14 The Secondary Assessment

Multimedia Directory Slide 58 Physical Examination Techniques Video Slide 101 Trauma Patient Assessment Video Slide 148 Decision-Making Information Video Slide 152 Leadership Video Slide 153 Delegating Authority Video This video appears later in the presentation; you may want to preview it prior to class to ensure it loads and plays properly. Click on the link above in slideshow view to go directly to the slide.

Topics The Secondary Assessment Body System Examinations Secondary Assessment of the Medical Patient Secondary Assessment of the Trauma Patient Detailed Physical Exam Planning Your Time: Plan 170 minutes for this chapter. The Secondary Assessment (10 minutes) Body System Examinations (30 minutes) Secondary Assessment of the Medical Patient (30 minutes) Secondary Assessment of the Trauma Patient (20 minutes) Detailed Physical Exam (20 minutes) continued on next slide

Topics Reassessment Critical Thinking and Decision Making Planning Your Time: Reassessment (20 minutes) Critical Thinking and Decision Making (40 minutes) Core Concepts: Components of the secondary assessment How examinations are conducted History-taking techniques Physical examination techniques Body system examinations Secondary assessment of the responsive medical patient Secondary assessment of the unresponsive medical patient Secondary assessment of the trauma patient with minor injury Secondary assessment of the trauma patient with serious injury or multisystem trauma Detailed physical exam Observing trends during reassessment Reassessment for stable and for unstable patients Critical thinking concepts for the EMT

The Secondary Assessment Teaching Time: 10 minutes Teaching Tips: The secondary assessment, simply stated, is where we find out what is wrong with the patient. It is a series of examinations, both hands-on and through the patient history. You may hear this called a secondary survey or secondary examination. In most cases these mean the same thing. The secondary assessment is performed after the scene size-up and the primary assessment.

Components of the Secondary Assessment Physical examination Patient history History of the present illness (HPI) Past medical history (PMH) Vital signs Covers Objective: 14.2 continued on next slide

Components of the Secondary Assessment Sign Something you can see Symptom Something the patient tell you Reassessment is a continual process. Covers Objective: 14.2

Techniques of Assessment History-taking techniques Ask open-ended questions Use mnemonics SAMPLE OPQRST Covers Objective: 14.3 continued on next slide

Techniques of Assessment Physical examination techniques Observe Auscultate Palpate Covers Objective: 14.3

Techniques of Assessment Covers Objective: 14.3 Observe the patient for an overall sense of his condition.

Body System Examinations Teaching Time: 30 minutes Teaching Tips: The purpose of this section is to walk the students through the examination process for each body system paying particular attention to history and physical examination techniques for each.

Respiratory System The most important determination when assessing the respiratory system is whether patient is breathing adequately. Covers Objective: 14.5

Respiratory Assessment—History Obtain history of existing respiratory conditions and medications taken for each. Determine if medications have been taken as prescribed. Determine if signs and symptoms of this episode match previous episodes. Covers Objective: 14.5

Respiratory Assessment—Physical Examination Mental status Level of respiratory distress Chest wall motion Auscultate lung sounds Use pulse oximetry Observe edema Fever Covers Objective: 14.5

Cardiovascular System Heart Blood vessels Cardiac patient and patient in shock or with a vascular problem Covers Objective: 14.5

Cardiovascular System—History Existing cardiac conditions and medications Signs and symptoms of episode Description of chest pain using OPQRST Determine specific characteristics of pain Covers Objective: 14.5

Cardiovascular System—Physical Examination Look for signs condition may be severe. Obtain pulse. Obtain blood pressure. Note pulse pressure. Look for jugular vein distention (JVD). Palpate the chest. Observe posture and breathing. Covers Objective: 14.5

Nervous System Mental status Signs of dysfunction in the body Covers Objective: 14.5

Neurologic Assessment—History Determine patient's mental status. Determine patient's normal state of mental functioning. Obtain history of neurologic conditions. Note patient's speech. Covers Objective: 14.5

Neurologic Assessment—Physical Examination Perform a stroke scale. Check peripheral sensation and movement. Gently palpate the spine. Check extremity strength. Check patient's pupils for equality and reactivity. Covers Objective: 14.5

Endocrine System The most common endocrine emergency is the diabetic patient. Covers Objective: 14.5

Endocrine Assessment—History Diabetes mellitus or thyroid disease history Current medications and whether being taken properly Whether patient has eaten or exerted energy at an unusual level Whether patient is sick Whether patient has taken blood glucose or uses insulin pump Covers Objective: 14.5

Endocrine Assessment—Physical Examination Evaluate patient's mental status. Observe the patient's skin. Obtain a blood glucose level. Look for an insulin pump. Covers Objective: 14.5

Gastrointestinal System Looking for: What goes in What comes out What it looks like when it comes out Covers Objective: 14.5

Gastrointestinal Assessment—History Oral intake Pain Gastrointestinal issues Vomiting Bowel movements Covers Objective: 14.5

Gastrointestinal Assessment—Physical Examination Observe patient's position. Assess the abdomen. Inspect other parts of the gastrointestinal system. Inspect vomitus or feces if available. Covers Objective: 14.5

Immune System Allergic reaction most relevant for EMS Anaphylaxis Covers Objective: 14.5

Immune System—Patient History History of allergies If so, what are typical reactions like? Symptoms of tightness in chest or throat Medications for allergic reaction Covers Objective: 14.5

Immune System—Physical Examination Perform physical examination Inspect point of contact with allergen. Inspect patient's skin for hives. Inspect the face, lips, and mouth for swelling. Listen to lungs to assure adequate breathing. Covers Objective: 14.5

Musculoskeletal System Medical diseases in this system are rare. Bones most important aspect to assess Covers Objective: 14.5

Musculoskeletal Assessment—History Prior injuries Whether patient takes blood-thinning medication History to determine if a medical problem caused the traumatic injury Covers Objective: 14.5

Musculoskeletal Assessment—Physical Examination Inspect for signs of injury, such as deformity. Palpate areas with suspected injury. Compare sides for symmetry. Be alert for crepitation. Assess patient head-to-toe if there are multiple injuries or if the patient is unresponsive. Covers Objective: 14.5

Secondary Assessment of the Medical Patient Teaching Time: 30 minutes Teaching Tips: The aim of assessment is making a diagnosis. Teach that assessment is not merely a list of questions but rather a means to an end. Use programmed patients of different ages and cultures to add reality to patient interview practice. Create standardized skill sheets for patient history to provide students with a practice reference. Do not discount the value of physical examination in the medical patient.

Secondary Assessment of the Medical Patient Assessment varies depending on patient's ability to communicate. Responsive medical patient Focus on chief complaint. Unresponsive medical patient Focus on physical findings. Covers Objectives: 14.6 and 14.7 Knowledge Application: Prior to the lesson, brainstorm with students to define what they feel are the important elements of a patient history.

