1. 13 Part IV Patient Assessment Advance Preparation Student Readiness
Assign the associated section of MyBRADYLab and review student scores.
Review the chapter material in the Instructor Resources, which includes Student Handouts, PowerPoint slides, and the MyTest Program.
Prepare
Schedule assistant instructors to supervise student practice of patient assessment skills. A ratio of one instructor per four students is suggested.
Obtain equipment required for assessment (stethoscopes, pen lights, pulse oximeters, and other needed equipment).
Bring in several news stories about injuries (look in the newspaper or on a television station website) for an activity described in the lesson plan.
Plan 500 to 600 minutes (8 to 10 hours) for this class as follows:
Part IV, Reassessment: 40 minutes
Introduction: 5 minutes
Purposes of the Reassessment: 10 minutes
Describes the reasons for reassessment as detecting changes in patient condition, identifying missed injuries or conditions, and making adjustments in treatment
Repeat the Primary Assessment: 10 minutes
Explains reassessment of mental status, airway, breathing, and circulation and reconsidering patient priorities
Complete the Reassessment: 15 minutes
Describes the process of repeating key components of the assessment and the effects of interventions and recording the information

2. Learning Readiness EMS Education Standards, text p. 311
Explain to students what the National EMS Education Standards are. The National EMS Education Standards communicate the expectations of entry-level EMS providers. As EMTs, students will be expected to be competent in these areas. Acknowledge that the Standards are broad, general statements. Although this lesson addresses the listed competencies, the competencies are often complex and require completion of more than one lesson to accomplish.

3. Learning Readiness Objectives
Please refer to pages 311 and 312 of your text to view the objectives for this chapter.
Objectives are more specific statements of what students should be able to do after completing all reading and activities related to a specific chapter. Remind students they are responsible for the learning objectives and key terms for this chapter.

4. Learning Readiness Key Terms
Please refer to page 312 of your text to view the key terms for this chapter.
Assess and reinforce the objectives and key terms using quizzes, handouts from the electronic instructor resources, and workbook pages.

5. Setting the Stage
Overview of Lesson Topics
Reassessment

6. Case Study Introduction
EMT Shawn Jones is caring for a 60-year-old woman whose chief complaint is a severe headache, and who presented with slurred speech. Prior to transport, the patient was alert and oriented, and Shawn had obtained the following baseline set of vital signs: pulse 72 and regular, BP 170/90, and respirations 16 and regular, with an SpO2 of 98%, and pupils that are equal and reactive.
Case Study
Present the Case Study Introduction provided in the PowerPoint slide set.
Lead a discussion using the case study questions provided on the subsequent slide(s).
The Case Study with discussion questions continues throughout the PowerPoint presentation.
Refer to the Case Study Guide in the Instructor Resources for more information.
Case Study Discussion
Use the case study content and questions to foreshadow the upcoming lesson content

7. Case Study
What are the reasons Shawn will reassess this patient en route to the hospital?
How often should he reassess this patient?
What will Shawn look for, specifically, in this patient as he reassesses her condition?

8. Introduction
All decisions about patient care and transport are based on an accurate, thorough patient assessment.
Assessment includes scene size-up, primary assessment, secondary assessment, and reassessment.
During this lesson, students will learn about all of the components of the patient assessment procedures they will perform on every patient they encounter during their career as EMTs.

9. Reassessment
Reassessment is most often performed in the ambulance until care of the patient is transferred to hospital personnel.
If there is a delay in transport, reassessment begins at the scene.
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10. Reassessment Reassessment is performed on all patients.
Purposes of reassessment are to:
Determine any changes in the patient's condition.
Assess the effectiveness of emergency care.
Critical Thinking Discussion
What are potential consequences of failing to reassess patients?
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11. Reassessment If deterioration is noted Look for the cause.
Intervene in any problems found during reassessment.
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12. Reassessment Reassessment process Assess Intervene Reassess
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13. Reassessment Three basic reasons for reassessment
To detect any change in the patient's condition
To identify any missed injuries or conditions, especially those that are life threatening
To adjust the emergency care as needed

14. Click on the response that is NOT a basic reason for performing reassessment.
To gain information for continuous quality improvement purposes
To detect changes in the patient's condition
To identify any injuries or conditions missed during the initial primary and secondary assessments
To gain information to make adjustments in emergency care

