Unit 14, 15 flashcards
what is the history of present illness (HPI)?
information gathered regarding symptoms and nature of patient’s current concern
What is past medical history (PMH)?
information gathered regarding patient’s health problems in past
What is SAMPLE? to learn about the patient’s past medical history.
signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to injury or illness
OPQRST to learn about the chief
complaint and history of the present illness/injury.
– Onset
– Provocation
– Quality
– Region; radiation
– Severity
– Time
Respiratory Assessment—Physical
Examination
Mental status
Level of respiratory distress
Chest wall motion
Auscultate lung sounds
Use pulse oximetry
Observe edema
Fever
Cardiovascular System—History
- Existing cardiac conditions and medications
- Signs and symptoms of episode
- Description of chest pain using O P Q R S T
- Determine specific characteristics of discomfort
cardiovascular system examination
1) look for signs condition may be severe
2) obtain pulse
3) obtain blood pressure
4) note pulse pressure
5) look for jungular vein distantion
6) palpate the chest
7) observe
nervous system assessment
1) mental status
2) determine their normal state of mental functioning
3) obtain history of neurologic conditions
4) note patients speech
nervous system examination
1) perform a stroke scale
2) check peripheral sensation and movement
3) gently palpate the spine
4) check extremity strength
5) check patients
6) examine the patient gait (pattern of walking)
The most common endocrine emergency
is the diabetic
patient.
Endocrine Assessment—History
- Diabetes mellitus or thyroid disease history
- Current medications and whether being taken properly
- Whether patient has eaten or exerted energy at an unusual level
- Whether patient is sick
- Whether patient has taken blood glucose or uses insulin pump
Endocrine Assessment—Physical
Examination
Evaluate patient’s mental status.
Observe the patient’s skin.
Obtain a blood glucose level.
Look for an insulin pump.
Look for medical jewelry.
Gastrointestinal System Looking for
– What has gone in
– What has come out
– What it looks like when it comes out
Gastrointestinal Assessment—
History
Pain or discomfort (OPQRST)
Oral intake
History of gastrointestinal issues
Vomiting
Bowel movements
Gastrointestinal Assessment—
Physical Examination
- Observe patient’s position.
- Assess the abdomen.
- Inspect other parts of the gastrointestinal system.
- Inspect vomitus or feces if available.
immune system problem most relevant for EMS
allergic reaction
anaphylaxis
Immune System—Physical
Examination
- Inspect point of contact with allergen.
- Inspect patient’s skin for rash or hives.
- Inspect the face, lips, and mouth for swelling.
- Listen to the patient speak.
- Listen to lungs to ensure adequate breathing.
Musculoskeletal Assessment—
History
- Prior injuries
- Whether patient takes blood-thinning medication
- Underlying diseases or conditions that make
fractures more common - History to determine if a medical problem caused
the traumatic injury
Musculoskeletal Assessment—
Physical Examination
1) inspect for signs of injury, such as deformity
2) palpate areas with suspected injury
3) compare sides for symmetry
4) be alert for crepitation
5) Assess patient head-to-toe if there are multiple injuries or if the patient is unresponsive
Crepitation
the grating sound or feeling of broken bones being rubbed together
EMT diagnosis
Diagnosis is label for condition.
– Based on history, physical examination, vital signs
– Involves both physical and intellectual activity
Diagnosis shortcuts and biases
– Representativeness
– Availability
– Overconfidence
– Confirmation bias
– Illusory correlation
– Anchoring and adjustment
– Search satisfying
Secondary Assessment of MEDICAL pateint
- Assessment varies depending on patient’s ability to
communicate.
– Responsive medical patient
▪ Can answer history questions
– Unresponsive medical patient
▪ Cannot answer history questions
Responsive Medical Patient
1) Obtain a patient history.
2) Perform physical exam.
3) Obtain baseline vital signs.
4) Administer interventions and transport the patient.
diagnosis
a description or label for a patient’s condition that assist a clinician in further evaluation and treatment
differential diagnosis
a list of potential diagnoses compiled early in the assessment of the patient
traditional approach to diagnosis in medicine
1) patient assessment (history, physical exam, vital signs, tests)
2) list of possible causes/ diagnoses
3) further evaluation
4) consider results of evaluation
5) narrow the list (may have to consider additional possibilities before reaching diagnosis)
emergency approach to diagnosis
1) primary assessment to find and treat immediate threats to life
2) patient assessment (history, physical exam, vital signs, tests) with special attention to looking for red flags
3) consider the most serious conditions associated with the patient’s presentation and rule them in or out (rule out the worst-case scenario)
4) list of possible causes/diagnoses (differential diagnosis)
5) further evaluation in light of time and resources available in the ED
6) consider results of evaluation
7) narrow the list (may have to re-state the chief complaint as the diagnosis)
EMS approach to diagnosis
1) primary assessment to find and treat immediate threats to life
2) patient assessment (history, physical exam, vital signs, tests) looking for red flags
simultaneously the EMT begins treatment that may be beneficial and is not harmful ex- oxygen
3) consider the most serious condition associated with the patient’s presentation that can be treated in the field and rule them in or out
4) list of possible causes/ diagnosis
5) further evaluation in light of limited time available and restricted resources present in the field
6) consider results of evaluation
7) narrow the list (may need to restate cheif complaint)
representativeness in diagnosis
judging a condition based on symptoms that resemble a particular pattern leading to possible misdiagnosis if a patient doesn’t fit the classic case
availability in decision making
tendency to think of diagnoses that are more easily remembered due to recent experiences
History of the present illness or injury (HPI) versus past medical history (PMH)
HPI- the story of the current illness
PMH- past medical history
primary assesment
initial evaluation focusing on life threatening conditions ABCs: airway, breathing, circulation
secondary assessment
more detailed evaluation SAMPLE and head to toe examination
confirmation bias
focusing on evidence that supports initial diagnosis and ignoring new evidence for a different condition
illusory correlation
believing a relationship exists between two things when in reality there is no actual connection
anchoring and adjustment
relying too much on the first piece of evidence and making minor adjustments when new info is presented
search satisfying
stopping the search for other issues once an initial problem is found
ambiguity importance
emts must be comfy with uncertainty when encountering unknown situations with limited info
How do you open an airway in a spinal injury patient?
jaw thrust