Responsive Medical Patient Take a history of present illness. Take a past medical history Perform physical exam. Obtain baseline vital signs. Administer interventions and transport the patient. Covers Objective: 14.6

Take a History of the Present Illness Obtain from patient. Obtain from family or bystanders. Ask open-ended questions. Covers Objective: 14.10 Point to Emphasize: Speaking to a medical patient often provides important assessment information. Discussion Question: Describe the procedure for establishing the history of the present illness in a medical patient. continued continued on next slide

Take a History of the Present Illness Chief complaint Why patient activated EMS What is bothering patient most Covers Objective: 14.10 Point to Emphasize: Use the history of the present illness to expand upon the chief complaint. continued on next slide

Take a History of the Present Illness Onset What were you doing when the pain started? Provocation Does anything trigger pain? Quality Describe the pain. Covers Objective: 14.10 Points to Emphasize: Use OPQRST to standardize details. The chief complaint and the history of the present illness will help focus the physical examination of the conscious medical patient. Discussion Topic: Define and describe OPQRST. continued on next slide

Take a History of the Present Illness Region, Relief Where is pain? Does it seem to spread or shoot anywhere? Severity How bad is pain? (1–10 scale) Time When did pain start? Covers Objective: 14.10 Points to Emphasize: Use OPQRST to standardize details. The chief complaint and the history of the present illness will help focus the physical examination of the conscious medical patient. Discussion Topic: Define and describe OPQRST.

Take a Past Medical History Symptoms Allergies Medications Pertinent past history Last oral intake Events leading to illness Covers Objective: 14.11 Point to Emphasize: SAMPLE is a mnemonic used in discussing patient history. Discussion Questions: Define and describe SAMPLE. Knowledge Application: Have each student complete a SAMPLE history on the student beside him.

Tailoring the Physical Exam for Specific Chief Complaints Important information can be gained by tailoring history to patient's chief complaint. Ask questions pertinent to chief complaint Body systems approach Focus questioning and examination on particular body system most likely involved. Covers Objective: 14.11

Pediatric Note Get on same level with child. Put questions in simple language. Gather information from caregivers. Covers Objective: 14.11

Perform a Physical Exam Usually brief Examine areas of concern based on chief complaint. Covers Objective: 14.3 Discussion Topic: Describe the assessment of a conscious and responsive medical patient. Class Activity: Take a field trip. Visit a local nursing home and practice the assessment of a conscious medical patient with residents there.

Perform a Physical Exam Covers Objective: 14.3 Discussion Topic: Describe the assessment of a conscious and responsive medical patient. Class Activity: Take a field trip. Visit a local nursing home and practice the assessment of a conscious medical patient with residents there. Auscultate to listen for the presence and absence of lung sounds.

Obtain Baseline Vital Signs Essential to assessment of medical patient Later assessments of vital signs will be compared to baseline. Covers Objective: 14.3

Administer Interventions and Transport the Patient Remember a decision for prompt transportation of critical patients or those with specific complaints is part of a treatment plan. Covers Objective: 14.4

Think About It Where would you focus your physical examination on a patient complaining of shortness of breath? Covers Objective: 14.6 Talking Points: You would focus on the chest and the respiratory system in general. Look at the chest. Listen to lung sounds. Palpate the chest looking for abnormalities.

Unresponsive Medical Patient Begin with physical exam and baseline vital signs Then gather history from bystanders or family members Do rapid assessment of entire body Covers Objective: 14.7 Point to Emphasize: In an unresponsive medical patient, physical findings and vital signs will guide the patient assessment. Class Activity: Give students a variety of written medical scenarios as homework. Have them consider the findings and detail the appropriate assessment strategies. Critical Thinking: In what ways might the assessment of an unconscious medical patient be similar to the assessment of a patient who does not speak your native language?

Perform a Rapid Physical Exam Similar to head-to-toe physical exam for trauma patient Assess head, neck, chest, abdomen, pelvis, extremities, and posterior. Covers Objective: 14.7 continued on next slide

Perform a Rapid Physical Exam Neck Jugular vein distention, medical identification devices Chest Breath sounds Abdomen Distention, firmness or rigidity Covers Objective: 14.7 continued on next slide

Perform a Rapid Physical Exam Pelvis Incontinence of urine or feces Extremities Pulse, motor function, sensation, oxygen saturation, medical identification devices Check for Medical ID devices. Check pupils. Covers Objective: 14.7

Obtain Baseline Vital Signs Assess: Pulse Respirations Skin Pupils Blood pressure Take note of any abnormalities. Covers Objective: 14.7

Consider a Request for ALS Personnel Obtain baseline vital signs. Consider a request for ALS personnel. Depends on geographic options, types of facility available Covers Objective: 14.7

Take a History of Present Illness and a Past Medical History Question bystanders What is the patient's name? What happened? Did you see anything else? Did the patient complain before this happened? Does patient have any known illnesses or problems? Is the patient taking any medications? Covers Objective: 14.7 Discussion Topics: Describe the assessment of an unresponsive medical patient. Discuss how assessment of an unresponsive medical patient will differ from assessment of a responsive medical patient. Class Activity: Assign each student a medical scenario. Ask the student to determine which medical assessment strategy would be most appropriate. Knowledge Application: Divide the class into small groups. Use programmed patients to present a variety of assessment scenarios. Discuss assessment strategies.

Administer Interventions and Transport Patient Look for mechanism of injury or signs that suggest a spine injury. If needed, immobilize the patient's spine.

Think About It What other mechanisms might you have to obtain patient history other than speaking to bystanders? Covers Objective: 14.7 Talking Points: Consider contacting the patient's family. Review the patient's medications. Review the scene for additional clues such as medical devices.

Think About It Covers Objective: 14.7 Talking Points: Consider contacting the patient's family. Review the patient's medications. Review the scene for additional clues such as medical devices. MEDICAL HISTORY. Interview family and bystanders for information about the present illness (OPQRST) and also the SAMPLE history

Physical Examination Techniques Video Covers Objective: 14.3 Video Clip Physical Examination Techniques: Inspection, Palpation, Auscultation, and Percussion What physical examination techniques should an EMT utilize? Why should an EMT inspect an area before palpating it? List possible findings that an EMT may discover during palpation. What areas of the body should an EMT auscultate? Explain how to perform percussion. Click on the screenshot to view a video on the subject of physical examination techniques. Back to Directory

Mid-Chapter Review The secondary assessment of the medical patient takes two forms, depending on whether the patient is or is not responsive. continued on next slide

Mid-Chapter Review You assess the responsive patient by getting a history of the present illness and a past medical history then performing a physical exam of affected parts of the body before getting baseline vital signs. continued on next slide

Mid-Chapter Review Since unresponsive medical patients cannot communicate, it is appropriate to start the assessment with a rapid physical exam. Baseline vital signs come next; then you interview bystanders, family, and friends to get any history that can be obtained. continued on next slide

Mid-Chapter Review You may not change any field treatment as a result of the information gathered here, but the results of the assessment may be very important to the emergency department staff.