15. Reassessment Detect any change in condition.
Changes can occur rapidly.
Look for signs of deterioration and signs of improvement.
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16. Reassessment Detect any change in condition.
Common causes for deterioration include:
Continued blood loss
Airway compromise
Inadequate breathing or oxygenation
Poor perfusion
Brain injury
Discussion Question
What are some specific things that should be rechecked in the reassessment process?
Knowledge Application
Given several scenarios, students should be able to direct the reassessment of a patient, based on the primary and secondary assessments and treatments provided.
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17. Reassessment Identify any missed injuries or conditions.
The initial conditions for performing the primary and secondary assessments may not be ideal.
Darkness
Crowds
Weather
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18. Reassessment Identify any missed injuries or conditions.
The initial conditions for performing the primary and secondary assessments may not be ideal.
Noise
Scene hazards
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19. Reassessment Identify any missed injuries or conditions.
Investigate any new complaints the patient may have.
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20. Reassessment Adjust emergency care.
If the patient's condition changes, you may need to make adjustments in the care you are providing.
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21. Reassessment Document reassessment findings. Frequency of reassessment
Every 5 minutes for unstable patients
Every 15 minutes for stable patients
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22. Reassessment Steps of reassessment Repeat the primary assessment.
Reassess and record vital signs.
Repeat the secondary assessment for other complaints, injuries, or a change in the chief complaint.
Check interventions.
Note trends in the patient's condition.
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23. Reassessment Repeat the primary assessment. Reassess mental status.
Changes in speech pattern or appropriateness
Ability to obey commands
Glasgow Coma Scale
Compare reassessment findings to the baseline and document findings.
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24. Reassessment Repeat the primary assessment. Reassess the airway.
If the patient is alert and talking, the airway is patent.
In unresponsive patients, inspect the mouth and listen for abnormal sounds; intervene as needed.
If the patient is being ventilated, check for increased resistance to ventilation.
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25. Reassessment Repeat the primary assessment. Reassess breathing.
Look, listen, and feel.
Look for changes in mental status.
Check effectiveness of positive pressure ventilation.
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26. Reassessment Repeat the primary assessment.
Use pulse oximetry to monitor oxygenation.
Apply oxygen to any patient who:
Has signs or symptoms of hypoxia, hypoxemia, respiratory distress, poor perfusion, or heart failure
Complains of dyspnea
Has a decrease in the SpO2 reading to less than 94%
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27. Reassessment Repeat the primary assessment. Reassess circulation.
Check for changes in pulse rate and quality.
Reassess bleeding.
Reassess the skin and capillary refill.
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28. Reassessment Repeat the primary assessment.
Re-establish patient priorities.
Adjust transport plans as needed.
Adjust interventions as needed.
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29. Reassessment Complete the reassessment. Repeat vital signs.
Repeat components of the secondary assessment.
Check interventions.
Note trends in the patient's condition.

30. The Rapid Secondary Assessment for the Medical Patient
EMT SKILLS 13-7
The Rapid Secondary Assessment for the Medical Patient

31. Reassure the patient as you begin to repeat the primary assessment.

32. Reassess vital signs.

33. Repeat appropriate elements of the physical exam.

34. Check and adjust interventions as necessary.

35. Record trends in the patient's condition.

36. Case Study Conclusion
Shawn repeats the primary assessment, which reveals that the patient is still alert, and has a patent airway, adequate breathing, and adequate perfusion. He repeats vital signs and detects changes. The pulse is now 68 per minute, and the BP is 178/90. Respirations are 16, and there has been no change in the SpO2.
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37. Case Study Conclusion
Shawn repeats a neurological examination, and finds no change in the pupils, but notices weakness on the patient's right side, which was not present initially. Shawn is concerned with these findings, and notifies his partner, as well as reporting the changes to the receiving hospital.
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38. Case Study Conclusion
At the receiving hospital, the physician thanks Shawn for his update, saying that it increased their level of concern and helped them prepare to immediately treat the patient when she arrived.

39. Lesson Summary
Reassessment is performed on all patients for three reasons:
To detect changes in condition
To identify missed injuries or conditions
To adjust emergency care as needed
Follow-Up
Answer student questions.
Follow-Up Assignments
Review Chapter 13 Summary.
Complete Chapter 13 In Review questions.
Complete Chapter 13 Critical Thinking questions.
Assessments
Handouts
Chapter 13 quiz
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40. Lesson Summary The steps of reassessment are:
Repeat the primary assessment.
Reassess vital signs.
Repeat the secondary assessment.
Check interventions.
Note trends in the patient's condition.
Class Activity
As an alternative to assigning the follow-up exercises in the lesson plan as homework, assign each question to a small group of students for in-class discussion.
Teaching Tips
Answers to In Review questions are in the appendix of the text. Advise students to review the questions again as they study the chapter.