1. Principles of Patient Assessment in EMS

2. Focused History and Physical Exam of the Medical Patient

3. Introduction
In the absence of trauma it is most likely a medical complaint
Determine the chief complaint
Responsive patients – begin SAMPLE & FH, get the history of present illness
Positive findings
Pertinent negatives

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FH & PE Medical Patient
Determine if the patient is responsive
Reasonable response
Can interview patient if they are responsive
Establish rapport and obtain consent
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5. The Responsive Medical PatientCC
OPQRST
SAMPLE
Focus PE on specific body system:
Respiratory or cardiac
Neurological or behavioral
Abdominal or obstetrical
Geriatric or pediatric
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Questions to Ask
CC – Why was EMS called?
O – When did symptoms/ CC begin?
P – What seems to provoke it (ie: exercise, fever)?
Q – How do you describe the sensation (ie: crushing, stabbing, pressure…)?
R – Where is the pain & where does it go? Does anything relieve it?
S – How would you rate this experience on a scale of 1 to 10?
T – When did it start?
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7. Responsive Medical Patient: SAMPLE Examples
S – nausea, vomiting, blurred vision
A – drugs, insects, plants, environmental
M – lasix, potassium, insulin, penicillin
P – recent surgery, CABG, pacemaker, diabetes
L – meal, drinks, meds
E – stress or emotional event
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8. Responsive Medical Patient: Additional Steps
Focused PE (guided by the CC):
Respiratory
Cardiac
Neurological
Behavioral
Abdominal
Geriatric
Pediatric
Multiple body systems evaluated as needed (skin, muscles, circulatory, GI…)
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9. The Unresponsive Medical Patient
Begin with the PE, then talk
Perform a rapid physical exam (RPE)
Get baseline VS
Consider other tests:
EtCO2
Pulse oximetry
Temperature
ECG
Blood sugar
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10. Speak to The Family & Bystanders
Ask about SAMPLE history
Ask about patient’s general health status
Ask for list of meds
Ask about advanced directives
Take one family member along to the hospital
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Look for Clues!
Vial of Life
Medic alert bracelet, necklace, or anklet
Global Med-Net service
Look in the refrigerator for meds
Have the police look for a wallet card
Look for meds and check them in your pocket reference
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Conclusion
The FH & PE follows one of two pathways depending if the patient is responsive or not responsive.
The order of steps in the FH & PE of the medical patient depends on the patients responsiveness.
The exam is either rapid, in the patient who is not responsive, or focused in the responsive patient.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.