Secondary Assessment of the Trauma Patient Teaching Time: 20 minutes Teaching Tips: Build on previous lessons. Link secondary assessment to scene size-up and primary assessment. Use a standardized skill sheet to give students a frame of reference from which to work from. Initially, keep scenarios standardized. As students progress, add realistic twists. Use a programmed patient or anatomical model to demonstrate assessment technique. Describe realistic situations when discussing assessment decision making. Realism will improve critical thinking. Students will frequently attempt to verbalize elements of an assessment. Make students actually perform steps to promote muscle memory. Be sure to differentiate the rapid trauma assessment from the detailed assessment. Speed is essential in the rapid trauma assessment and students often become mired in detail. Use specific detail when discussing physical examination. Be careful of relying too much upon DCAP-BTLS. Make sure students have examples of what they are really looking for. Use video graphics to demonstrate mechanism of injury and discuss how these observations might impact assessment decision making.

Secondary Assessment of the Trauma Patient Injuries can range from slight to severe. To determine how serious an injury is consider: Location of injury or injuries on patient Patient's mental status Covers Objectives: 14.8 and 14.9 Points to Emphasize: The primary assessment evaluation and treatment must be completed before the secondary assessment. The secondary assessment of a trauma patient will be driven primarily by the mechanism of injury. EMTs generally assume spinal injury in the assessment of a trauma patient. Talking Points: Enough time must be spent at the scene to adequately assess the patient and give proper emergency care. If the mechanism of injury (MOI) is significant, you will do the focused history and physical exam differently than if the mechanism of injury is not significant. continued on next slide

Secondary Assessment of the Trauma Patient To determine how serious an injury is consider: Patient's airway status Vital signs Mechanism of injury Patient's age or preexisting conditions Covers Objectives: 14.8 and 14.9 Points to Emphasize: The primary assessment evaluation and treatment must be completed before the secondary assessment. The secondary assessment of a trauma patient will be driven primarily by the mechanism of injury. EMTs generally assume spinal injury in the assessment of a trauma patient. Talking Points: Enough time must be spent at the scene to adequately assess the patient and give proper emergency care. If the mechanism of injury (MOI) is significant, you will do the focused history and physical exam differently than if the mechanism of injury is not significant.

Trauma Patient with Minor Injury/Low Priority Assessment is focused on areas patient notes are painful or that mechanism of injury (MOI) indicates. Determine the chief complaint Conduct a history of present illness to gain information on how injury occurred Covers Objective: 14.8 Point to Emphasize: Although it is important to consider mechanism OF injury, a better way to look at this is to consider mechanism OR injury, because not just the mechanism of injury but also actual injuries to the patient must be assessed in forming a complete evaluation of the severity or potential severity of the patient's condition. In a trauma patient with no significant mechanism of injury, the secondary exam will focus on areas identified in the chief complaint and by the mechanism of injury.

Determine the Chief Complaint What the patient tells you is the matter Covers Objective: 14.8 Point to Emphasize: Although it is important to consider mechanism OF injury, a better way to look at this is to consider mechanism OR injury, because not just the mechanism of injury but also actual injuries to the patient must be assessed in forming a complete evaluation of the severity or potential severity of the patient's condition. In a trauma patient with no significant mechanism of injury, the secondary exam will focus on areas identified in the chief complaint and by the mechanism of injury.

Conduct a History of the Present Illness Nature of force involved Direction and strength of force Protective equipment used by patient Actions taken to prevent or minimize injury Areas of pain and injuries resulting from incident Covers Objective: 14.10 Point to Emphasize: When getting the history of the present illness for a trauma patient, gather information on how the injury occurred in addition to relevant details. This information typically includes the nature of the force involved; the direction and strength of the force; equipment used to protect the patient; actions taken to prevent or minimize injury and areas of pain and injuries resulting from the incident. Discussion Topic: Describe the key elements of a history of the present illness with regard to a trauma patient. What are the important questions to consider? Knowledge Application: Practice taking patient histories. Hand out prewritten scripts to students and have their colleagues perform histories. Practice asking the appropriate questions.

Physical Examination Areas assessed depend on injuries and chief complaint. Mechanism of injury may point to potential injuries. Three techniques: observation, palpation, and auscultation Covers Objective: 14.8 Point to Emphasize: When performing a physical exam, your decision on which areas of a patient's body to assess will depend partly on what you can see and what the patient tells you (the chief complaint). Mechanism of injury must also be considered. Discussion Topic: Describe what criteria you would use to determine the area of focus when performing a physical exam.

Physical Examination Covers Objective: 14.8 Point to Emphasize: When performing a physical exam, your decision on which areas of a patient's body to assess will depend partly on what you can see and what the patient tells you (the chief complaint). Mechanism of injury must also be considered. Discussion Topic: Describe what criteria you would use to determine the area of focus when performing a physical exam. PERFORM A PHYSICAL EXAMINATION OF THE RELEVANT BODY SYSTEMS. Respiratory, Cardiovascular, Neurologic, Endocrine, Gastrointestinal, Reproductive, Genitourinary.

Physical Examination Observe for: Abnormalities in symmetry Color Shape Movement Covers Objective: 14.8 Point to Emphasize: There are three techniques of physical examination that an EMT must master: observe, palpation, and auscultation. continued on next slide

Physical Examination Palpate for: Abnormalities in shape Temperature Texture Sensation Covers Objective: 14.8 continued on next slide

Physical Examination Auscultate for: Decreased or absent breath sounds Covers Objective: 14.8 Discussion Topics: Describe the assessment of an unresponsive trauma patient. Define the three key elements of physical examination: auscultation, inspection, and palpation. continued on next slide

Physical Examination DCAP-BTLS Deformities Contusions Abrasions Punctures and penetrations Burns Tenderness Lacerations Swelling Covers Objective: 14.8 Point to Emphasize: DCAP-BTLS is a memory aid that is used when performing the physical examination. It stands for deformities, contusions, abrasions, punctures and penetrations, burns, tenderness, lacerations, and swelling. Discussion Topic: Define the elements of DCAP-BTLS.

