1. Emergency Medicine - 2009

5. Patient Assessment in
Emergency Medicine

6. Patient Assessment: Overview
General approach:
 Look, listen, feel, smell
(Inspection, Auscultation, Palpation, Olfaction)
 Priorities:
• Airway
• Breathing
• Circulation
 History and exam

7. Focused History
S: Symptoms
A: Allergies
M: Medications
P: Pertinent past medical history
L: Last oral intake
E: Events

9. More details of Chief Complaint
O: Onset
P: Provocation
Q: Quality
R: Region
R: Radiation (of pain)
R: Relieving factors
S: Severity
T: Time

10. Examination
Primary Survey:
Airway: Open airway? Snoring? Struggling?
Breathing: Is patient breathing, in distress?
Circulation: Pulse present? Active bleeding?
Skin perfusion?
Disability: Unresponsive? Paralyzed?
Major deficits?
Exposure: Remove or look under clothes

11. Level of Consciousness
A: Alert
V: responds to Verbal stimuli
P: responds to Painful stimuli
U: Unresponsive
Alternative descriptions:
 Lethargic, obtunded, stuporous, comatose
 Glasgow Coma Scale

12. Examination
Secondary Survey:
 History
 Vital signs:
Pulse rate, quality, location
Respiratory rate and effort
Blood pressure
Temperature
Head-to-toe quick exam


13. Physical Exam Clues
Pulse:
Rapid, full Early bleeding, fear, fever,
exercise, high BP
Rapid, weak Shock, allergic reaction,
failing heart, dehydration
Slow Airway problem, brain injury,
drug overdose, stroke
Irregular Cardiac arrhythmia, ischemia
No pulse Cardiac arrest

14. Physical Exam Clues
Skin:
Cool, damp Shock, hemorrhage,
hypoglycemia, allergic rxn
Cold, dry Exposure to cold
Hot, wet Infection
Heat exposure / heat stroke
Hot, dry Heat stroke, infection,
some drug overdoses
Flushed Infection, drugs, heat exposure
Blue (cyanotic) Hypoxia—check A & B

15. Physical Exam Clues
Pupils:
Dilated, reactive Stimulant drugs
Fear
Dilated, fixed Brain death
Atropine / eye drops
Constricted Narcotics
Pontine stroke
Unequal CNS catastrophe
Congenital
Glass eye!

16. Reassess the patient…
Symptoms: What patient tells you
Signs: What you find on exam
Serial exams are crucial!
Reassess patient after each
intervention, and recheck vital signs
every 5-10 min.