CH 14 Principles of Assessment (May be combined with Assessment Cards)

Question 1

Past Medical History (PMH)

Answer 1

Information gathered regarding the patient’s health problems in the past

Question 2

Open-ended questions

Answer 2

A question requiring more than just a “yes” or “no” answer

Question 3

Close Ended questions

Answer 3

A question requiring only a “yes” or “no” answer (can also be just a one way or the other answer, other than a yes or no)

Question 4

Chief Complaint

Answer 4

The patient’s statement that describes the symptoms or concerns associated with the primary problem the patient is having

Question 5

HX of Present Illness/Injury (HPI)

Answer 5

The events and or mechanism leading up to the patient’s current problem

Question 6

OPQRST

Answer 6

A memory aid in which the letters stand for questions asked to get a description of the present illness: onset, provocation, quality, region/radiation, severity, time

Question 7

You are beginning to start your patient. When you start the assessment process, you have decided to use the OPQRST. When you use the acronym, what does the “O” stand for?

Answer 7

Onset - What were you doing when the pain or problem began

Question 8

You then move to P

Answer 8

Provocation - Does anything seem to trigger the pain or problem? Does anything make it better?

Question 9

You move on to the Q

Answer 9

Quality - Can you describe the pain for me?

Question 10

You move to the R

Answer 10

Region/Radiation - Where is the pain, can you point to it? Does it seem to shoot or spread anywhere else than where you showed me?

Question 11

You move to the S

Answer 11

Severity - How bad is the pain or problem? If Zero (0) is NO PAIN, and (10) is the worst pain you have EVER felt, what is your level of pain?

Question 12

You have come to the last part of the assessment memory aid (OPQRST) what does the T mean?

Answer 12

Time - When did the pain start? Has it changed at all since it first started? Was the pain a sudden onset or did it come on gradually?

Question 13

SAMPLE

Answer 13

A memory aid in which the letters stand for elements of the past medical hx; sx of allergies, medications, , pertinent past hx, last oral intake, and events leading to the injury or illness

Question 14

You are still with your patient, and you have performed the OPQRST. You are now using the SAMPLE to determine the patients past hx You start with the S

Answer 14

Signs and Symptoms What’s wrong (you have found out this information as part of your OPQRST)

Question 15

You are now moving to the A

Answer 15

Allergies - is your patient allergic to any medications or foods, does your patient have any food allergies?

Question 16

You are moving onto the M

Answer 16

Medications - What medications is your patient currently taking? What medications did the patient STOP taking recently. Does the patient take any over the counter (OTC) medications? Do they take any other drugs (legal or illegal), we are not law enforcement, however, we need to know the medications or drugs that the patient has taken to be able to convey that information to the receiving personnel as it can/will affect the treatment of the patient.

Question 17

You now move onto P

Answer 17

Pertinent past HX - Has your patient been experiencing any medical problems? Has the patient recently been to the doctor. Has there been any medication changes?

Question 18

You now move onto L

Answer 18

Last oral intake - When was the last time that your patient had anything to eat or drink? What WAS the last thing that your patient ate and drank?

Question 19

Your final thing to address is the E (this is something that you addressed in the OPQRST)

Answer 19

Events leading up to the injury (this is something that you addressed in the OPQRST) What sequence of events led to today’s problem? (example: the patient passed out, then got into a car crash versus got into a car crash, then passed out, versus, passed out while driving and then got into a car crash)

Question 20

Jugular Vein Distension

Answer 20

Bulging of the neck veins

Question 21

Crepitation

Answer 21

The grating sound or feeling of broken bones rubbing together

Question 22

Differential Diagnosis

Answer 22

A list of potential diagnosis compiled early in the assessment of the patient

Question 23

You are interviewing your patient and you ask, “What does your discomfort in your chest feel like?” This would be an example of: 1. a heuristic 2. an open-ended question 3. a closed-ended question 4. differential diagnosis

Answer 23

2. an open-ended question It allows the patient to explain themselves. It forces the patient to describe their situation in their own words. A closed-ended question only has two (2) options (example would be a “yes or no question.” A heuristic question is a “rule of thumb” Differential diagnosis would involve you compiling multiple possibilities in the interest of narrowing down a single diagnosis

Question 24

The purpose of a good hx question is to 1. rule out life threats 2. get the hx completed as soon as possible 3. identify new questions to ask 4. determine the patient’s reliability as a source of information

Answer 24

3. identify new questions to to ask The response to a good hx question will lead you to new questions (two more). The ultimate goal is to get the most relevant information to help direct your care

Question 25

What process would you use to discover the circumstances surrounding the chef complain of the responsive medical patient? 1. AVPU 2. OPQRST 3. PERRL 4. SAMPLE

Answer 25

2. OPQRST This stands for Onset, Provocation, Quality, Radiation, Severity, Time This will ensure that you address all critical aspects of the chief complaint SAMPLE primarily involves the past medical hx PERRL is what you use to assess pupils AVPU assess consciousness

Question 26

PERRL - (Used for eye assessment)

Answer 26

P - Pupils E - Equal R - Round R - Reactive L - Light

Question 27

Thinking about the memory aids that we have, in what order would the memory aids be used?