Obtain Baseline Vital Signs and a Past Medical History After physical exam is conducted on a trauma patient, then assess his baseline vital signs and take a past medical history. Use SAMPLE and other pertinent questions when examining the patient. Covers Objective: 14.8 Knowledge Applications: Use multimedia graphics to illustrate various mechanisms of injury. Present scenarios and have the class discuss the type of secondary assessment that they would use in each case. Prepare the students for practical sessions with a written exercise. Have students write out and practice the steps of the secondary exam. continued on next slide

Obtain Baseline Vital Signs and a Past Medical History SAMPLE Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to injury or illness Covers Objectives: 14.8 and 14.9 Discussion Topic: Define the elements of SAMPLE.

Applying a Cervical Collar Apply if MOI, history, or signs and symptoms indicate use. Make sure collar is correct size. Covers Objective: 14.3 Point to Emphasize: Apply a cervical collar to any patient who may have an injury to the spine based on mechanism of injury, history, or signs and symptoms.

Sizing a Cervical Collar: 1. Measure the patient's neck. Apply Cervical Collar Covers Objective: 14.3 Point to Emphasize: Apply a cervical collar to any patient who may have an injury to the spine based on mechanism of injury, history, or signs and symptoms. Sizing a Cervical Collar: 1. Measure the patient's neck.

Apply Cervical Collar Covers Objective: 14.3 Point to Emphasize: Apply a cervical collar to any patient who may have an injury to the spine based on mechanism of injury, history, or signs and symptoms. Sizing a Cervical Collar: 2. Measure the collar. The chin piece should not lift the patient's chin and hyperextend the neck. Make sure the collar is not too small or tight, which would make the collar act as a constricting band.

Applying a Cervical Collar Assess patient's neck prior to placing collar. Reassure patient. Size collar. Remove jewelry and move hair. Keep patient's head in the in-line anatomical position. Slide collar into place from front. Covers Objective: 14.3

Applying an Adjustable Collar to a Seated Patient Apply Cervical Collar Covers Objective: 14.3 Applying an Adjustable Collar to a Seated Patient continued

Applying a Cervical Collar Collar alone does not provide adequate in-line immobilization. Must be paired with manual stabilization or fixation to long board. Covers Objective: 14.3 Discussion Topics: Describe the assessment of a trauma patient with no significant mechanism of injury. Describe the role of spinal immobilization during assessment of the trauma patient.

Trauma Patient with Serious Injury or Multisystem Trauma/High Priority Continue spinal stabilization Consider a request for Advanced Life Support (ALS) personnel Covers Objective: 14.9 Point to Emphasize: In a trauma patient with a significant mechanism of injury, a rapid trauma exam will provide a more expedited physical exam in anticipation of rapid transport. Additionally, there are additional steps that you will need to perform on a patient with a significant mechanism of injury compared to the steps for the patient with no significant mechanism of injury.

Secondary Assessment: Trauma Patient with Significant Injury Covers Objective: 14.9 Point to Emphasize: In a trauma patient with a significant mechanism of injury, a rapid trauma exam will provide a more expedited physical exam in anticipation of rapid transport. Additionally, there are additional steps that you will need to perform on a patient with a significant mechanism of injury compared to the steps for the patient with no significant mechanism of injury. RAPID TRAUMA ASSESSMENT: Rapidly assess each part of the body. HEAD: Check for wounds, tenderness, and deformities plus crepitation.

Perform a Rapid Trauma Assessment Requires only a few moments Should be performed at scene Care provided en route will be based on this assessment. Covers Objective: 14.9 Point to Emphasize: Although the mechanism of injury can provide a lot of information about the kinds of injuries a patient may have, there is still the possibility that patients will have "hidden injuries." continued on next slide

Perform a Rapid Trauma Assessment Rapid assessment of the head Palpate cranium, face, ears, eyes, nose, and mouth Blood or clear fluid are serious findings. Rapid assessment of the neck Wounds, tenderness, deformities, and jugular vein distention Stoma or tracheostomy Covers Objective: 14.9 Knowledge Application: Use manikins to practice rapid trauma assessments. Coach this session well and have a keen eye for time. Do not let students turn rapid trauma assessments into detailed assessments.

Assessing Chest and Abdomen Covers Objective: 14.9 RAPID TRAUMA ASSESSMENT: Rapidly assess each part of the body. CHEST: Auscultate for breath sounds (presence, absence, and equality).

Assessing the Chest Covers Objective: 14.9 RAPID TRAUMA ASSESSMENT: Rapidly assess each part of the body. CHEST: Inspect and palpate for wounds, tenderness, and deformities plus crepitation and paradoxical motion.

Perform a Rapid Trauma Assessment Application of a cervical collar Size and apply if indicated by protocols Rapid assessment of the chest Paradoxical motion, crepitation, and breath sounds Rib cage and chest must be exposed. Covers Objective: 14.9 Knowledge Application: Use manikins to practice rapid trauma assessments. Coach this session well and have a keen eye for time. Do not let students turn rapid trauma assessments into detailed assessments. continued on next slide

Perform a Rapid Trauma Assessment Rapid assessment of the abdomen Distention, pulsating mass Gently press down on quadrants. Rapid assessment of the pelvis Bleeding Priapism Rapid assessment of the extremities Tenderness, deformities, circulation, sensation, and motor function Covers Objective: 14.9 Knowledge Application: Use manikins to practice rapid trauma assessments. Coach this session well and have a keen eye for time. Do not let students turn rapid trauma assessments into detailed assessments.

Assessing the Abdomen Covers Objective: 14.9 RAPID TRAUMA ASSESSMENT: Rapidly assess each part of the body. ABDOMEN: Check for wounds, tenderness, and deformities plus firm, soft, and distended areas.

Perform a Rapid Trauma Assessment Rapid assessment of the posterior body and immobilization on a backboard Roll patient on side, then assess When you roll the patient into a supine position, they will be on the backboard. Obtain baseline vital signs and past medical history Use pulse oximeter if applicable Covers Objective: 14.9 Knowledge Application: Use manikins to practice rapid trauma assessments. Coach this session well and have a keen eye for time. Do not let students turn rapid trauma assessments into detailed assessments.

Posterior/Back Covers Objective: 14.9 Discussion Topic: Describe the assessment of a trauma patient with a significant mechanism of injury. Class Activity: Assign each student a trauma scenario. Ask the student to determine which type of secondary assessment would be most appropriate under the circumstances. Have students write out the steps of their assessment. Have them work on the assessment at home and report on their conclusions in class. Knowledge Application: Describe significant trauma situations and discuss the role of ALS. Consider local challenges and protocols for obtaining advanced care. RAPID TRAUMA ASSESSMENT: Rapidly assess each part of the body. POSTERIOR: Check for wounds, tenderness, and deformities. (To examine posterior, roll patient using spinal precautions.)

