Brady2, Emergency Care Slides

1
Chapter
11
Assessment of the Medical Patient
2
Chapter
11

• Focused History and Physical Exam
  (Responsive Patient)
• Focused History and Physical Exam
  (Unresponsive Patient)

3
Focused History and Physical Exam
Responsive Medical Patient
4
Steps in Focused History and Physical Exam
Responsive Medical Patient

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

5
History of Present Illness

Onset Provocation Quality Radiation
Severity Time
O P Q R S T
6
SAMPLE History
Signs and symptoms Allergies
Medications Pertinent past history Last
oral intake Events leading to problem

S A M P L E
7
Focused Physical Exam
As appropriate, assess

• Head
• Neck
• Chest
• Abdomen
• Pelvis
• Extremities
• Posterior

8
Baseline Vital Signs

• Respirations
• Pulse
• Skin color, temperature, condition

• Pupils
• Blood Pressure

9
When the patient has a chief complaint for
which you can administer treatment, you will
need to get certain additional information.
(Continued)
10
Get additional information for

• Chest pain
• Difficulty breathing
• Allergies
• Altered mental status
• Poisoning and overdose
• Exposure to heat or cold

11
Focused History and Physical Exam
Unresponsive Medical Patient
12
Steps in Focused History and Physical Exam

Unresponsive Medical Patient

• Rapid physical exam
• Baseline vital signs
• Consider requesting ALS
• History of present illness
• SAMPLE history

13
Position patient to correct airway.
14
Rapid Assessment
Start with rapid assessment

• Head
• Neck
• Chest
• Abdomen
• Pelvis
• Extremities
• Posterior

15
Baseline Vital Signs

• Respirations
• Pulse
• Skin color, temperature, condition

• Pupils
• Blood Pressure

16
History of Present Illness
Onset Provocation Quality Radiation
Severity Time
O P Q R S T

17
Sample History
Get SAMPLE history from bystanders, family, or
friends.
18
REVIEW QUESTIONS
1. What is the order of the focused
history and physical exam of a responsive medical
patient?
2. What do the letters in OPQRST
stand for?
19
REVIEW QUESTIONS
3. What questions do you ask to
get a SAMPLE history?
4. What is the order of the four steps
in the focused history and physical exam of an
unresponsive medical patient?
20

• What is the priority of this patient?
• What are the next steps in the management of
  this patient?
• What part of the focused history and physical
  exam
• should follow next?
• What signs or symptoms would you look for to
  determine
• if the patient was getting better or worse?