Answer 27

AVPU - (In order to assess alertness of the patient) OPQRST - (In order to determine the medical condition of the patient PERRL - when you are assessing the patients pupils SAMPLE - getting to know their past hx This will get you through your assessment steps

Question 28

You arrive on the scene of a 34 y/o male complaining of severe abdominal pain that started about two (2) hours prior to your being called, and has persisted for the last two (2) hours. On arrival, during your assessment, when you ask him to rate his pain on a 0-10 scale, what part of the OPQRST are you at?

Answer 28

Severity The severity refers to us having them rate it as a 0 fir no pain, and 10 being the worst pain they have even been in their entire life.

Question 29

Your patient tells you that he had a heart valve replaced two (2) years ago. This is considered: 1. pertinent past medical hx 2. a chief complaint 3. a part of the cardiovascular body system examination 4. hx of present illness

Answer 29

1. pertinent past medical hx In SAMPLE, the “P” is pertinent past medical hx (here, his previous heart valve surgery). Him advising you of this would be definitely be considered pertinent past medical hx

Question 30

Your patient is a 12 y/o M, who recently had a seizure. By the time that you arrive, he is alert and tells you that his back hurts. You ask his mother who is there what medications he is on. What element of the SAMPLE layout are you using? 1. M 2. A 3. S 4. P

Answer 30

1. M This refers to medication, and asking what medications that the patient is on, relates to this part of the interview. The patient advising how he feels at the moment relates to S or Sx or Symptoms. His complaint of back pain could be interpreted as his chief complaint A refers to allergies O refers to pertinent past medical hx

Question 31

Which of the following would you assess during the physical examination of the respiratory system? 1. Unusual breath odors 2. Ankle edema 3. Use of nitroglycerine 4. Palpation of the abdomen

Answer 31

2. Ankle Edema During the respiration assessment you would observe edema, which could be dependent edema in the ankles

Question 32

You have asked the patient about recent oral intake. This helps you assess recent oral intake. This helps you assess which body system? 1. Respiratory system 2. Gastrointestinal system 3. Endocrine system 4. Cardiovascular system

Answer 32

2. Gastrointestinal system

Question 33

Which of the following diagnostic shortcuts would make the EMT say “this patient has the same thing my last patient had?” 1. illusory correlation 2. overconfidence 3. confirmation bias 4. availability

Answer 33

4. Availability This would cause the EMT to recall a recent diagnosis and apply it to a current patient.

Question 34

You are examining a patient with abdominal problems and think that you’ve traced the problem to something that the patient ate last night. You IMMEDIATELY stop asking questsions about the present illness and proceed to the past medical hx. This best fis which heuristic (rule of thumb)? 1. Represntativeness 2. Confirmation bias 3. Search Satisfying 4. Availability

Answer 34

3. Search Satisfying

Question 35

You are called to a college party, where you find an unresponsive 19 y/o F. There is much evidence of alcohol consumption at the party. Which of the following behaviors are you demonstrating if you rapidly conclude that the patient is intoxicated? 1. Search satisfying 2. Anchoring 3. Overconfidence 4. Confirmation Bias

Answer 35

2. Anchoring

Question 36

On a call to a crime-ridden area where drug abuse is common, you are SURE that the current call for a patient with altered mental status and difficulty breathing will involve drugs. When you arrive on scene, you look for anything that confirms this hypothesis and ignore anything that does NOT point to drug abuse. This is: 1. anchoring 2. illusionary correlation 3. confirmation bias 4. availabilty

Answer 36

3. confirmation bias

Question 37

Representativeness

Answer 37

When you encounter a patient with a certain grup of signs and symptoms that resemble a certain condition, you assume that the patient has that condition. Representativeness is at the heart of pattern recognition and is an important heuristic. DISADVANTAGE: Patients do not always present with the typical signs and symptoms of a condition. As a result, when a patient does not fit the classic pattern, it is easy for the health care provider to mistakenly conclude the patient doesn’t have that condition.