Some General Principles Communicate with patient. Expose injured area before examining it. Maintain eye contact. Assume spinal injury. Stop or alter assessment process to provide care. Covers Objective: 14.9 Talking Points: Respect cultural modesties and differences as you lay hands on a patient. Be sensitive to their feelings and misgivings. Communicate. Class Activity: Use SAMPLE or DCAP-BTLS as a take home assignment. Have students perform assessments and report back their findings using the above listed acronyms. Knowledge Application: Use programmed patients and moulage. Have students practice both assessment decisions and the actual assessments.

Assess Distal Circulation, Sensation, Motor Function Covers Objective: 14.9 Critical Thinking: You are treating a trauma patient approximately three blocks away from the hospital, and you find yourself needing to maintain his airway. How will you complete the secondary assessment of this patient? 1. Assess distal circulation in the upper extremities by feeling for radial pulses.

Assess Distal Circulation, Sensation, Motor Function Covers Objective: 14.9 Critical Thinking: You are treating a trauma patient approximately three blocks away from the hospital, and you find yourself needing to maintain his airway. How will you complete the secondary assessment of this patient? 2. Assess distal motor function by checking the patient's ability to move both hands.

Assess Distal Circulation, Sensation, Motor Function Covers Objective: 14.9 Critical Thinking: You are treating a trauma patient approximately three blocks away from the hospital, and you find yourself needing to maintain his airway. How will you complete the secondary assessment of this patient? 3. Assess strength in the hands by asking the patient to squeeze your fingers.

Assess Distal Circulation, Sensation, Motor Function Covers Objective: 14.9 Critical Thinking: You are treating a trauma patient approximately three blocks away from the hospital, and you find yourself needing to maintain his airway. How will you complete the secondary assessment of this patient? 5. Check distal circulation in the lower extremities by feeling the posterior tibial pulse just behind the medial malleolus of the ankle.

Pediatric Note Lesser mechanisms can cause significant damage. Explain assessments more thoroughly in this population. Covers Objective: 14.9 Knowledge Application: Use pediatric manikins or actual children to practice assessment. Discuss how the approach differs from that of an adult.

Think About It What criteria would you use to decide whether to perform a focused physical exam or a rapid trauma exam? Covers Objective: 14.14 Talking Points: A focused physical exam is used for patients with no significant mechanism of injury. A rapid trauma exam is used for severely injured patients, patients who are unable to communicate with providers, or patients with a significant mechanism of injury.

Trauma Patient Assessment Video Covers Objective: 14.9 Video Clip Trauma Patient Assessment What Standard Precautions must the EMT take when assessing a trauma patient? What is the role of the EMT in assessing and managing a trauma patient? Click on the screenshot to view a video on the subject of managing treatment of a trauma patient. Back to Directory

Detailed Physical Exam Teaching Time: 20 minutes Teaching Tips: Use a standardized skill sheet to give students a frame of reference from which to work. Use a programmed patient or anatomical model to demonstrate assessment technique. Use real-world examples and "war stories" to point out the importance of finding subtle injuries. Emphasize a "hands on" approach. This lesson is easy to verbalize; however, a good detailed assessment requires actual contact with the patient.

Detailed Physical Exam Typically completed en route to hospital Gathers additional information Complements primary and secondary assessments Performed after all critical interventions completed Primary assessment re-evaluated again before initiating Covers Objective: 14.2 Points to Emphasize: Performing a detailed physical exam is always a lower priority than addressing life-threatening problems. The purpose of the detailed physical exam is to gather additional information about the patient's injuries that was not found in the primary or secondary assessments. Talking Points: It is reasonable to defer the detailed exam for critical intervention. Frequently this will mean that a detailed exam does not get initiated before arrival at the ED. This is acceptable. However, when possible the detailed assessment should be completed as it may identify problems not found in the less detailed rapid trauma exam. Discussion Topics: Describe the components of a detailed assessment. Considering the overall patient assessment, discuss when a detailed assessment would be utilized. Knowledge Application: Have students work in groups. Assign each group a trauma scenario and a specific type of patient. Have the groups discuss how and when they would conduct their detailed assessments.

Trauma Patient with a Significant Injury For these patients, you will have assessed almost the entire body during the rapid trauma assessment. Now need to assess the entire body more thoroughly to possibly reveal signs or symptoms of injury you may have missed or have changed since the rapid trauma assessment. Covers Objective: 14.2 Points to Emphasize: The detailed assessment is similar to the rapid trauma assessment but is conducted with a higher level of scrutiny. The more severe the mechanism of injury, the higher the requirement to search for subtle injuries (if time and patient status allow). Discussion Topic: Compare and contrast the detailed assessment and the rapid trauma assessment. How are they similar? How are they different? Class Activity: Have students write out a detailed assessment. Assign homework to list the components of a detailed assessment. Ask students to attempt to list from memory first and then to correct, using resources. Knowledge Applications: Assign detailed assessments as homework. Have students complete standardized skill sheets at home. Assign five detailed assessments to be completed prior to the next session. Have students work in groups. Assign each group a region of the body; then have the groups discuss the potential traumatic findings associated with a detailed assessment. Critical Thinking: What findings might you look for in the detailed assessment of a trauma patient?

Before Beginning the Detailed Physical Exam Remember to perform this only after you have performed all critical interventions. If you are treating a severely injured patient and are too busy to complete the detailed exam, it is not a failure. It is your responsibility to give the patient the best care possible, which may mean skipping the exam in order to maintain ABCs. Covers Objective: 14.2 Points to Emphasize: The detailed assessment is similar to the rapid trauma assessment but is conducted with a higher level of scrutiny. The more severe the mechanism of injury, the higher the requirement to search for subtle injuries (if time and patient status allow). Discussion Topic: Compare and contrast the detailed assessment and the rapid trauma assessment. How are they similar? How are they different? Class Activity: Have students write out a detailed assessment. Assign homework to list the components of a detailed assessment. Ask students to attempt to list from memory first and then to correct, using resources. Knowledge Applications: Assign detailed assessments as homework. Have students complete standardized skill sheets at home. Assign five detailed assessments to be completed prior to the next session. Have students work in groups. Assign each group a region of the body; then have the groups discuss the potential traumatic findings associated with a detailed assessment. Critical Thinking: What findings might you look for in the detailed assessment of a trauma patient?

Performing the Detailed Physical Exam Expose patient. Work around immobilization equipment. Components similar to rapid trauma exam More detail and focus Covers Objective: 14.2

Trauma Patient Who Is Not Seriously Injured Generally does not need a detailed physical exam Keep a high index of suspicion, and when in doubt perform a detailed physical exam. Be aware of patient's fear and need for emotional support. Covers Objective: 14.2

Think About It Is it necessary to always complete a detailed assessment on a trauma patient with no significant mechanism or injury? Covers Objective: 14.13 Talking Points: This is a difficult question. Although it may not be absolutely necessary, you must assure that all the elements of a detailed assessment can be addressed. This may mean communicating with the conscious patient or it may mean actually completing a detailed assessment. Each situation must be judged individually and this decision depends greatly upon your confidence level and the patient's ability to communicate problems.

