Assessment of the Medical Patient

Question 1

Assessment differences between the Responsive vs. Unresponsive Patient

Answer 1

• Assessment varies depending on patient’s ability to communicate
– Responsive medical patient: focus on chief complaint
– Unresponsive medical patient: focus on physical findings

Question 2

What are the steps in the Secondary Assessment

of Responsive Medical Patient

Answer 2

• History of present illness
• Past medical history
• Focused physical exam
• Baseline vital signs

Question 3

History of present Illness

Answer 3

• Obtain from patient
• Obtain from family or bystanders
• Ask open-ended questions

Question 4

Chief Complaint

Answer 4

– Why patient activated EMS

– What is bothering patient most

Question 5

History of Present Illness—OPQRST

Answer 5

• Onset: What were you doing when it started?
• Provokes: What makes pain worse?
• Quality: Describe pain.
• Radiation: Where is pain? Does it seem to spread?
• Severity: How bad is pain? (1–10 scale)
• Time: When did pain start?

Question 6

Past Medical History SAMPLE

Answer 6

• Symptoms
• Allergies
• Medications
• Pertinent past history • Last oral intake
• Events leading to illness

Question 7

Why is it important to tailor the history questions to the patient

Answer 7

• Important information can be gained by
tailoring history to patient’s chief complaint
• Ask questions pertinent to complaint
• Body systems approach: focus questioning and examination on particular body system most likely involved

Question 8

What are special considerations when gathering a pediatric history

Answer 8

• Get on same level with child
• Put questions in simple language
• Gather information from caregivers

Question 9

Perform Focused Physical Exam

Answer 9

• Usually brief

* Examine areas of concern based on chief complaint

Question 10

Obtain Baseline Vital Signs

Answer 10

• Essential to assessment of medical patient

* Later assessments of vital signs will be compared to baseline

Question 11

• Where would you focus your physical examination on a patient complaining of shortness of breath?

Answer 11

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Question 12

Secondary Assessment of Unresponsive Medical Patient

Answer 12

• Inability to communicate shifts initial focus from chief complaint and history taking
• Begin with physical exam and baseline vital signs
• Gather history from bystanders or family members
• Do rapid assessment of entire body

Question 13

What are the steps in the Rapid Physical Exam

Answer 13

• Similar to physical exam for trauma patient

* Assess head, neck, chest, abdomen, pelvis, extremities, and posterior

Question 14

What are some Important Physical Findings of the Rapid Physical Exam

Answer 14

• Neck: JVD, medical identification devices
• Chest: breath sounds
• Abdomen: distention, firmness or rigidity
• Pelvis: incontinence of urine or feces
• Extremities: pulse, motor function, sensation, oxygen saturation, medical identification devices
• Obtain baseline vital signs
• Consider a request for ALS personnel

Question 15

What are the steps in getting the history of the present illness and Past Medical History for an Unresponsive Patient

Answer 15

• Question bystanders
– What is patient’s name?
– What happened?
– Did you see anything else?
– Did patient complain before this happened?
– Does patient have any illnesses or problems? – Is patient taking medications?

Question 16

• What other mechanisms might you have to obtain patient history other than speaking to bystanders?

Answer 16

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Question 17

Responsive Adult Medical Patient

Answer 17

• Primary assessment
• Patient alert; no life-threatening problems
• Secondary assessment
• History of present illness
• Past medical history and physical exam
• Vital signs
• Transport

Question 18

Unresponsive Adult Medical Patient

Answer 18

• Primary assessment
• Patient not alert; ABCs compromised
• Rapid physical exam
• Vital signs
• Past medical history from family
• Transport
• Prepared for more detailed exam en route

Question 19

Chapter Review

Answer 19

• The history and physical exam of the medical patient takes two forms, depending on whether the patient is responsive.
• You assess the responsive patient by getting a history of the present illness and a past medical history, then performing a physical exam of affected parts of the body before getting baseline vital signs.
• Since unresponsive medical patients cannot communicate, it is appropriate to start the assessment with a rapid physical exam. Baseline vital signs come next, and then you interview bystanders, family, and friends to get any history that can be obtained.
• You may not change any field treatment as a result of the information gathered here, but the results of the assessment may be very important to the emergency department staff.

Question 20

Remember

Answer 20

• Determine if the patient is responsive
enough to provide a history.
• If a patient cannot provide a history, can someone present at the scene do so?
• Consider what kind of history and physical exam the patient’s chief complaint suggests.

Question 21

• Explain how and why the history and physical exam for a medical patient differs from the history and physical exam for a trauma patient.

Answer 21

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Question 22

• Explain how and why the history and physical exam for a responsive medical patient differs from the history and physical exam for an unresponsive medical patient.

Answer 22

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Question 23

• You are trying to get information from the very upset son of an unresponsive man. He is the only available family member. He is so upset that he is having difficulty talking to you.
• How can you quickly get him to calm down and give you his father’s medical history?

Answer 23

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