EMT Lecture - Medical Patient Assessment

Medical Patient Assessment Overview

Introduction to Medical Patient Assessment

• The medical patient assessment is similar to the child patient assessment, leveraging existing knowledge from trauma assessments.

• The outline for medical assessments mirrors that of trauma assessments, including scene size-up, primary history-taking, secondary assessment, and reassessment.

Key Differences in Assessment Approach

• Transitioning from trauma to medical assessments involves focusing on the nature of illness rather than mechanisms of injury.

• Patients may present with various symptoms like stomachaches or headaches; understanding their reason for calling is crucial.

Importance of Cervical Spine Care

• Emphasizing cervical spine care in both medical and trauma assessments ensures comprehensive evaluation and safety.

• Primary assessment focuses on identifying life-threatening emergencies using ABC (Airway, Breathing, Circulation).

Primary Assessment Steps

General Impression and Initial Observations

• Assess general appearance: age, gender, race; document how the patient was found for context.

• Evaluate responsiveness through verbal stimuli and painful stimuli; serious pain should be used for accurate assessment.

Life-Threatening Conditions

• Identify immediate life threats such as severe bleeding or unresponsiveness; quick CPR checks are essential if necessary.

Differences Between Trauma and Medical Patients

Interaction with Patients

• Unlike trauma patients who may be unresponsive or only react to pain, medical patients typically engage in dialogue during assessments.

Handling Unresponsive Medical Patients

• In cases where a medical patient is unresponsive, apply trauma assessment techniques while being mindful of their specific condition.

Abdominal Pain and Patient Assessment

Encountering a Child with Abdominal Pain

• The speaker recounts a personal experience of responding to a call about abdominal pain, arriving at a house where he finds a 9-10 year old child alone on the couch.

• The absence of adults raises immediate concerns for the speaker, prompting him to investigate further into the situation.

• Upon speaking with the child, he learns that the child was hit by a car while crossing the street and sought help due to severe stomach pain.

Assessing Trauma and Airway Management

• The discussion shifts to trauma assessment protocols, emphasizing the importance of spinal immobilization when necessary.

• In cases where patients are responsive (e.g., an elderly woman), airway management techniques differ; if they can speak in full sentences, it indicates an open airway without needing suction or OPA insertion.

Circulation and Vital Signs Evaluation

• The speaker explains how assessing circulation involves looking for life-threatening hemorrhages and checking vital signs like blood pressure through radial pulse assessment.

• A correlation is established between pulses and systolic blood pressure; finding a radial pulse suggests adequate systolic pressure above 80 mmHg.

Understanding Patient History Through Questions

• Emphasis is placed on gathering information from bystanders or family members as part of patient assessment.

• The acronym PQRST is introduced as a tool for EMTs to remember critical questions regarding patient history but highlights challenges in translating these acronyms into effective inquiries.

Importance of Contextual Questions in Medical Assessment

• The speaker stresses that understanding what patients were doing when symptoms began (onset) is crucial for accurate diagnosis.

Understanding Pain Assessment in Medical Care

The Importance of Patient Communication

• Effective communication is crucial when assessing a patient's pain, especially during initial interactions. Understanding the context of the pain helps medical professionals provide better care.

• The continuum of care emphasizes that not all questions are for immediate treatment; some serve to gather essential information for medical records.

Key Questions in Pain Assessment

Provocation and Alleviation

• Asking patients what makes their pain better or worse is vital. This can include stopping an activity or changing positions, which may not directly relate to medication but informs treatment plans.

Quality of Pain

• Patients often struggle to describe their pain accurately. Open-ended questions about the quality (e.g., stabbing, crushing) allow for more personal insights rather than limiting them to multiple-choice answers.

• It’s acknowledged that many patients may find it difficult to articulate their pain due to its intensity, highlighting the need for patience and understanding from healthcare providers.

Radiation of Pain

• Understanding whether pain radiates or moves is critical. Instead of using technical terms like "radiate," simpler language should be employed to ensure patient comprehension.

• A practical approach involves asking patients to point with one finger where they feel the pain, simplifying communication and enhancing clarity in diagnosis.

Severity Assessment Techniques

Rating Pain Intensity

• The common practice among EMTs involves asking patients to rate their pain on a scale from one to ten, where ten represents the worst possible pain. This question is frequently revisited throughout patient transport for accurate monitoring.

Understanding Patient Pain Assessment

Gender Differences in Pain Reporting

• Men tend to respond to inquiries about pain more readily than women, even when they are in severe discomfort. This highlights a potential difference in how genders communicate health issues.

• Women may underreport their pain levels, often rating it lower than it actually is, which can complicate diagnosis and treatment.

Importance of Pain Assessment Questions

• It is crucial for healthcare providers to ask patients specific questions about their pain: current level on a scale from one to ten, onset time, and duration of the pain.

• Understanding the timeline of the patient's pain—when it started and how long it has persisted—is essential for accurate assessment.

The OPQRST Methodology

• The OPQRST acronym stands for Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Time. This method helps structure patient interviews effectively.

• Interventions should also be assessed; asking what the patient has done to alleviate their pain can provide insights into its nature.

Assessing Body Systems

• After initial questioning using OPQRST, healthcare providers should assess the body systems related to the patient's complaint for additional symptoms or conditions.

• A comprehensive understanding of symptoms like pedal edema (swollen ankles), which may indicate congestive heart failure (CHF), is vital for diagnosis.

Conceptual Understanding Over Rote Learning

• Healthcare professionals are encouraged not just to memorize questions but to understand underlying concepts behind them. This approach fosters better communication with patients and family members.

• Asking open-ended questions allows healthcare providers to gather more detailed information about a patient's condition rather than relying solely on standard queries.

Understanding Environmental and Drug-Related Emergencies

Assessing Drug Overdose Situations

• Importance of recognizing signs of drug use, such as track marks on the arm, to determine what substances may have been ingested.

• Emphasis on using common sense in assessing a patient's condition, especially in cases involving children or elderly individuals.

• Questions to consider include duration outside and environmental factors contributing to the patient’s state.

Conducting Secondary Assessments

• Focused assessments are crucial; assess specific areas where patients report pain rather than performing full-body scans unless necessary.

• Understanding jugular venous distention as an indicator of potential issues during trauma assessments.

Identifying Symptoms and Conditions

• Differentiating between rebound tenderness (often associated with infection) and point tenderness during examinations.

• Recognizing instability in the pelvic girdle as a critical assessment point for trauma patients.

Treatment Protocol Overview

• Role-playing scenarios will be essential for practical understanding; students must articulate treatment plans based on findings from assessments.

• Review of cardiac treatments and pharmacology is vital; contraindications must be understood before administering medications.

Environmental Emergency Treatments

• Discussion on active vs. passive treatments for environmental emergencies, including warming packs for hypothermia cases.