Mid-Chapter Review The patient without a significant mechanism of injury receives a history of the present illness and physical exam focused on areas that the patient complains about and areas that you think may be injured based on the mechanism of injury. Next gather a set of baseline vital signs and a past medical history. continued on next slide

Mid-Chapter Review For the patient with a significant injury or MOI, ensure continued manual stabilization of the head and neck, consider whether to call Advanced Life Support personnel (if available), get a brief history of the present illness, and perform a rapid trauma assessment. continued on next slide

Mid-Chapter Review In the rapid trauma assessment, look for wounds, tenderness, and deformities, plus certain additional signs appropriate to the part being assessed (as summarized in Table 14-8). Systematically examine the head, neck, chest, abdomen, pelvis, extremities, and posterior body. continued on next slide

Mid-Chapter Review After assessing the neck, apply a cervical collar. After completing the physical assessment, immobilize the patient to a spine board and get a baseline set of vital signs and a past medical history. continued on next slide

Mid-Chapter Review After you have performed the appropriate critical interventions and begun transport, the patient may receive a detailed physical exam en route to the hospital. continued on next slide

Mid-Chapter Review The detailed physical exam is very similar to the rapid trauma assessment, but there is time to be more thorough in the assessment. The detailed physical exam does not take place before transport unless transport is delayed. continued on next slide

Mid-Chapter Review The detailed physical exam is most appropriate for the trauma patient who is unresponsive or has a significant injury or unknown MOI. A responsive trauma patient with no significant injury or MOI will seldom require a detailed physical exam.

Reassessment Teaching Time: 20 minutes Teaching Tips: Continue to build upon the larger assessment lesson. Present reassessment in the context of the previous lessons. Use real-life scenarios and "war stories" to link the need for reassessment to actual situations and consequences. This lesson lends itself well to multimedia presentations. Display images of patient decline over time.

Reassessment Continues on initial steps of assessment Identifies changes and trends Must never be skipped except when lifesaving interventions prevent you from doing it Covers Objective: 14.12 continued on next slide

Reassessment Identifies Changes Trends Deterioration Improvement Subtle and profound Trends Deterioration Improvement Covers Objective: 14.12 Point to Emphasize: Patient status can change rapidly. It is important to continue the patient assessment to identify potential changes. continued on next slide

Reassessment Communicate with the patient. Explain process. Consider patient's feelings, such as anxiety or embarrassment. Covers Objective: 14.4

Components of Reassessment Repeat the primary assessment Recheck for life-threatening problems Reassess mental status. Maintain open airway. Monitor breathing for rate and quality. Reassess pulse for rate and quality. Monitor skin color and temperature. Reestablish patient priorities. Covers Objective: 14.12 Point to Emphasize: Reassessment includes repeating the following: the primary assessment, vital signs, pertinent parts of the patient history, pertinent parts of the physical examination. Discussion Topics: Describe the necessary elements of a thorough reassessment. How might elements of the primary assessment change over time? Class Activity: Provide a patient scenario to the class. As a homework assignment, ask students to write out a detailed reassessment plan.

Pediatric Note The mental status of an unresponsive child or infant can be checked by shouting (verbal stimulus) or flicking the feet (painful stimulus). Crying is an expected response from a child with adequate mental status.

Components of Reassessment Reassess and record vital signs Compare results with baseline measurements. Reevaluate oxygen saturation. Document findings to record and identify trends. Covers Objective: 14.12

Think About It Think of an example of a problem that might develop into a life threat to the patient on the way to the hospital. Covers Objective: 14.12 Talking Point: Discuss with the class the responses the students come up with.

Components of Reassessment Repeat pertinent parts of the history and physical exam Chief complaint may change, especially with regard to severity. Ask about changes in symptoms, especially ones anticipated because of treatments administered. Covers Objective: 14.12 Point to Emphasize: Readdressing the chief complaint, patient history, and physical exam will help the EMT to identify changes that have occurred since initial contact. Discussion Topic: Discuss how readdressing chief complaint and patient history may make an assessment more accurate. Knowledge Application: Work in small groups with programmed patients. Give each group a scenario involving a rapidly declining patient and then discuss reassessment strategies. continued on next slide

Components of Reassessment Repeat pertinent parts of the history and physical exam Repeat physical exam to identify changes from baseline. Check any interventions. Covers Objective: 14.12 Point to Emphasize: Readdressing the chief complaint, patient history, and physical exam will help the EMT to identify changes that have occurred since initial contact. Discussion Topic: Discuss how readdressing chief complaint and patient history may make an assessment more accurate. Knowledge Application: Work in small groups with programmed patients. Give each group a scenario involving a rapidly declining patient and then discuss reassessment strategies. continued on next slide

Components of Reassessment Check interventions Ensure adequacy of oxygen delivery and artificial ventilation. Ensure management of bleeding. Ensure adequacy of other interventions. Covers Objective: 14.12

Check Interventions Covers Objective: 14.12 4. Check interventions.

Think About It Describe an example of an intervention that might need to be reevaluated and discuss your process for examining it. Covers Objective: 14.12 Talking Points: Oxygen administration requires reevaluation. The fact that you put the patient on oxygen initially does not prevent the tank from running out later, or the tubing from becoming kinked or disconnected. Check the entire path of the oxygen from the tank to the patient. Look at the regulator and confirm that it has sufficient oxygen. Make sure that the tube is firmly connected to the regulator. Follow the tubing and make sure there are no kinks that would prevent the flow of oxygen. Look at the mask. Assure proper fit and flow rate.

Observing Trends Repeat reassessment steps frequently. Establish and document trends. Trending Observing patterns that have emerged among vital signs Trends may indicate new treatments or adjustments to ongoing treatments. Covers Objective: 14.12 Point to Emphasize: Reassessment also will help the EMT to identify trends that can point to improvement or decline in patient status.

2. Reassess and record vital signs. Observing Trends Covers Objective: 14.12 Point to Emphasize: Reassessment also will help the EMT to identify trends that can point to improvement or decline in patient status. 2. Reassess and record vital signs.

