patient assessment is assessing the patients and everything around the scene and understanding what is going on with our patients it starts off when we first get to the scene and it's gonna end all the way at the end of our patient care this patient assessment is broken up into five major parts first we have scene size up scene size up means what do you see when you first get to the scene and we're gonna break each one of these down so stay tuned to the video for that primary assessment primary assessment is going to be mainly looking for life threats and doing a rapid exam of the patient history taking is getting the patient's history and will have mnemonics for this along the way the secondary assessments that is a more detailed assessment usually in route to the hospital and reassessment is going to be continually to reassess our primary and secondary assessments as we are getting closer and closer to the hospital until we transfer care to the nurse or doctor at hospital now let's break these down each one individually by section and before we get to help our patient here we first gotta ensure the scene is safe either the scene has been cleared by the police department or dispatch information shows the scene is safe for ems to enter so that is ensuring scene safety with that being said we're going to take standard precautions so we go up to the scene we have gloves we may have a mask we may have a gown depending on the information that we get on the call right now one thing on these two things next is we're going to determine which is the noi and an moi what does that mean an moi is the mechanism of injury that's a traumatic call a trauma call so if someone's in a car accident if they fail we're going to we're going to make a determination what the mechanism of injury is how did that person get injured the noi stands for the nature of illness means what is the nature why are they sick what makes the patient sick what makes them complain today that's on the medical side now don't forget you give a medical and traumatic call in one we're trying to determine that as we do our scene sign that by what do we see what's going on what's dispatch information right we've take stand precautions already talked about that the next the next two the first is determining how many patients now i think about us a lot when we're talking about motor vehicle accidents right so we go to more vehicle accident maybe three or four cars how many patients do we have and then it reminds me to say hey do we need more equipment or more people so if we have one patient and we're an ems crew we should have enough resources if we have multiple patients or if we need let's say a lift assist with this patient or we see something in the scene where we need specialized resources the fire department might have or we get unseen whoa we might need law for this this is what we talk about need more equipment or people consider getting more help now the first thing i want you to remember with the primary assessment is to expose your patient but notice this patient was wearing a hat shirt expose the patients remember that's so key especially in traumatic calls now starting the primary assessment the general impression the general impression first is when you first walk up what do we see what do we see around the patient in the scene who else is with the patient on the scene and what does the patient look like as a general impression two extreme examples an 80 year old female sitting on the couch by herself who appears to be breathing and then over here we have a 10 car motor vehicle accident with patients all over the freeway two different scenes that's general impression next we approach our patients and we're going to say hey my name is evan i'm with the ambulance what's going on or what happened today right that all works we're looking for the level of consciousness is the patient awaken alert do they only respond to verbal commands they only respond to a motor command or are they completely unresponsive when we approach right that's level of conscious now we that that with that being said with that being said if someone speaks in full senses their airway is patents they have a patent airway if you're speaking full sentences again your airway is open now here's why is there star under circulation here's why if you walk up to a patient and you see they have a major bleed externally and they're bleeding out you need to take care of that life threat first before doing anything else so you expose your patient you're going through your station you expose the patient major bleed take care of that first then go back to your airway and breathing okay that's why the star is here right so again what do i mean by airway we need to make sure the patient's airway is clear speaking of full senses great what if they're not or if they're unresponsive we have to either do a head tilt chin lift on a medical side or a draw a jaw thrust maneuver on a traumatic side to open the airway then once we open the airway we have to clear the airway so suction if needed it could be blood or vomit in the airway clear it out then we got to keep it open if they're unresponsive right so we keep it with an adjunct could be an opa it could be an npa right we want to keep it open then we gotta ventilate our patient make sure they're breathing after they're breathing right so that see how all goes together right and let's say that patient didn't have any bleeding you would assess obviously how their skin looks you expose the patient you get a pulse that's your circulation right now i want to give you a few more tips here while i'm here with breathing too with breathing look at their chest rise and fall right that's a big huge part and what is their general respiratory efforts right do we hear any abnormal sounds like strider or wheeze for example right but this is a quick rapid exam we can do this very fast see if we have an airway assess the chest how how does our breathing look and then expose and look for any major bleeds now the other thing about the rapid assessment when we're talking about trauma our first mnemonic i'm going to put it right here is d cap b t l s this mnemonic will help you when you're scanning your patients what you're looking for is any deformities contusions abrasions punctures moving on btls burns tenderness lacerations swelling you're looking for anything like that when you're doing any of your exams on a physical exam now quick rapid exam just go quick rapid looking frames life threats the key here is looking for life threats if you see a lay threat you got to treat it now once we've done that transport decision how critical is our patient right here are we going noise inside to the hospital are going license in the hospital does this patient need to be flown out right where are we at with this patient are we taking in the hospital are we not taking the hospital this is a transport decision so at this point this is all done when you first purchase the patient when we're making this transport decision the next thing we're going to is history taking right we're going to get a patient history if we can if they're awake right this can be done not always just sitting on scene getting a history while we're moving the patient let's say the stair chair or moving the patient