EMT: Brady Emergency Care 11th Edition - Chapter 11 - Assessment of the Medical Patient

Terms Definitions
Define "medical patient."
A patient suffering from one or more medical diseases or conditions.
What is the most important source of information when assessing a medical patient?
What a medical patient can tell you, which is why unconscious medical patients present a uniquely difficult situation.
Why would the assessment of a medical patient be difficult if they've lost consciousness?
Because the most important source of information pertaining to that patient is what they can tell you.
How do you remember what questions to ask when interviewing a patient about the history of their present illness or complaint?

What's a mnemonic device for remembering what vital signs you have to take?

Blood Pressure
What's the first determination you must make when dealing with a medical patient that will dictate the course of the rest of the assessment?
Whether they're responsive or unresponsive
After your primary assessment of a responsive medical patient, what five steps do you take?
1) Take a history of the present illness

2) Take a SAMPLE history

3) Perform a focused physical exam

4) Obtain baseline vital signs

5) Administer interventions and transport
After your primary assessment of an unresponsive medical patient, what six steps do you take?
1) Rapid physical exam

2) Obtain baseline vital signs

3) Consider and call for ALS

4) History of present illness (info gathered from family, friends, bystanders, medicine cabinet, fridge, ID bracelets, etc.).

5) SAMPLE history

6) Administer interventions and transport
What does OPQRST stand for? When do you use it?
OPQRST is a mnemonic device used to remember what information to gather when asking about the history of the present illness. Besides generally asking about the chief complaint, you will want to ask about:

Onset (what were you doing when this started?)

Provocation (does anything make the pain/illness worse?)

Quality (Describe the pain for me. Is it an ache? A stabbing pain? etc.)

Radiation (Does the pain spread to other parts of your body?)

Severity (How much does it hurt on a 1-10 scale?)

Time (How long has this been going on?)
At what stage do you determine the chief complaint of a medical patient?
During the initial assessment.
How do you determine if a patient is a medical patient or a trauma patient?
Look for a mechanism of injury. If there's no mechanism of injury, the patient is a medical patient. If there is a mechanism of injury, treat the patient as a trauma case.
Define "medical patient."
A patient suffering form one or more medical diseases or conditions.
What is the key to moving from the initial assessment to the focused history and physical exam?
Determining the mechanism of injury (or lack thereof) and the chief complaint.
When you're interviewing a patient about their present illness, what two things are you trying to do?
1) Gather important information

2) Reduce patient's fear and promote cooperation
When you have a conscious, responsive patient, who should you interview first about the illness?
The patient
If the patient tells you that multiple things are bothering him, what do you do first?
Ask what's bothering him the most
What kind of questions should you ask your patient: open-ended questions, or questions that give the patient a specific choice (such as "is your pain dull or sharp?)
Ask open-ended questions to gather most of your information.

Give the patient more pointed questions if they cannot answer open-ended questions adequately.
What does SAMPLE stand for?
Pertinent past medical history
Last oral intake
Events leading up to the illness
To whom will you provide information gathered during the patient assessment?
Emergency department staff
Why is it important to gather a SAMPLE history?
This will help you determine what interventions to take on scene and during transport, and it will give you important treatment information that you can pass on to hospital staff.
When obtaining OPQRST and SAMPLE info from a child, what important changes must you make in your approach?
1) Get to eye-level with the child

2) Speak simply, with easy to understand words.

3) Obtain necessary information from parents or guardians
What three situations involving a known prior history deserve special mention because the patient may carry the treatment on his person?
1) Patient with difficulty breathing that has an inhaler

2) Patient with chest pain who has nitroglycerin

3) Patient with an allergic reaction who has an epinephrine auto-injector
How might you deal with a 79-year old woman that keeps rambling about things unrelated to the chief complaint?
Be kind, respectful, and assertive. Redirect the patient and let them know that it's very important that they answer some specific questions so you can help.
How might you deal with a 16-year-old female, surrounded by her family, with abdominal pain that could be a result of a pregnancy... but you haven't asked her yet if she's pregnant?
Speak with the patient privately. That may require sending parents on a quick errand to get some medications or medical info. You might even have to put the patient in the ambulance. Once you're in private, ask the sensitive question.
How would you get information from a 32-year-old male with diabetes, who hasn't eaten lately, that just kind of stares vacantly when you speak with him?
Get information from family. His inaction might be a result of his medical condition.
How might you get information from a 22-year-old college student that has been acting strangely for weeks, according to his roommate? He's currently sitting on his bed, rocking back and forth, mumbling.
Ensure your own safety first, then get to eye level with the patient, and try to develop a rapport and see if he's responsive. Reel him in if you can and get the pertinent info.
When in doubt...
...get the patient to the hospital
When dealing with a medical patient, what object on their person might be of great help?
A medical ID bracelet or necklace. If you find one, make sure to alert hospital staff to it during transfer of care.
Must you check a patient's pupils when they're unresponsive and their eyes are closed?
When dealing with an unresponsive medical patient and you have to decide whether or not to request ALS backup, what do you do?
You will request it.
When obtaining a SAMPLE history from bystanders due to an unresponsive patient, what six questions should you ask?
1) Patient's name

2) What happened?

3) Did the bystander see anything else?

4) Has the patient had any recent complaints leading up to the incident?

5) Does the patient have any known illnesses or problems?

6) Is the patient taking any medications?
When dealing with medical patients, what extremely important clue should you be on the lookout for?
A "Vial of Life" sticker on the main door, front window, or fridge. This will alert you to the presence of a "Vial of Life," which is a bottle or baggie with specific medical information inside it.
What's the main difference between the focused history and exam of a trauma patient and that of a medical patient?
In the case of a medical patient, the most important information will likely come straight from the patient's mouth rather than from examining the scene and the patient.
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