Reassessment for Stable and Unstable Patients Patient's condition, as well as length of time with patient, will determine how often you reassess. The more serious patient's condition, the more often you will reassess. Covers Objective: 14.13 Discussion Topics: Describe how the technique of reassessment might vary between a stable patient and an unstable patient. Discuss how the technique of reassessment might vary between a medical patient and a trauma patient. Class Activity: Apply this lesson to the primary assessment. Describe a critical patient and discuss how primary assessment treatments will need to be reevaluated. Knowledge Application: Create a mock call. Group students into response teams and use programmed patients. Ask students to assess a patient from start to finish. continued on next slide

Reassessment for Stable and Unstable Patients When to reassess Every 15 minutes for stable patient Every 5 minutes for unstable or potentially unstable patient If you believe there may have been a change in patient's condition, repeat at least primary assessment. Covers Objective: 14.13 Discussion Topic: Have students work backward. Discuss a patient who has gotten worse. Discuss how reassessment findings could have predicted the deterioration. Knowledge Application: As a take-home assignment, give students specific pathologies. Ask them to research and report on ways in which the developing pathology might alter the chief complaint and/or the physical examination over time.

Mid-Chapter Review Reassessment is the last step in your patient assessment. You should reassess a stable patient at least every 15 minutes and an unstable patient at least every 5 minutes. continued on next slide

Mid-Chapter Review Elements of reassessment include repeating the primary assessment, repeating and recording vital signs, repeating pertinent parts of the history and physical exam, and checking the interventions you performed for the patient. continued on next slide

Mid-Chapter Review Interventions you need to check include oxygen, bleeding, spine immobilization, and splints.

Critical Thinking and Decision Making Teaching Time: 10 minutes Teaching Tips: Break old assumptions. EMTs do diagnose. Critical thinking is an essential tool for the EMS provider. Make judgment and critical thinking an ongoing part of your course. When practicing scenarios (in any lesson), add elements of critical thinking and decision making.

EMT Diagnosis and Critical Thinking Diagnosis is label for condition. Based on history, physical examination, vital signs Involves both physical and intellectual activity Covers Objective: 14.14 Points to Emphasize: A diagnosis is the conclusion that the EMT reaches, after assessing a patient, about the nature of the patient's condition. Critical thinking is an analytical process that can help to solve problems in an organized and efficient manner. EMTs must use critical thinking to arrive at a diagnosis. Talking Points: Diagnosis for the EMT is called "presumptive diagnosis," "field diagnosis," or "working diagnosis." It can be difficult to differentiate between all the information received; therefore the EMT must simultaneously use critical thinking to determine what information is pertinent. Discussion Topics: Define diagnosis. Discuss what is meant by critical thinking. Describe its role in EMS. Class Activity: Hand out a patient scenario that includes signs and symptoms and assessment findings. Have students develop a diagnosis and defend their conclusions. Knowledge Application: Have a class discussion on critical thinking. Brainstorm important elements of critical thinking and discuss how they relate to making a diagnosis. Critical Thinking: Some say EMTs cannot diagnose. Discuss why their arguments might or might not be true.

EMT Diagnosis and Critical Thinking Covers Objective: 14.14 Points to Emphasize: A diagnosis is the conclusion that the EMT reaches, after assessing a patient, about the nature of the patient's condition. Critical thinking is an analytical process that can help to solve problems in an organized and efficient manner. EMTs must use critical thinking to arrive at a diagnosis. Talking Points: Diagnosis for the EMT is called "presumptive diagnosis," "field diagnosis," or "working diagnosis." It can be difficult to differentiate between all the information received; therefore the EMT must simultaneously use critical thinking to determine what information is pertinent. Discussion Topics: Define diagnosis. Discuss what is meant by critical thinking. Describe its role in EMS. Class Activity: Hand out a patient scenario that includes signs and symptoms and assessment findings. Have students develop a diagnosis and defend their conclusions. Knowledge Application: Have a class discussion on critical thinking. Brainstorm important elements of critical thinking and discuss how they relate to making a diagnosis. Critical Thinking: Some say EMTs cannot diagnose. Discuss why their arguments might or might not be true. The traditional approach to reaching a diagnosis includes interviewing the patient in the controlled environment of a clinic or office.

How a Clinician Reaches a Diagnosis Clinicians have different levels of training, experience, time, technology and other resources. Techniques vary among types of clinicians. Covers Objective: 14.14 Talking Points: The first steps are to gather information, consider possibilities, and reach a conclusion. How these steps are implemented varies significantly among traditional clinicians, emergency medicine clinicians, and EMS clinicians.

The Traditional Approach to Diagnosis in Medicine Assess patient List of conditions or diagnoses "Differential diagnosis" or "the differential" Further evaluation Reevaluate the differential Final diagnosis Covers Objective: 14.14 Point to Emphasize: The availability of resources is what often guides the approach to making a diagnosis. Discussion Topic: Contrast the traditional diagnostic method with the techniques of emergency providers. How do they differ, and why?

Traditional Approach to Diagnosis Covers Objective: 14.14 Point to Emphasize: The availability of resources is what often guides the approach to making a diagnosis. Discussion Topic: Contrast the traditional diagnostic method with the techniques of emergency providers. How do they differ, and why? The emergency physician assesses patients in the busy, hectic atmosphere of an emergency department. © Edward T. Dickinson, MD

The Emergency Medicine Approach to Diagnosis Quickly rule out and treat immediate life threats. Stabilize patient. Return to gather additional information. Focus on ruling out worst-case scenario. Red flags suggest problem serious. May be responsible for multiple patients Covers Objective: 14.14 Point to Emphasize: Emergency physicians and EMS providers must account for immediate life threats in their diagnostic procedures. Discussion Topic: Discuss how experienced providers approach making a diagnosis. What specific traits do they use in their technique? Class Activity: Discuss problem solving with your medical director. What insights might this person have?

The EMS Approach to Diagnosis Must be very efficient Be available for another call as soon as possible. Work in uncontrolled environment Limited tools and skill set Narrow educational focus Covers Objective: 14.14 Knowledge Applications: Have students work in small groups to examine particular diagnostic methods (traditional, emergency physician, and EMT). Have groups present and discuss their findings. Have students interview experienced providers about how they reach a diagnosis. Discuss students' findings. continued on next slide

The EMS Approach to Diagnosis Follows same steps as emergency physician Most are abbreviated or limited. Considers most serious conditions associated with patient Rules them in or out Creates a diagnosis Covers Objective: 14.14 Discussion Topic: Contrast the traditional diagnostic method with the techniques of emergency providers. How do they differ, and why? Class Activity: Challenge students with exceptionally difficult scenarios. The point is not necessarily to reach the correct diagnosis, but rather to develop a working strategy. Discuss. Critical Thinking: What are the bad diagnostic habits of the experienced provider? How might you avoid these habits as you develop in your career?

Think About It You can reach a diagnosis, but your work is not done. Why? Covers Objective: 14.14 Talking Points: You must continually look for information that will rule in/rule out your conclusions. Patients may have more than one thing wrong with them, so you cannot stop looking.

