Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

Chapter 10 – Rapid Physical Exam © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives Describe when the EMS provider would perform the rapid physical exam (RPE). Describe when the EMS provider would perform the rapid physical exam (RPE). List factors to consider when removing patient clothing as part of the RPE. List factors to consider when removing patient clothing as part of the RPE. Describe the sequence for evaluation of body parts or regions as part of the RPE. Describe the sequence for evaluation of body parts or regions as part of the RPE. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Objectives (continued) List pertinent information the EMS provider should gather from family or caretakers when a patient is unable to provide it. List pertinent information the EMS provider should gather from family or caretakers when a patient is unable to provide it. Describe how the EMS provider can best gain proficiency in conducting the RPE quickly and accurately. Describe how the EMS provider can best gain proficiency in conducting the RPE quickly and accurately. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Introduction A rapid PE is completed on the unresponsive medical patient, conscious stroke, intoxicated, or postictal patient. A rapid PE is completed on the unresponsive medical patient, conscious stroke, intoxicated, or postictal patient. The RPE is a rapid systematic exam of the following body areas: The RPE is a rapid systematic exam of the following body areas: Head/neck Head/neck Chest/abdomen/pelvis Chest/abdomen/pelvis Back/buttocks Back/buttocks Extremities Extremities © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Introduction (continued) The RPE is similar to the rapid trauma exam (RTE) The RPE is similar to the rapid trauma exam (RTE) The acronym DCAP-BTLS is used to recall assessment points. The acronym DCAP-BTLS is used to recall assessment points. Deformities Deformities Contusions Contusions Abrasions Abrasions Punctures/penetrations Punctures/penetrations Burns Burns Tenderness Tenderness Swelling Swelling © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Steps in the RPE Utilize appropriate BSI precautions Utilize appropriate BSI precautions Remove any clothing needed to actually look at the skin Remove any clothing needed to actually look at the skin Consider environmental conditions Consider environmental conditions Be considerate for privacy and modesty Be considerate for privacy and modesty Reconsider the nature of illness (NOI) Reconsider the nature of illness (NOI) Be alert for any possible MOIs Be alert for any possible MOIs © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Steps in the RPE (continued) Systematically evaluate each of the following body areas from head-to-toe: Systematically evaluate each of the following body areas from head-to-toe: Head & Neck Head & Neck Assess for DCAP-BTLS, crepitation and JVD Assess for DCAP-BTLS, crepitation and JVD Do not poke fingertips into fractures or soft spots Do not poke fingertips into fractures or soft spots Chest Chest Assess for DCAP-BTLS, paradoxical motion, crepitation and breath sounds Assess for DCAP-BTLS, paradoxical motion, crepitation and breath sounds Note any obvious scars from past medical history (e.g.: CABG) Note any obvious scars from past medical history (e.g.: CABG) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Steps in the RPE (continued) Abdomen Abdomen Assess for DCAP-BTLS, firmness, softness, and distension Assess for DCAP-BTLS, firmness, softness, and distension Note any tenderness, masses, or bulges Note any tenderness, masses, or bulges Note any scars as a clue to past medical history Note any scars as a clue to past medical history Pelvis Pelvis Assess for DCAP-BTLS, pain, tenderness, unstable motion Assess for DCAP-BTLS, pain, tenderness, unstable motion The pelvis is made up of 3 bones (ilium, ischium, pubis) and the lower spine The pelvis is made up of 3 bones (ilium, ischium, pubis) and the lower spine The potential for blood loss is great and may mask 1,500 ml The potential for blood loss is great and may mask 1,500 ml © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Steps in the RPE (continued) Extremities Extremities Assess for DCAP-BTLS, distal pulse, motor function & sensation (PMS) Assess for DCAP-BTLS, distal pulse, motor function & sensation (PMS) Assess reflexes, strength and range of motion (ROM) Assess reflexes, strength and range of motion (ROM) Posterior Posterior Assess for DCAP-BTLS Assess for DCAP-BTLS This area is often overlooked This area is often overlooked Do not roll patient onto a fractured hip or arm! Do not roll patient onto a fractured hip or arm! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Following the RPE Obtain baseline VS Obtain baseline VS Obtain the SAMPLE history Obtain the SAMPLE history Consider info from the: family, bystanders, caretakers and first responders Consider info from the: family, bystanders, caretakers and first responders Look for clues on medical history Look for clues on medical history Consider calling physician if known Consider calling physician if known Ask about advanced directives Ask about advanced directives Explain to the family/caretaker what is happening and what to expect next Explain to the family/caretaker what is happening and what to expect next © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion Upon completion of IA, if you determine the patient has a medical emergency and is not responsive, the RPE should be done. Upon completion of IA, if you determine the patient has a medical emergency and is not responsive, the RPE should be done. The RPE is a systematic exam of the head, neck, chest, abdomen, pelvis, posterior, and extremities. The RPE is a systematic exam of the head, neck, chest, abdomen, pelvis, posterior, and extremities. Time is often a factor Time is often a factor Achieving proficiency takes practice! Achieving proficiency takes practice! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.