onto the stretcher or getting them out of that austere environment we can get a history we can talk to bystanders and family that are with the patient if they're not able to get to get that history that's coming up next now there's three mnemonics memory tricks that will help you remember content and then one key fact that you need to learn to understand history taking the first one is getting a sample history so samples and mnemonic s is for signs and symptoms so what that means is what were the sign symptoms that started on the onset of you deciding to call 9-1-1 so essentially what is going on with you and what happened a does the patient have any allergies m is for medications what medications does the patient take next is going to be the past medical history so past medical history of this patient for example like diabetes high blood pressure high cholesterol anxiety asthma right l is last oral intake when was the last time the patient ate something to think about here could also be when was the last time the patient took their medications right and then the final part is e which is events leading up now next mnemonic i'm going to put on the screen right here it is o p q r s t so obq rst you can kind of investigate more about the patient's chief complaint let's say they had chest pain so the o the o stands for onset so what were you doing what happened when this first occurred at the onset right where were you where are the symptoms when did this first happen that's onset now the next op so that we're on the p is provokes does the pain get better or worse if you sit or stand or lie back does anything help or is anything make it worse or actually provoke it right that's going to be your p o p q the q is for quality so what does the pain feel like is it crushing is it stabbing is it knife like try to let the patient actually describe it don't give them is it feel crushing or knife like you're like ask him what does it feel like to you can you describe it a little more detail or something i think about is have you ever felt this way before or does this feel different that's the quality right now opqr the r is talking about radiation so this is pain go anywhere is it radiate anywhere that's your r s is severity one to ten ten is the worst pain of your life one it's barely an annoyance i barely feel it i feel weird even mentioning it five somewhere in the middle right so one to ten pain scale now the last part of the opq rst t is time so time is when about how long it's been going on for what time was it when this first started that's your time now in this section i got about history taking something important i gotta talk to you about permanent negatives so a pertinent negative what that is give an example we know that if someone is having a heart attack they may have these sign symptoms chest pain difficulty breathing some back pain knowledge of vomiting right their medical history could be like diabetes high blood pressure high cholesterol family history smoking right to name a few so if i go to a patient and let's say this patient has chest pain if i ask the patient about their chest pain and i say well you're having chest pain you're saying it's 8 out of 10. do you have a hard time breathing do you have any nausea vomiting do you have back pain are you a diabetic do you have high blood pressure do you have high cholesterol if they say no to all those things that is what we call a permanent negative meaning this patient has chest pain but they address chest pain by itself not all these other bad things that conclude that this is really bad that's good for the patients and that is to go on your documentation as well so this is now time for our secondary assessment if this patient has been emerging at this point we are in the ambulance we are on our way to hospital we are telling the hospital we're coming we're getting vital signs and we're doing a more detailed what we call secondary assessment from head to toe in this patient we exposed the patient earlier right we got our first finding to the patient now we're going to go into details so i'd like to share with you some of these details so the first thing that we're going to do here with this patient i'm just going to move them up a little bit like this there we go is we're first going to check the patient's head and we're looking for a dcap btls as we're going along right so any sign of trauma here look behind the ear do we have any battle sign behind the ear right that could be sign of a bad fracture head injury stuff like that right anything coming out of the ears we could do a pupil exam of the patient are the pupils normal are they constricted or they dilate are they equal are they unequal are they reactive right with the pupils we can go on here looking at the nose make sure everything's good there look at the cheekbones the mandible the actual mouth we can open your mouth light in the mouth right scan down to the neck feel the spine the back of the neck we can listen with our scope we have right here to our actual trachea right we can gather lung sounds on this patient right we get lung sounds back are they normal is there wheezing is there rails is a wrong guy is the chest horizon fall equal on both sides is one side absent and one side clear like a pneumothorax that would happen right we're going to palpate their abdomen we're going to examine the abdomen right we're going to move down to the pelvis we're going to scan the legs any pain in your legs we're going to scan the arms right we're going to get pulses along the way while we're doing all this then don't forget we're going to bring the patient forward and we're gonna scan the patient's entire spine on the back right so that's gonna be a quick little secondary assessment now there are so many different exams and things you can do on the secondary assessments but the main thing is is the more detailed look in your patient you're doing that during transports now the last part is reassessment so with this patient we've done a secondary assessment now what do we do continue to reassess get more vital signs blood pressure pulse sorry at your heart rate respiratory rates blood glucose capnography pulse oximetry you're going to learn about all these things right keep doing vitals keep doing a physical exam to this patient and remember if you're in the animals and transporting you've got a really critical patient you're gonna be radio patching and doing radio communication to the hospital and tell them you got a critical patient you don't just show up with a critical patient you want to warn them in advance what we call a radio patch so you'll be learning about that in class as well the first link in the description is lifetime access to my video vault if you are someone getting ready for school and you want to get a leg up on all this education you want to learn more or if you're someone in school right now you're trying to pass or if you're someone getting ready for your national registry exam at any level from responder emt advanced emt paramedic the vault includes it all it's the first link in description and you also get access to our community group to ask me questions and network with like my providers on the same journey as you it's the first link down below i will catch you in the next video take care you