Emergency Care in the Streets: Chapter 11 Patient Assessment

Key Learning Objectives

• Form a field impression using scene and patient assessment findings.
• Identify components of a patient assessment process.
• Describe essential actions or steps within each component.

Importance of Patient Assessment

• Essential skill for paramedics.
• Involves assessing the scene, obtaining chief complaint, medical history, and a secondary assessment.
• Leads to a differential diagnosis and a working diagnosis.
• Should be organized, systematic, and flexible.

Sick vs. Not Sick

• Determine if the patient is sick based on several indicators:
  • Chief complaint
  • Respirations
  • Pulse
  • Mental status
  • Skin color, temperature, and condition
  • Mechanism of injury for trauma patients
• Assess if the situation is life-threatening.

Establishing the Field Impression

• Communicate with the patient effectively.
• Consider whether the issue is medical or trauma-related.
• Be flexible and ready to respond to the patient's needs.

Scene Size-Up

• Evaluate the scene for safety and stability.
• Prioritize the safety of the EMS team and responders.
• Call for additional resources if necessary.
• Utilize protective equipment as needed.

Mechanism of Injury (MOI) and Nature of Illness (NOI)

• MOI: How the injury occurred and potential severity.
• NOI: General type of illness the patient is experiencing.
• Consider additional resources for multiple patients or special conditions.

Primary Survey

• Use inspection, palpation, and auscultation techniques.
• Form a general impression of the patient within 60-90 seconds.
• Assess mental status (AVPU), airway, breathing, and circulation (ABCs).

History Taking

• Gain information about the patient's current and past medical history.
• Use effective communication techniques, including open-ended questions.
• Ensure confidentiality and understanding cultural differences.

Secondary Assessment

• Involves obtaining vital signs and performing a physical exam.
• Focus on areas related to the chief complaint.
• Utilize inspection, palpation, percussion, and auscultation techniques.

Critical Thinking and Clinical Reasoning

• Employ knowledge of anatomy, physiology, and pathophysiology.
• Develop a working and differential diagnosis.

Monitoring Devices

• Use ECG and other monitoring tools as needed.

Reassessment

• Continuous monitoring of patient status.
• Reassess every 15 minutes for stable patients, every 5 minutes for unstable patients.

Conclusion

• Comprehensive patient assessment is crucial for effective emergency care.
• Stay organized and adaptable in various scenarios.

Remember to subscribe for more screencasts from the 8th edition of the paramedic book.