Emergency Medicine - 2009
Patient Assessment in
Emergency Medicine
Patient Assessment: Overview
General approach:
 Look, listen, feel, smell
 (Inspection, Auscultation, Palpation, Olfactio...
Focused History
S:   Symptoms
A:   Allergies
M:   Medications
P:   Pertinent past medical history
L:   Last oral intake
E:...
More details of Chief Complaint
O:   Onset
P:   Provocation
Q:   Quality
R:   Region
R:   Radiation (of pain)
R:   Relievi...
Examination
Primary Survey:
 Airway:      Open airway? Snoring? Struggling?
 Breathing: Is patient breathing, in distress?...
Level of Consciousness
A:   Alert
V:   responds to Verbal stimuli
P:   responds to Painful stimuli
U:   Unresponsive

Alte...
Examination
Secondary Survey:
 History
 Vital signs:
      Pulse rate, quality, location
      Respiratory rate and effo...
Physical Exam Clues
Pulse:
Rapid, full   Early bleeding, fear, fever,
              exercise, high BP
Rapid, weak   Shock,...
Physical Exam Clues
Skin:
Cool, damp        Shock, hemorrhage,
                  hypoglycemia, allergic rxn
Cold, dry     ...
Physical Exam Clues
Pupils:
Dilated, reactive   Stimulant drugs
                    Fear
Dilated, fixed      Brain death
 ...
Reassess the patient…
Symptoms:     What patient tells you
Signs:        What you find on exam

Serial exams are crucial!
...
Patient  Assessment  E R C
Patient  Assessment  E R C
Patient  Assessment  E R C
Patient  Assessment  E R C
Patient  Assessment  E R C
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Patient Assessment E R C

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Patient Assessment E R C

  1. 1. Emergency Medicine - 2009
  2. 2. Patient Assessment in Emergency Medicine
  3. 3. Patient Assessment: Overview General approach:  Look, listen, feel, smell (Inspection, Auscultation, Palpation, Olfaction)  Priorities: • Airway • Breathing • Circulation  History and exam
  4. 4. Focused History S: Symptoms A: Allergies M: Medications P: Pertinent past medical history L: Last oral intake E: Events
  5. 5. More details of Chief Complaint O: Onset P: Provocation Q: Quality R: Region R: Radiation (of pain) R: Relieving factors S: Severity T: Time
  6. 6. 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
  7. 7. 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
  8. 8. Examination Secondary Survey:  History  Vital signs: Pulse rate, quality, location Respiratory rate and effort Blood pressure Temperature Head-to-toe quick exam 
  9. 9. 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
  10. 10. 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
  11. 11. 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!
  12. 12. 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.

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