1. Introduction to Emergency Medical Care 1
Advance Preparation
Research related multimedia links for illustration purposes.
Prepare assessment equipment for psychomotor sessions.
Invite assistant instructors and programmed patients to assist with psychomotor sessions.

2. How to perform reassessment
The significance of changes in vital signs over time
The difference in reassessments for stable versus unstable patients

3. Topics Reassessment Comparing Assessments
Planning Your Time: Plan 30 minutes for this chapter.
Reassessment (20 minutes)
Comparing Assessments (10 minutes)
Note: The total teaching time recommended is only a guideline.

4. 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.

5. State Standard
20) Accurately perform the components of patient assessment to identify and manage immediate life threatening illnesses and injuries within the scope of practice of the EMR for pediatric, adult, and geriatric patients, utilizing rubrics from textbooks, National HOSA guidelines, or clinical standards of practice. Include the following areas:
a. Scene Size-up
b. Primary Survey or Assessment
c. History Taking
d. Secondary Assessment
e. Reassessment

6. Objectives Students will be able to…
Identify the components of performing a reassessment
Perform a reassessment and compare the findings to an original assessment.

7. Reassessment Continues on initial steps of assessment
Identifies changes and trends
Talking Points: Assessment is a continuous, ongoing process.

8. What Reassessment Identifies
Changes (subtle and profound)
Trends
Deterioration
Improvement
Point to Emphasize: Patient status can change rapidly. It is important to continue the patient assessment to identify potential changes.

9. Communicate with Patient
Explain process
Consider patient’s feelings, such as anxiety or embarrassment

10. Repeat Primary Assessment
Recheck for life-threatening problems
Reassess mental status
Maintain open airway
Monitor breathing (rate and quality)
Reassess pulse (rate and quality)
Monitor skin color and temperature
Re-establish patient priorities
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.
Talking Points: Life-threatening problems that were not present or were brought under control during the primary assessment may develop or redevelop before the patient reaches the hospital.
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.

11. Reassess Vital Signs Compare results with baseline measurements
Re-evaluate oxygen
Document findings to record and identify trends
Talking Points: It is especially important to record each vital sign measurement as soon as you obtain it. In this way, you will not need to worry about remembering the different numbers you get for pulse rate, blood pressure, respiratory rate, and oxygen saturation. When you have more than one set of vital signs, it becomes even easier to forget them if you have not written them down. Another reason to document your reassessment is so that you can see trends in the patient’s condition.

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.
Talking Points: Mental status problems might become worse, leading to airway issues. A partially obstructed airway might become completely obstructed, as in burns, neck trauma, or anaphylaxis. Respiratory distress might become respiratory failure, as in asthma or exacerbated COPD.

13. Repeat Focused Assessment
Chief complaint may change, especially with regard to severity
Ask about changes in symptoms, especially ones anticipated because of treatments administered
Repeat physical exam to identify changes from baseline
Check any interventions
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.
Talking Points: The focused assessment involves the pertinent parts of the history and physical exam related to the patient’s specific complaint or injuries. As you learn more about specific injuries and illnesses in later chapters, you will learn more signs to look for in your reassessment.
Discussion Topic: Discuss how readdressing chief complaint and patient history may make an assessment more accurate.

14. Repeat Focused Assessment
Repeat Physical Exam
Knowledge Application: Work in small groups with programmed patients. Give each group a scenario involving a rapidly declining patient and then discuss reassessment strategies.

15. Check Interventions
Ensure adequacy of oxygen delivery and artificial ventilation
Ensure management of bleeding
Ensure adequacy of other interventions
Talking Points: Whenever you check the interventions that you have performed for a patient, try to take a fresh look at the patient. Attempt to see the patient as though you had never seen him before. This may help you to evaluate the adequacy of your interventions more objectively and to adjust them as necessary. Interventions you need to check include oxygen, bleeding, spine immobilization, and splints.

16. Think About It
Describe an example of an intervention that might need to be reevaluated and discuss your process for examining it.
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.