Question 38

Availability

Answer 38

The urge to think of things because they are more easily recalled, often because of a recent exposure. If an EMT has a patient with chest pain who is diagnosed with a dissecting thoracic aneurysm , the next time there is a patient with CP, the EMT is more likely to think of dissecting thoracic aneuryism as a possibility, even though the condition is much less common than angina and myocardial infarction. This is simply due to the recent exposure to this condition Easiest way to avoid this is to reflect on how common a condition actually IS (i.e. MI vs dissecting thoracic anuerysm)

Question 39

Overconfidence

Answer 39

Being an EMT requires a significant degree of confidence. OVER confidence though can lead to problems. Can lead to tendencies to thinking that you know more than you actually do about a subject/condition than you do. Avoid this by remaining open-minded/objective as possible when evaluating how much eidence has been gathered and whether it has been gathered in a logical and thorough fashion

Question 40

Confirmation Bias

Answer 40

This happens when looking primarily for evidence which supports a belief or diagnosis that we already have in mind, so looking to actually get a confirmation of our belief

Question 41

Illusionary correlation

Answer 41

Seems that one event leads to another. Be skeptical about an event that conveinently leads to another. Do NOT jump to conclusions about an incident or finding or diagnosis. It may stop your from doing an in-depth assessment, so make sure that you do not allow this to happen.

Question 42

Anchoring and Adjustment

Answer 42

May consider a particular condition to be likely, and later thinking is anchored to that hypothesis. The EMT may adjust in time, but sometimes not as much as neccessary because of the starting point. An EMT may initially think that an unconscious person is “just dunk” and when information appears that she may have had head trauma, the EMT may cling to that hypothesis that they originally had anchored.

Question 43

Search Satisfying

Answer 43

You can be very satisfied when finally finding the cause of the problem. HOWEVER, once this HAPPENS, you can actually find yourself just STOPPING there, you may not look for any other problems. You need to continue your assessment and keep an open mind, and be satisfied about finding the one cause, but understand that there may be more than one thing wrong with any patient you are dealing with

Question 44

You and your partner are discussing a call you previously had. The EMT said the patient presented with classic MI sx. That is how you treated the patient. The patient was discharged 2 hours after you delivered him to the hospital. You are concerned that your assessment skills may be criticized and be viewed as not being as good as they should be, and the ED Physician will no longer trust your judgement. What should you think about when regarding your actions taken on this call? 1. Your misdiagnosis is a result of limited information 2. Your misdiagnosis is a result of confirmation bias 3. Your misdiagnosis is a common EMT mistake caused by illusionary correlation 4. Your misdiagnosis is a result of anchoring

Answer 44

1. Your misdiagnosis is a result of limited information

Question 45

You have a patient you is unresponsive on the floor. What is the best way to rule out trauma as a cause of your patients unresponsiveness? 1. Check the patients blood glucose in order to rule out hypoglycemia 2. Perform a stroke scale on the patient 3. Look for bystanders and ask them if they witnessed the incident 4. Examine the patient for signs of trauma

Answer 45

3. Look for bystanders and ask them if they witnessed the incident

Question 46

You respond to a patient with SOB, He reports that his breathing problems began this morning and have gotten worse over the day up until he finally called for you (over the last few hours). You ask if he has taken anything to help with his symptoms and he tells you that he has used his inhaler several times in the last hour. The information you have just gathered can be classified as: 1. results of a physical exam 2. the hx of present illness 3. relevant past medical hx 4. part of the SAMPLE hx

Answer 46

2. The hx of present illness

Question 47

An EMT’s assessment differs from an assessment made in the ED in which way? 1. The ED Physician 2. The EMT is working with limited resources 3. An EMT’s focus on life threats first 4. Time is available in the ED to make a diagnosis

Answer 47

2. The EMT is working with limited resources

Question 48

You are attending to an elderly patient who reports of having stomach cramps for several hours. He denies any trauma and has not eaten for several hours. Which of the following is most important to your assessment of this patient? 1. Asking if he has been having regular bowel movements 2. asking him if he is able to walk 3. determining if he has been taking his medications as prescribed 4. Finding out if he has any chest pain

Answer 48

1. Ask if he has been having regular bowel movements

Question 49

A description of a patients condition that assists a clinician in further evaluation and tx is known as which of the following? 1. Clinical decision 2. Red Flag 3. Diagnosis 4. Critical Thinking

Answer 49

3. Diagnosis