The Highly Experienced Clinician's Approach to Diagnosis in Medicine Experienced clinicians learn heuristics (shortcuts). Pattern recognition Features narrowing possibilities Allows efficient diagnosis and prompt treatment Realizes limitations of shortcuts Understands common biases of heuristics Covers Objective: 14.14 Point to Emphasize: Experienced clinicians develop key traits in the diagnostic approach. Discussion Topics: Describe the pitfalls of diagnostic shortcuts. How might they actually limit an EMTs ability to make an accurate diagnosis? Discuss how experienced providers approach making a diagnosis. What specific traits do they use in their technique? Knowledge Application: Work in small groups. Assign each group a particular diagnostic trait of an experienced provider. Ask them to discuss that trait and present their findings to the class. Findings must include advantages, disadvantages, and applicability to EMS. continued on next slide

The Highly Experienced Clinician's Approach to Diagnosis in Medicine Common heuristics Representativeness Availability Overconfidence Confirmation bias Illusory correlation Anchoring and adjustment Search satisfying Covers Objective: 14.14 Point to Emphasize: Experienced clinicians develop key traits in the diagnostic approach. Discussion Topics: Describe the pitfalls of diagnostic shortcuts. How might they actually limit an EMTs ability to make an accurate diagnosis? Discuss how experienced providers approach making a diagnosis. What specific traits do they use in their technique? Knowledge Application: Work in small groups. Assign each group a particular diagnostic trait of an experienced provider. Ask them to discuss that trait and present their findings to the class. Findings must include advantages, disadvantages, and applicability to EMS.

Decision-Making Information Video Covers Objective: 14.14 Video Clip Decision-Making Information Why is it important to cast away underlying assumptions when making a decision? What is the difference between decision making and problem solving? Why is it important to define a problem? Discuss the steps in solving a problem. What is group think? Click on the screenshot to view a video on the subject of making decisions. Back to Directory

How an EMT Can Learn to Think Like an Experienced Physician Learn to love ambiguity. Understand the limitations of technology and people. Realize that no one strategy works for everything. Form a strong foundation of knowledge. Covers Objective: 14.14 Points to Emphasize: There are critical thinking traits that EMTs can learn from experienced providers. Adopting these attitudes can improve their capability to solve problems and work through difficult issues. Ambiguity and uncertainty will always be present in medicine. This is true in the back of an ambulance as well. Talking Points: Understand the limits of your knowledge and realize you won't always have the answer you seek. When you get a vital sign or a value that doesn't seem right, don't assume it's wrong. Investigate it. Discussion Topics: Describe the role of ambiguity in the diagnostic process. How do the limitations of technology impact an EMT's diagnostic technique? continued on next slide

How an EMT Can Learn to Think Like an Experienced Physician Organize the data in your head. Change the way you think. Learn from others. Reflect on what you have learned. Covers Objective: 14.14 Points to Emphasize: Many of the attitudes and understandings of experienced clinicians focus upon flexibility. This is an extremely important trait for a new EMT to develop. Discussion Topics: How do both a strong foundation of learning and continued education improve an EMT's ability to diagnose? Define and discuss the term elaborated knowledge. Class Activity: Discuss problem solving with an experienced EMS provider. What lessons has this person learned from experience? Knowledge Application: Have students work in small groups. Assign each group an attitude or understanding of an experienced clinician. Have the groups present ways in which those traits improve diagnostic technique. Critical Thinking: This section presents "learning from others" as a positive trait used to improve diagnostic technique. What actual steps might you use on the job to realize this strategy?

Think About It What are some of the important things to remember as you learn how to make a diagnosis and improve your critical thinking skills in EMS? Covers Objective: 14.14 Talking Points: Reaching a diagnosis is a process that can be learned. Critical thinking comes from study, practice, and reflection. It is a skill that takes time. Know the boundaries of your knowledge. Do not let a diagnosis attempt delay your patient care.

Leadership Video Covers Objective: 14.14 Video Clip Leadership What are the desired outcomes of effective leadership? Why is it important for an EMT to be an effective leader? List qualities of an outstanding leader. When providing emergency care, why must an EMT balance the needs of others? Discuss some roles associated with different levels of management. Click on the screenshot to view a video on the subject of effective leadership. Back to Directory

Delegating Authority Video Covers Objective: 14.14 Video Clip Delegating Authority What is delegation? Who is accountable when a task has been delegated to another person? What can delegation accomplish? Why should an EMT be able to delegate tasks to others effectively? What factors might negatively impact effective delegation? Why is praise from a leader essential? Click on the screenshot to view a video on the subject of delegation. Back to Directory

Chapter Review

Mid-Chapter Review EMTs make some diagnoses in the field, although they are not as extensive or detailed as physicians' diagnoses. The traditional approach to reaching a diagnosis is to assess the patient, draw up a list of differential diagnoses, assess further to rule in or rule out different conditions, and narrow the list until you reach a conclusion. continued on next slide

Mid-Chapter Review Highly experienced physicians don't always use the traditional approach. They use heuristics (shortcuts) in combination with their experience and training, which speeds up the process of reaching a diagnosis. continued on next slide

Mid-Chapter Review Shortcomings of heuristics include representativeness, anchoring and adjustment, overconfidence, confirmation bias, illusory correlation, and search satisfying. continued on next slide

Mid-Chapter Review Learn to think more critically by accepting the ambiguity of EMS working conditions, understanding limitations of people and technology, forming a strong foundation of knowledge, and organizing the data in your mind. continued on next slide

Mid-Chapter Review When considering the cause of a patient's condition, don't let your search for a cause delay your treatment of the patient.

Remember Use MOI to determine the need for a rapid trauma assessment. Assume spinal injury. Work as a team to complete the assessment.

Questions to Consider How do the focused physical exam of a trauma patient with a significant MOI differ from those for a trauma patient with no significant MOI? Talking Points: A focused physical exam is used for patients with no significant MOI. In this case a conscious patient will direct you to specific areas of pain or injury. In some cases, MOI will help focus your assessment. A rapid trauma exam is used for severely injured patients, patients who are unable to communicate with providers, or patients with a significant MOI. In this case the exam covers the entire body to identify unseen injuries and potential life threats. MOI guides this, but the scope is the entire body. continued on next slide

Questions to Consider List the steps and areas covered in the rapid trauma assessment. How are these steps different in the detailed assessment? Talking Points: The areas covered include the head, neck, chest, abdomen, pelvis, back, extremities, and baseline vitals. These areas are the same in a detailed assessment, but the level of detail and time spent in each area is greater.

Critical Thinking You are assessing a patient who fell three stories. He is unresponsive and bleeding into his airway. The driver of the ambulance is positioning the vehicle and bringing equipment to you. continued on next slide

Critical Thinking How do you balance the patient's need for airway control (he requires frequent suctioning) with the need to assess his injuries? Talking Points: In this case, airway management takes priority over assessment. Any time a life threat is identified, care must begin.