Ch09 eec3

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Ch09 eec3

  1. 1. Assessment of the Medical Patient Nine Chapter
  2. 2. <ul><li>How to perform a focused history and physical exam for a medical patient </li></ul><ul><li>Differences in assessments of responsive and unresponsive medical patients </li></ul><ul><li>How to perform an ongoing assessment for a medical patient </li></ul>Nine Chapter CORE CONCEPTS
  3. 3. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME
  4. 4. F OCUSED HISTORY AND PHYSICAL EXAM: RESPONSIVE MEDICAL PATIENT
  5. 5. Steps in Focused History and Physical Exam: Responsive Medical Patient <ul><li>History of present illness </li></ul><ul><li>SAMPLE history </li></ul><ul><li>Focused physical exam </li></ul><ul><li>Baseline vital signs </li></ul>
  6. 6. History of Present Illness Onset Provocation Quality Radiation Severity Time = = = = = = O P Q R S T
  7. 7. SAMPLE History Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to problem = = = = = = S A M P L E
  8. 8. Focused Physical Exam <ul><li>Head </li></ul><ul><li>Neck </li></ul><ul><li>Chest </li></ul><ul><li>Abdomen </li></ul><ul><li>Pelvis </li></ul><ul><li>Extremities </li></ul><ul><li>Posterior </li></ul>As appropriate, assess:
  9. 9. Baseline Vital Signs <ul><li>Respirations </li></ul><ul><li>Pulse </li></ul><ul><li>Skin color, temperature, condition </li></ul><ul><li>Pupils </li></ul><ul><li>Blood pressure </li></ul>
  10. 10. When the patient has a chief complaint for which you can administer treatment, you will need to get certain additional information. (Continued) Additional Information
  11. 11. Get additional information for: <ul><li>Chest pain </li></ul><ul><li>Difficulty breathing </li></ul><ul><li>Allergies </li></ul><ul><li>Altered mental status </li></ul><ul><li>Poisoning and overdose </li></ul><ul><li>Exposure to heat or cold </li></ul>
  12. 12. P RECEPTOR P EARL The assessment and management of a medical patient need to incorporate as much pertinent information as you can obtain about the patient’s medical history, medications, and recent illnesses. It is not uncommon for patients to have multiple overlapping medical conditions that may contribute to today’s problem.
  13. 13. F OCUSED HISTORY AND PHYSICAL EXAM: UNRESPONSIVE MEDICAL PATIENT
  14. 14. <ul><li>Rapid physical exam </li></ul><ul><li>Baseline vital signs </li></ul><ul><li>Consider requesting ALS </li></ul><ul><li>History of present illness </li></ul><ul><li>SAMPLE history </li></ul>Steps in Focused History and Physical Exam: Unresponsive Medical Patient
  15. 15. Position patient to correct airway. Initial Step
  16. 16. <ul><li>Head </li></ul><ul><li>Neck </li></ul><ul><li>Chest </li></ul><ul><li>Abdomen </li></ul><ul><li>Pelvis </li></ul><ul><li>Extremities </li></ul><ul><li>Posterior </li></ul>Rapid Physical Exam Start with rapid assessment:
  17. 17. Baseline Vital Signs <ul><li>Respirations </li></ul><ul><li>Pulse </li></ul><ul><li>Skin color, temperature, condition </li></ul><ul><li>Pupils </li></ul><ul><li>Blood pressure </li></ul>
  18. 18. SAMPLE History Get SAMPLE history from bystanders, family, or friends.
  19. 19. S TEPS IN THE ONGOING ASSESSMENT <ul><li>Repeat initial assessment. </li></ul><ul><li>Reassess and record vital signs. </li></ul><ul><li>Repeat focused assessment. </li></ul><ul><li>Check on treatment in progress. </li></ul>
  20. 20. Repeat Initial Assessment <ul><li>Check mental status. </li></ul><ul><li>Maintain open airway. </li></ul><ul><li>Monitor breathing </li></ul>(rate and quality) . (Continued)
  21. 21. <ul><li>Reassess pulse (rate and quality) . </li></ul><ul><li>Monitor skin (color, temperature, condition) . </li></ul><ul><li>Reevaluate patient’s priority. </li></ul>Repeat Initial Assessment
  22. 22. Observing Trends <ul><li>Trends are changes over time. </li></ul><ul><li>Changes noted over time are significant (e.g., changes in blood pressure or pulse). </li></ul><ul><li>Repeated assessments are required to observe trends. </li></ul>
  23. 23. Check Interventions (look at bag on NRB) . <ul><li>Adequacy of oxygen delivery </li></ul><ul><li>Adequacy of artificial ventilation </li></ul>(make sure you see visible chest rise) . (Continued)
  24. 24. <ul><li>External bleeding (look for new blood) . </li></ul><ul><li>Check splinted extremities for distal pulse, movement, and sensation (PMS). </li></ul>Check Interventions
  25. 25. 1. How is the focused history and physical exam performed for a medical patient? 2. What is the difference between the assessments of responsive and unresponsive medical patients? 3. What is done in the ongoing assessment of the medical patient? R EVIEW QUESTIONS

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