How do you approach your assessment

[daedalus]

The often claimed "most important thing in EMS" (I agree) is the patient assessment. How do you approach it?

I have taken the proper method in stride so I do not have to relearn later. I do this on every prehospital call in the same order:

General information (age, sex, ethnicity)

quick scan of ABCs

C/C (why were we called today?)

HPI (history of present illness)
aka OPQRST

Prior medical and surgical history

Family and social history (rarely appropriate but sometimes I ask about ETOH and drug use)

Allergies

Medications

Review of systems (I actually do this, at least the relevant body systems. If you do not do this, start doing it. Your histories will become so much better. The other day I caught so many missed symptoms and complaints on a abdominal pain patient by just going through the GI review)

and than the exam
general (vital signs, LOC)
and appropriate body systems.


I found that doing it this way makes me feel competent and thorough, and I have been giving better reports since.

I know this is all pretty basic, but it seems like the basic stuff is what we need to work on getting down. How about you?

 

[WuLabsWuTecH]

You do pt info before ABCs?


Scene Safe/Proper BSI

Is this an "Oh S*** situation?"

If yes, proceed with ABCs, cspine as needed, initiate interventions as we find them. Once someone has taken care of ABCs, we move on to rapid assessment including vitals, transport without delay.

No?

Then ABC assessment
Ask about C/C
Vitals (Usually in the order pulse, respirs, bp, pulseox, abnormal qualitative findings, blood glucose)
Focused physical
Get SAMPLE and OPQRST as applicable in those orders.
Ask for additional pertanent information.
Transport

Since we have 3 people on scene, usuall one does the talking, one does the vitals getting, and one starts physical so a lot of the above happens at the same time.



What do you mean review of systems?

 

[Sasha]

You mean writing your assesments, or doing them in general. In general I start off with "Hello, my name is Sasha" gloved handshake if applicable. "And we will be taking you to (insert facility here). How are you feeling today?" and go from there off the patient. If good "So, why are you in the hospital?" and go off the patient.

 

[daedalus]

You mean writing your assesments, or doing them in general. In general I start off with "Hello, my name is Sasha" gloved handshake if applicable. "And we will be taking you to (insert facility here). How are you feeling today?" and go from there off the patient. If good "So, why are you in the hospital?" and go off the patient.

I now preform it the same as I write it out. If it is an IFT, I pretty much do what you do.

Hi, I'm Daedalus, this is my partner (insert name). we will be going to (insert other facility). How are you feeling?

And than, vital signs and a nurses report, any changes? Good to go.

 

[ResTech]

For medical patients I always like to walk into the room and get a good impression by looking at the patient and their environment. I than proceed to introduce myself... " Hi, my name is Derek, I am a Paramedic Student... I understand your having some chest pain today".. or whatever the chief complaint is. I have found this is a good way to open up communication and get the patient talking and the assessment rolls from there.

 

[fma08]

I also was wondering what you meant by review of systems.

 

[mycrofft]

I had the best open ended question to start off.

(Calmly) "Hi, y'all, what's goin' on here?".

While I am taking vitals and observing pt and scene (safety survey done on approach), I make sure to ask the questions I would shoot myself for not asking if they lose consciousness: "Are you taking any medications including over the counters, are you allergic to anything, do you have any pre-extant problems, what's going on now, why have you stopped answering me...".
See?

 

[WuLabsWuTecH]

You mean writing your assesments, or doing them in general. In general I start off with "Hello, my name is Sasha" gloved handshake if applicable. "And we will be taking you to (insert facility here). How are you feeling today?" and go from there off the patient. If good "So, why are you in the hospital?" and go off the patient.

If that works for you, that's great, but for me that's a bit too personal. I'm here to help you in your emergency, not to make new friends so the handshake is a bit too much for me. I haven't seen it in my partners either. But you do have a certain people charm about you--I don't carry Roxy with me!

Just out of curiosity, you guys choose the hospital for the patient? I've never heard of that except in instances when a lot of hospital close...

 

[Hockey]

A handshake? Can't say I've ever done that (maybe at the end with a family member or something)

Maybe its because I know how vulnerable you can become to attack by giving a handshake.


First words out of my mouth on every call usually is "Whats going on here today?"

 

[daedalus]

I also was wondering what you meant by review of systems.

a series of questions to interrogate about other symptoms that were not found during your history of present illness, completed by body systems.

http://medinfo.ufl.edu/year1/epc97/handouts/ros.html

 

[Sasha]

If that works for you, that's great, but for me that's a bit too personal. I'm here to help you in your emergency, not to make new friends so the handshake is a bit too much for me. I haven't seen it in my partners either. But you do have a certain people charm about you--I don't carry Roxy with me!

Just out of curiosity, you guys choose the hospital for the patient? I've never heard of that except in instances when a lot of hospital close...

I'm on IFT. When we are dispatched, we already have a destination, and there is always a reason for the transport. Maybe they need a urologist and the sending hospital does have that specialty, maybe they're having a STEMI and need to go to a hospital with a cath lab, not the little super clinic (that is a hospital that is just barely above a clinic, transfers anyone who requires more than a bandaid, it seems. ) that EMS brought them too or they walked in to. I have only had to divert from that recieving hospital once and that is because the patient changed thier mind completely and wanted to go home.

I also did state "If applicable". If we walk in and the nurses go "Who are you picking up? 2!?!? OH THANK GOD!!!" we find out a little more about the reaon behind the "Oh thank God!" before we go into the room, if it's just because they're cranky, I'll still do my best to be personable and such, if it's because they are combative and restrained, or have a propensity to batter the nurses, no handshake for them!

I find that if you are personable and cheerful, the patients (even the cranky ones) are more recpetive and easier to deal with. Even our emergent transports. It takes all of two seconds to introduce yourself, handshake or not, before you go disconnecting and reconnecting them.

 

[wyoskibum]

The often claimed "most important thing in EMS" (I agree) is the patient assessment. How do you approach it?

I agree and it is import to have systematic and consistent approach to be sure that you are doing a thorough assessment. It is a difficult skill to teach and most people just need plenty of experience before they become more confident.

When we teach assessment, we tend to teach it sequentially. In reality, most of can multi-task. When we walk in the door we are forming our General Impression while observing age, sex, MOI/NOI. We are obtaining SAMPLE Hx while our partner is obtaining baseline vitals, applying ECG, etc..

I found that doing it this way makes me feel competent and thorough, and I have been giving better reports since.

Which is important especially when you start forming an impression and deciding what treatment to give your patients. Or if you need to get an order for a certain drug or justify your treatment.