ASSESSMENT OF THE MEDICAL PATIENT

MEDICAL ASSESSMENT
I s t h is a m e d ic a l o r a t r a u m a p a t ie n t ? M e d ic a l T ra u m a C o m p o n e n t? Yes D e t e r m in e M .O .I. T ra u m a A s s e s s m e n t
Institute for Emergency Medical Services

No M e d ic a l A s s e s s m e n t

MECHANISM OF INJURY
YES NO

TRAUMA SURVEY

MEDICAL ASSESSMENT & PHYSICAL EXAM

Institute for Emergency Medical Services

MEDICAL ASSESSMENT PRIMARY SURVEY
Responsive Medical Patient

BODY SUBSTANCE ISOLATION
Gloves Glasses Mask Apron Overalls
(As appropriate)
Institute for Emergency Medical Services

SCENE SIZE-UP
Scene safe Universal precautions Number of patients Mechanism of injury Do I need Additional help

Institute for Emergency Medical Services

INITIAL ASSESSMENT
General impression of patient
Skin colour, rate and depth of respirations, effort, patients position, age, sex, weight, height

Considers C-spine stabilisation Determine level of consciousness
Shake and shout / “hello can you hear me?”

Determine chief complaint/apparent life threats
Institute for Emergency Medical Services

AIRWAY
Assessment of the airway “Can you open your mouth for me?” Establishes and maintains a patent airway

Institute for Emergency Medical Services

BREATHING
Assessment of breathing Initiate appropriate oxygen therapy Assure adequate ventilation

Institute for Emergency Medical Services

CIRCULATION
Assessment of pulse Assess and control any major bleeding Assess skin (colour, temperature, condition) Assess capillary re-fill

Institute for Emergency Medical Services

DISABILITY
A = Alert V = Verbal P = Pain U = Unresponsive
P

= Pupils  E = Equal  A = And  R = Round  R = React  L = Light

Institute for Emergency Medical Services

CUPS DECISION

Institute for Emergency Medical Services

CUPS DECISION
C U P S Critical Unstable Potentially unstable Stable
Institute for Emergency Medical Services

CUPS DECISION
C Critical U Unstable P Potentially unstable S Stable
Institute for Emergency Medical Services

Load & go adult

Load & go infant/child

Why gather the history before physical exam or vital signs ?

For a medical patient the history usually provides the most important information

Institute for Emergency Medical Services

DIFFERENT “FOCUSED MEDICAL” QUESTIONS
Respiratory & Cardiac Altered Mental Status Allergic Reaction Piosoning/Overdose Environmental Emergency Obstetrics* Behavioural
Institute for Emergency Medical Services

FOCUSED MEDICAL HISTORY QUESTIONS
O = Onset P = Provocation Q = Quality R = Radiation S = Severity T = Time

CARDIAC AND RESPIRATORY
Institute for Emergency Medical Services

ONSET
What were you doing when it started? Do you think it was caused by anything in particular ?

Institute for Emergency Medical Services

PROVOKES
Can you think of anything that might have triggered this pain? Does anything make the pain better or worse? Can you make the pain happen ?
Institute for Emergency Medical Services

QUALITY
Can you describe the pain for me? Dull ache. Sharp Throbbing Shooting / / / / Tearing Gripping Stabbing Worst headache of my life

Institute for Emergency Medical Services

RADIATION
Where exactly is the pain? Does it spread anywhere? Gallbladder pain in R shoulder Cardiac pain in Jaw.

Institute for Emergency Medical Services

SEVERITY
How bad is the pain? On a scale of 1 to 10, with 10 being the worst you could possibly imagine, how would you rate your pain?

Institute for Emergency Medical Services

TIME
When did the pain start? Has it changed at all since it started?

Institute for Emergency Medical Services

QUESTIONING TECHNIQUES
Open Questions Closed Questions Leading Questions Comparative Questions
Institute for Emergency Medical Services

RESPIRATORY & CARDIAC
O = Onset? P = Provocation? Q = Quality? R = Radiation? S = Severity? T = Time?

Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

ALTERED LEVEL OF CONSCIOUSNESS
Description of episode Onset? Duration? Associated symptoms? Evidence of trauma? Seizures? Fever?

Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

ALLERGIC REACTION
History of allergies? What were you exposed to? Duration of exposure? Effects? Progression? Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

POISONING
Substance When was substance injested when did the exposure occur? How much did you injest? Over what time period? Estimated weight? Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

ENVIRONMENTAL EMERGENCIES
Source? Environment? Duration? Loss of consciousness? Effects- general/local?

Institute for Emergency Medical Services

OBSTETRICS
Are you pregnant? How long have you been pregnant? Pain or contractions? Bleeding or discharge? Do you feel the need to push? Last menstrual period?
Institute for Emergency Medical Services

BEHAVIOURAL
How do you feel? Determine suicidal tendencies Is the patient a threat to self or others? Is there a medical problem? Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

HISTORY OF PRESENT ILLNESS (HPI)
S A M P L E = Signs and Symptoms = Allergies = Medications = Pertinent past history = Last oral intake = Events leading to problem
Institute for Emergency Medical Services

SIGNS & SYMPTOMS
Can you describe what is wrong? Chief complaint (C.C)

Have you any other symptoms?
Institute for Emergency Medical Services

ALLERGIES
Are you allergic to anything?

