Chapter 16 Focused History and Physical Examination of the Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Assessment of the Medical Patient  The Responsive Medical Patient  The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Assessment of the Medical Patient  Patient priorities –Differ somewhat between patient with a medical illness and patient with trauma –Depend on whether the medical patient is awake and responsive or unresponsive

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Assessment of the Medical Patient  History –No mechanism of injury –An illness resulting in a call for emergency care –Obtain necessary information to prioritize care of the medical patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Assessment of the Medical Patient  Physical examination –Use the history to guide the physical exam –Physical examination findings often confirm the suspicions formed from the history

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 The Responsive Medical Patient  A very common type of patient  Has a medical illness and usually can communicate its details

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7  History of the present illness –Organize questions to get information quickly –Avoid long-winded accounts –Filter irrelevant history The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8  Chief complaint –First and most important part of the history –Main reason why patient called for help –Approach: introduce yourself and ask politely about the problem The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9  OPQRST –Specific questions to better define problem and determine treatment Onset of symptoms Provocation, or provoking factors Quality of symptoms Radiation of discomfort from primary location Severity of symptoms Time: length of time symptoms have been present The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 OPQRST History  Watch this video demonstrating obtaining the history using OPQRST

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11  SAMPLE history –Important elements of medical history to help further define the current problem Signs and symptoms Allergies to medications Medications Past medical history Last oral intake Events leading up to the current event The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 SAMPLE History  Watch this video as a demonstration of obtaining a patient history using SAMPLE

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13  Focused physical examination –Focus on the body area that seems affected by the current problem –Look for DCAP-BTLS when examining the specific body part in question The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14  Baseline vital signs –Assess Respiration Pulse Blood pressure Skin temperature and condition Pupils, pulse oximetry, and capillary refill in children The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15  Baseline vital signs –Abnormal vital signs Patient is high priority Initiate immediate transport The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16  Treatment and transport –High priority Treatment for life threats provided during initial assessment Further treatment and assessment administered during transport The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17  Treatment and transport –Low priority: complete focused history and physical with baseline vital signs on the scene before transport The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18  Online medical control –Necessary for permission to assist a patient with previously prescribed medications  Consider ALS –Necessary for treatment beyond EMT’s scope of practice The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19  Ongoing assessment –Continuously monitor for any changes in patient condition The Responsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Stop and Review  What is the focus during the assessment of the conscious and alert medical patient?  What acronym assists the EMT in determining the conscious medical patient’s response to pain?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 The Unresponsive Medical Patient  Unresponsive patient cannot give history  Perform rapid physical exam to determine sources of unresponsiveness

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22  Measure vitals  Try to obtain a history from the “family or bystanders The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23  Rapid physical examination –Similar to head-to-toe rapid exam for trauma patients –Perform a systematic assessment for DCAP-BTLS –Consider cervical spinal immobilization for unresponsive medical patients who may have fallen The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24  Head and neck –Abnormalities –Eyes, ears, nose, mouth –Pupils –Drainage from the nose –Scars or venous distension on neck The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25  Abdomen and pelvis –Expose and check for abnormalities –Palpate all four quadrants –Assess pelvis by compression of the iliac wings, hips, and pubis The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26  Extremities –Assess for abnormalities as for the trauma patient –Look for edema –Note pulses, motor, and sensory function –Check for MedicAlert emblems The Unresponsive Medical Patient Courtesy of the MedicAlert Foundation, Turlock, CA

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27  Back and buttocks –Assess for abnormalities –Listen to the lungs from the back if possible The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28  Vital signs –After the rapid physical assessment, a complete set of vital signs should be obtained –Carefully record and refer to this set as a baseline The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29  History –Quickly ask the family and bystanders about the patient history –Look for clues on the scene The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30  Treatment and transport –Life-threatening problems: Treatments provided during initial assessment Transport should directly ensue –If transport not initiated by the completion of the physical exam, then it should be addressed after the patient history The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31  Medical control and ALS –Consider ALS backup if patient requires advanced-level evaluation and treatment The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32  Ongoing assessment –Repeatedly assess patient during transport for any changes –Contact receiving hospital and advise of the nature of the patient’s illness or injury The Unresponsive Medical Patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Stop and Review  What is the first step of the assessment of the unresponsive medical patient?