1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 2 Patient Assessment

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 1 The History

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Establishing Patient Rapport The Comprehensive Patient History Special Challenges

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Interview In the majority of medical interviews, field diagnosis is based on history. It is conducted simultaneously with the physical exam. It is a structured, flexible, tool with several components. Patient condition dictates length and completeness.

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Situation, the patient, and conditions will determine ability to establish rapport. Respond to the patient with empathy to gain trust. Patient’s response to questions will guide the exam.

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Setting the Stage –In a healthcare facility, if a patient’s chart is available, review it before interviewing the patient. –Gather information from the first responder personnel. –Reconfirm information. Maintain an open mind!

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ If the patient cannot provide useful information, gather it from family or bystanders.

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport The First Impression –Your appearance should suggest neatness, cleanliness, pride, and professionalism. –Present yourself as a caring, competent, and confident health care professional. –Your voice, body language, gestures, and especially eye contact should communicate that you care about your patient’s problems.

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Introductions –Make eye contact with your patient and maintain it as you conduct the interview. –Use your patient’s name frequently during the interview. Avoid slang terms such as “honey,” “chief,” “pops,” or “sweetie.” –Be aware of other forms of nonverbal communication.

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Asking Questions –Ask questions in a way that elicits accurate information from your patient. –Use a combination of open-ended and closed- ended questions. Open-ended questions allow patient to explain how he/she feels. Closed-ended questions elicit short answers.

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Language and Communication –Effective communication means connecting with your patient. –Barriers to communication include: Cultural differences Language differences Deafness Speech impediments Blindness –When encountering communication barriers, try to enlist someone to help.

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Facilitation Reflection Clarification Empathy Confrontation Interpretation Asking about feelings Active listening techniques:

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Sensitive Topics –A paramedic must learn to become comfortable dealing with sensitive topics. –Sensitive topics may include sexual activities, death and dying, physical deformities, bodily functions, and domestic violence.

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Patient Rapport Sensitive Topics –Familiarize yourself with and practice some opening questions on sensitive topics. –It is critical that you remain calm, objective, and nonjudgmental.

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Comprehensive Patient History

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Preliminary Data Always record the date and time of the physical exam. Determine your patient’s age, sex, race, birthplace, and occupation. –These questions provide a starting point for the interview. After you have gathered the information, you should establish its reliability.

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Chief Complaint Begin with an open-ended question about your patient’s chief complaint. The chief complaint is the pain, discomfort, or dysfunction that caused the patient to request help. When possible, report and record the chief complaint in the patient’s own words.

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Present Illness OPQRST-ASPN Onset of the problem Provocative/ Palliative factors Quality Region/Radiation Severity Time Associated Symptoms Pertinent Negatives

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Past History Ask questions about the patient’s general state of health, childhood and adult diseases, psychiatric illnesses, accidents or injuries, surgeries, and hospitalizations. The patient’s condition, the situation, and time constraints will determine how much information you can and should gather on the scene.

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Current Health Status Current medications Allergies Tobacco Alcohol, drugs, and related substances Diet Screening tests Immunizations

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Current Health Status Sleep patterns Exercise and leisure activities Environmental hazards Use of safety measures Family history Home situation and significant others Daily life

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Current Health Status Important exercises Religious beliefs The patient’s outlook

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ You should take your patient’s medications with you to the hospital, when practical.

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Review of Systems A system-by-system series of questions designed to identify problems your patient has not already identified: –Skin –Head –Eyes –Ears –Nose –Mouth/Throat –Respiratory –Cardiovascular –Gastrointestinal –Genitourinary –Musculoskeletal –Neurologic –Psychologic –Endocrine –Hematologic

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Challenges

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Challenges Silence Overly talkative patients Multiple symptoms Anxiety Depression Sexually attractive or seductive patients Confusing behaviors or symptoms

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Challenges Patients needing reassurance Anger and hostility Intoxication Crying Limited intelligence Language barriers Hearing problems Blindness Talking with families or friends

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Establishing Patient Rapport The Comprehensive Patient History Special Challenges