Institute for Emergency Medical Services

MEDICATIONS
Do you take any medication? What do you take those for?

Institute for Emergency Medical Services

MEDICATIONS
Prescriptions Current Recent Birth Control Pills

Institute for Emergency Medical Services

MEDICATIONS
Non-Prescription Current Recent Vitamin supplements

Institute for Emergency Medical Services

PERTINENT MEDICAL HISTORY
Do you have any medical conditions that we should know about? Have you ever had a problem like this before?
Institute for Emergency Medical Services

LAST ORAL INTAKE
When was the last time you ate or drank? What did you eat or drink?
Institute for Emergency Medical Services

EVENTS
Sequence of events leading up to the illness How have you felt today? Anything out of the ordinary happen?

Institute for Emergency Medical Services

RE-CAP SO FAR
Scene size up ( SUNMD ) Initial assessment ( general impressions etc.. ) Airway Breathing Circulation Disability CUPS decision Focused medical questions / SAMPLE
Institute for Emergency Medical Services

BASELINE VITAL SIGNS
Pulse Respirations Blood Pressure Breath sounds SpO2 Skin colour, temperature, condition Capillary refill Pupils
Institute for Emergency Medical Services

INTERVENTIONS
Obtain medical direction Employ Dublin Fire Brigade Protocol PHECC C.P.G’s

Institute for Emergency Medical Services

INTERVENTIONS
Cardiac monitor Glucose measurement O2 , GTN , ASA , Glucose gel , Salbutomol Patient Positioning (e g : trendellenburg for hypovolaemia)
Institute for Emergency Medical Services

RE-EVALUATES CUPS
Re-evaluate transport decision It’s now Time to go

Institute for Emergency Medical Services

REPEATS FOCUSED EXAM
Based on patients Chief Complaint

Institute for Emergency Medical Services

REPEATS FOCUSED EXAM
Re-evaluate patient for obvious indications of illness that may have been missed Look for less obvious evidence of illness/injury

Institute for Emergency Medical Services

REPEATS FOCUSED EXAM
As appropriate, assess: Head Neck Chest Abdomen Pelvis Extremities Posterior

Institute for Emergency Medical Services

RE-CHECKS INTERVENTIONS
Cardiac monitor O2 Positioning

Institute for Emergency Medical Services

COMMUNICATIONS
It is imperitave that you strive to communicate well with your patient Trust Respect Professionalism

Institute for Emergency Medical Services

REPEAT VITAL SIGNS
Pulse Respirations Blood Pressure Breath sounds SpO2 Skin colour, temperature, condition Capillary refill Pupils
Institute for Emergency Medical Services

FROM THE TOP
Scene size up ( SUNMD ) Initial assessment ( general impressions etc.. ) Airway Breathing Circulation Disability CUPS decision Focused medical questions / SAMPLE
Institute for Emergency Medical Services

FROM THE TOP
Baseline vital signs Interventions Re-evaluates CUPS decision Repeats focused exam Re-checks interventions Communications Repeats vital signs

Institute for Emergency Medical Services

MEDICAL ASSESSMENT PRIMARY SURVEY
Unresponsive Medical Patient

UNRESPONSIVE PATIENT
ABCD / consider C spine control CUPS Rapid assessment History of present illness (bystanders) S.A.M.P.L.E. history (bystanders) Baseline Vital Signs Make relevant interventions
Institute for Emergency Medical Services

Position patient to correct airway

Institute for Emergency Medical Services

INITIAL ASSESSMENT Primary Survey

A B C D
Institute for Emergency Medical Services

CUPS DECISION

Institute for Emergency Medical Services

CUPS DECISION
C U P S Critical Unstable Potentially unstable Stable
Institute for Emergency Medical Services

CUPS DECISION
C Critical U Unstable P Potentially unstable S Stable
Institute for Emergency Medical Services

Load & go adult

Load & go infant/child

RAPID ASSESSMENT
Start with rapid assessment Head Neck Chest Abdomen Pelvis Extremities Posterior

Institute for Emergency Medical Services

RESPIRATORY & CARDIAC
O = Onset? P = Provocation? Q = Quality? R = Radiation? S = Severity? T = Time?

Interventions: Has anything helped or made the problem worse
Institute for Emergency Medical Services

HISTORY OF PRESENT ILLNESS (HPI)
S A M P L E = Signs and Symptoms = Allergies = Medications = Pertinent past history = Last oral intake = Events leading to problem
Institute for Emergency Medical Services

BASELINE VITAL SIGNS
Pulse Respirations Blood Pressure Breath sounds SpO2 Skin colour, temperature, condition Capillary refill Pupils
Institute for Emergency Medical Services

INTERVENTIONS
Cardiac monitor Glucose measurement O2 , GTN , ASA , Glucose gel , Salbutomol Patient Positioning (e g : trendellenburg for hypovolaemia)
Institute for Emergency Medical Services

FROM THE TOP
Scene size up ( SUNMD ) Initial assessment ( general impressions etc.. ) Airway Breathing Circulation Disability CUPS decision Rapid physical exam ( head to toe ) Focused medical questions / SAMPLE
Institute for Emergency Medical Services

FROM THE TOP
Baseline vital signs Interventions Re-evaluates CUPS decision Repeats physical exam Re-checks interventions Communications Repeats vital signs

Institute for Emergency Medical Services

QUESTIONS ?

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