Principles of Patient Assessment in EMS

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Presentation transcript:

Principles of Patient Assessment in EMS

Rapid Physical Exam

Introduction 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: Head/neck Chest/abdomen/pelvis Back/buttocks Extremities

Introduction (continued) The RPE is similar to the rapid trauma exam (RTE) The acronym DCAP-BTLS is used to recall assessment points. Deformities Contusions Abrasions Punctures/penetrations Burns Tenderness Swelling

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Steps in the RPE Utilize appropriate BSI precautions Remove any clothing needed to actually look at the skin Consider environmental conditions Be considerate for privacy and modesty Reconsider the nature of illness (NOI) 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: Head & Neck Assess for DCAP-BTLS, crepitation and JVD Do not poke fingertips into fractures or soft spots Chest Assess for DCAP-BTLS, paradoxical motion, crepitation and breath sounds 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 Assess for DCAP-BTLS, firmness, softness, and distension Note any tenderness, masses, or bulges Note any scars as a clue to past medical history Pelvis Assess for DCAP-BTLS, pain, tenderness, unstable motion 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 © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Following the RPE Obtain baseline VS Obtain the SAMPLE history Consider info from the: family, bystanders, caretakers and first responders Look for clues on medical history Consider calling physician if known Ask about advanced directives 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. The RPE is a systematic exam of the head, neck, chest, abdomen, pelvis, posterior, and extremities. Time is often a factor Achieving proficiency takes practice!