Chapter 10: Patient Assessment (12th Edition)

Key Components of Patient Assessment

• Scene Size-up

  • Scene safety and management
  • Identifying hazards, violence, or environmental factors
  • Additional or specialized resources (e.g., dive team, hazmat)
  • Standard precautions and handling multiple patient situations

• Primary Assessment

  • Assess level of consciousness
  • ABCs: Airway, Breathing, Circulation
  • Identifying life threats
  • Assess vital functions and initial general impression
  • Immediate interventions for life-threatening conditions

• History Taking

  • Chief complaint determination
  • Mechanism of injury or nature of illness
  • Investigate past medical history and pertinent negatives

• Secondary Assessment

  • Rapid body scan for focused assessment on pain areas
  • Assessment of vital signs and physical examination
  • Examination of respiratory, cardiovascular, neurologic, and musculoskeletal systems
  • Use of monitoring devices (e.g., pulse oximetry)

• Reassessment

  • How and when to perform reassessment
  • Regularly reassessing vital signs and conditions

Importance of Patient Assessment

• Essential EMT skill for every patient encounter
• Mastery of assessment skills and processes is crucial

Scene Size-Up Details

• Continuous monitoring of scene safety
• Scene changes dynamically
• Evaluate conditions and potential dangers (e.g., traffic, terrain)

Primary Assessment Details

• Identification and treatment of life threats
• Consciousness and ABCs
• Determining priority of care

History Taking

• Use OPQRST and SAMPLE mnemonics
• Signs and symptoms, allergies, medications, past medical history, last oral intake, events leading to illness/injury

Secondary Assessment Techniques

• Systematic physical exam
• Use of inspection, palpation, and auscultation
• Focused assessment for non-significant injuries
• Head-to-toe assessment for major trauma

Special Considerations

• Address potential issues like physical abuse, violence, and intoxication
• Consider cultural, linguistic, and sensory challenges

Monitoring Devices and Techniques

• Pulse oximetry and capnography
• Blood sugar monitoring
• Blood pressure measurement techniques

Reassessment Strategies

• Regular intervals: every 5 minutes for unstable patients, every 15 minutes for stable ones
• Reassess vital signs, chief complaint, and interventions

Key Concepts

• Signs vs. symptoms
• Prioritizing life-threatening conditions
• Scene safety first
• Continuous reassessment and adaptation to changes

Final Thoughts

• Patient assessment is a critical and continuous process
• EMTs must adapt to the dynamic nature of emergency scenes and patient conditions

Review Questions

1. Determine all scene size-up elements except for the ratio of pediatric to adult patients.
2. Retreat and wait for law enforcement if the scene is potentially unsafe.
3. Identify life threats in the primary assessment.
4. Rapid exam for life threats after initial assessment of an unconscious patient.
5. Use AVPU for assessing consciousness.
6. Check pulse at the carotid for unresponsive patients over one year old.
7. Understand radiation in the OPQRST mnemonic.

This chapter emphasizes the importance of thorough and skilled patient assessment in various emergency scenarios, highlighting the need for EMTs to be adaptable, observant, and knowledgeable in their approach.