17. Observing Trends Repeat reassessment steps frequently
Talking Points: In later chapters, you will learn about specific trends to look for in patients’ vital signs. For example, in Chapter 26, you will learn about trends in pulse rate and blood pressure as signs of shock.
Critical Thinking: Traumatic brain injuries can cause a specific trend in vital signs as patients decline. Discuss these trends.
Repeat reassessment steps frequently
Establish and document trends
continued

18. Observing Trends
Point to Emphasize: Reassessment also will help the EMT to identify trends that can point to improvement or decline in patient status.
Trending: observing patterns that have emerged among vital signs
Trends may indicate new treatments or adjustments to ongoing treatments.

19. Reassessment for Stable and Unstable Patients
Patient 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 reassess
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.

20. 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
Talking Points: Local protocol may require different intervals of reassessment.
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.

21. Comparing Assessments
Teaching Time: 10 minutes
Teaching Tips: This lesson is presented in scenario form. Consider this format to add realism and context to the lesson. Use real-world examples and “war stories” to demonstrate patient decline and the benefits of reassessment. Continue to build upon the larger assessment lesson. Present the various techniques of reassessment in the context of the previous lessons.

22. Reassessment: Stable Medical Patient
Repeat primary assessment
Repeat and record vital signs
Repeat pertinent parts of history and physical exam
Check interventions you performed
Repeat all steps every 15 minutes
Points to Emphasize: Patient stability will guide the course of reassessment. Reassessment of stable patients will evaluate the success or failure of interventions and may recognize problems not yet identified.
Discussion Topic: 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: Work in small groups with programmed patients. Give each group a scenario involving a rapidly declining patient and discuss reassessment strategies. Use various types of scenarios and levels of patient severity.

23. Reassessment: Unstable Trauma Patient
Repeat primary assessment to check for life-threatening problems
Repeat and record vital signs
Repeat trauma assessment
Check interventions you performed
Repeat all steps every 5 minutes
Point to Emphasize: Unstable patients, by nature, have a higher likelihood of decline. Reassessment must focus on recognizing that compromise.
Discussion Topic: Describe how the technique of reassessment might vary between a stable patient and an unstable patient.
Knowledge Application: Discuss the scenarios presented in the chapter. Describe the various assessments and discuss why they were appropriate or inappropriate.
Critical Thinking: How might a prolonged transport time alter your reassessment process? How might a very brief transport time alter the process?

24. Activity
You will be performing a primary assessment and reassessment on a partner. I will give you a scenario. Your initial assessment should be for a medical patient. I will give you any changes in status during your reassessment.
Exit Ticket: Answer individually
What findings in the reassessment would tell you that the patient is responding well to oxygen therapy?
What findings would tell you a patient was about to “crash”?

25. Chapter Review

26. Chapter Review
Reassessment is the last step in your assessment of a patient.
You should reassess a stable patient at least every 15 minutes and an unstable patient at least every 5 minutes.
continued

27. Chapter Review
Elements of reassessment include the primary assessment, vital signs, pertinent parts of the history and physical exam, and checking the interventions you performed for the patient.
Interventions you need to check include oxygen, bleeding, spine immobilization, and splints.

28. Remember
Assess if the patient’s condition changed in any way, indicating the need for new interventions. Is the airway clear? Is breathing adequate? Is circulation intact?
Check the interventions you performed. Are they functioning as they should?
Adjust interventions if necessary.

29. Questions to Consider
Name the four steps of reassessment and list what assessments you will make during each step.
Explain the value of recording, or documenting, your assessment findings, and explain the meaning of the term trending.
Talking Points: The four steps include repeating the initial assessment, reassessing vital signs, repeating the focused assessment, and checking interventions. Documentation prevents memory loss errors and identifies trends. Trending allows you to see patterns emerge that can indicate patient deterioration or the need for further intervention.

30. Critical Thinking
What must you do if your reassessment turns up one of these findings?
Gurgling respirations
Bag on nonrebreather mask collapses completely when patient inhales
Snoring respirations
Talking Points: Gurgling respirations indicate the need for suction. Bag collapse indicates not enough flow is reaching the patient. Flow rates must be increased. Snoring respirations indicate partial airway obstruction. More aggressive airway maneuvers are necessary.

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