medical Services
BASELINE VITAL SIGNS
PulsePulse
RespirationsRespirations
Blood PressureBlood Pressure
Breath soundsBreath sounds
SpOSpO22
Skin colour, temperature, conditionSkin colour, temperature, condition
Capillary refill Capillary refill
PupilsPupils
Institute for Emergency Medical Services
INTERVENTIONS
Cardiac monitorCardiac monitor
Glucose measurementGlucose measurement
OO2 , 2 , GTN , ASA , Glucose gel , SalbutomolGTN , ASA , Glucose gel , Salbutomol
Patient Positioning Patient Positioning (e g : trendellenburg for hypovolaemia) (e g : trendellenburg for hypovolaemia)
Institute for Emergency Medical Services
FROM THE TOPFROM THE TOP
Scene size up ( SUNMD )Scene size up ( SUNMD )Initial assessment ( general impressions etc.. )Initial assessment ( general impressions etc.. )AirwayAirwayBreathingBreathingCirculationCirculationDisabilityDisabilityCUPS decisionCUPS decisionRapid physical exam ( head to toe )Rapid physical exam ( head to toe )Focused medical questions / SAMPLEFocused medical questions / SAMPLE
Institute for Emergency Medical Services
FROM THE TOPFROM THE TOP
Baseline vital signsBaseline vital signs
InterventionsInterventions
Re-evaluates CUPS decisionRe-evaluates CUPS decision
Repeats physical examRepeats physical exam
Re-checks interventionsRe-checks interventions
CommunicationsCommunications
Repeats vital signsRepeats vital signs
QUESTIONS ?QUESTIONS ?
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