Principles of Patient Assessment in EMS. Comprehensive Exam and Health Assessment.

Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

Comprehensive Exam and Comprehensive Exam and Health Assessment Health Assessment

IntroductionIntroduction Comprehensive exam and health Comprehensive exam and health

assessment is an exam of the body as assessment is an exam of the body as a whole.a whole.

Most often performed in the clinic Most often performed in the clinic setting.setting.

This is a lengthy process, thus not This is a lengthy process, thus not appropriate in the prehospital setting.appropriate in the prehospital setting.

Some parts of the exam may be useful Some parts of the exam may be useful in the field. in the field.

Using the SensesUsing the Senses Examiner utilizes inspection, Examiner utilizes inspection,

auscultation, palpation, and auscultation, palpation, and percussion to complete the process.percussion to complete the process.

In forming a general impression, In forming a general impression, inspection (both visual and smell) are inspection (both visual and smell) are utilized.utilized.

Look for signs of distress and begin Look for signs of distress and begin to differentiate normal from to differentiate normal from abnormal findings. abnormal findings.

Inspection & PalpationInspection & Palpation Note age, gender, behavior, skin Note age, gender, behavior, skin

CTC, hygiene and appropriate dress.CTC, hygiene and appropriate dress. Note any unusual odors or pertinent Note any unusual odors or pertinent

visual clues.visual clues. Utilize light tough, deep touch, and Utilize light tough, deep touch, and

compare side-to-side for symmetry.compare side-to-side for symmetry. Warm your hands/equipment prior to Warm your hands/equipment prior to

touching the patient.touching the patient. Explain your steps prior to touching. Explain your steps prior to touching.

PercussionPercussion Combines touching and tapping the Combines touching and tapping the

fingertips on various body parts while fingertips on various body parts while listening to determine size, position listening to determine size, position and consistency of underlying and consistency of underlying structures. structures.

The Comprehensive ExamThe Comprehensive Exam A complete head-to-toe exam (small A complete head-to-toe exam (small

children toe-to-head).children toe-to-head). Components include: MS, a general Components include: MS, a general

survey, VS, skin CTC, head, eyes, survey, VS, skin CTC, head, eyes, ears, nose, and throat (HEENT), chest ears, nose, and throat (HEENT), chest and cardiopulmonary system, and cardiopulmonary system, abdomen, external genitalia, abdomen, external genitalia, musculoskeletal, peripheral vascular musculoskeletal, peripheral vascular and nervous systems.and nervous systems.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Comprehensive Exam Comprehensive Exam (continued)(continued)

MS:MS: Observe appearance, behavior and Observe appearance, behavior and

postureposture IA use AVPU and GCS (as necessary)IA use AVPU and GCS (as necessary)

Appearance:Appearance: Observe dress, grooming, personal Observe dress, grooming, personal

hygienehygiene Facial expressions often provide cluesFacial expressions often provide clues


Behavior:Behavior: Observe emotions, character of Observe emotions, character of

responses, appropriate physical responses, appropriate physical movement and ROMmovement and ROM

Observe the patient’s manner, affect, Observe the patient’s manner, affect, and interaction to their surroundingsand interaction to their surroundings




Speech:Speech: Assess speech and language for quality, Assess speech and language for quality,

rate, loudness and impairmentsrate, loudness and impairments 4 types of speech impairments include: 4 types of speech impairments include:

language, articulation, voice production language, articulation, voice production and fluency disordersand fluency disorders

New onset is a significant finding (CVA, New onset is a significant finding (CVA, TBI, tumor)TBI, tumor)


Mood:Mood: Assess for appropriateness for present Assess for appropriateness for present

situationsituation Some patient’s will have diagnosis of Some patient’s will have diagnosis of

mood disorders and may exhibit mood disorders and may exhibit changes due to disorders (mania, changes due to disorders (mania, depression)depression)




Thought Content:Thought Content: Assess patient’s thought content and Assess patient’s thought content and

perceptions for logical and organized perceptions for logical and organized thought processesthought processes

Assess patient’s insight into his own Assess patient’s insight into his own illness and ability of judgment/decision illness and ability of judgment/decision making about daily routine/caremaking about daily routine/care

Abnormal findings may include: phobias, Abnormal findings may include: phobias, hypochondriasis, obsession, compulsion hypochondriasis, obsession, compulsion or delusionsor delusions


Perceptions:Perceptions: Abnormal findings may include: Abnormal findings may include:

illusions, hallucinations, blocking, illusions, hallucinations, blocking, confabulation, neologism, confabulation, neologism, circumlocation, circumstantiality, circumlocation, circumstantiality, loosening associations, flight of ideas, loosening associations, flight of ideas, word salad, echolalia, and clangingword salad, echolalia, and clanging




Memory:Memory: Assess short term, long term, and recall Assess short term, long term, and recall

memorymemory If AMS check blood sugarIf AMS check blood sugar


General Survey:General Survey: LOC and signs of distressLOC and signs of distress Apparent state of health and skin CTCApparent state of health and skin CTC Height, build, and sexual developmentHeight, build, and sexual development WeightWeight Posture, gait and motor activityPosture, gait and motor activity Dress, grooming, personal hygieneDress, grooming, personal hygiene Odors and facial expressionsOdors and facial expressions




Vital Signs:Vital Signs: Obtain a complete set of baseline and Obtain a complete set of baseline and

serial vitalsserial vitals The Skin:The Skin:

Inspect and palpate noting the following Inspect and palpate noting the following characteristics:characteristics:

Color, moisture, temperature, texture, Color, moisture, temperature, texture, mobility and turgor, lesions, hair mobility and turgor, lesions, hair distribution, nailsdistribution, nails



Head, Ears, Eyes, Nose, and Throat (HEENT):Head, Ears, Eyes, Nose, and Throat (HEENT): Palpate and inspect the scalp for DCAP-BTLSPalpate and inspect the scalp for DCAP-BTLS Note facial asymmetry/deficits, skin CTC, hair distributionNote facial asymmetry/deficits, skin CTC, hair distribution Assess visual acuity, visual fields, EOMS, accomodation, Assess visual acuity, visual fields, EOMS, accomodation,

and pupillary reactionand pupillary reaction Use of an opthalmoscope to perform a detailed exam of Use of an opthalmoscope to perform a detailed exam of

the eye requires practicethe eye requires practice Assess ears for drainage acute hearing loss is a Assess ears for drainage acute hearing loss is a

significant findingsignificant finding Use of an otoscope to perform a detailed exam of the ear Use of an otoscope to perform a detailed exam of the ear

requires practicerequires practice Inspect the nose for DCAP-BTLS and drainageInspect the nose for DCAP-BTLS and drainage Inspect lips, mouth, tongue, teeth and throatInspect lips, mouth, tongue, teeth and throat Inspect neck, note scars and JVD and ROMInspect neck, note scars and JVD and ROM Inspect and palpate posterior neck for DCAP-BTLSInspect and palpate posterior neck for DCAP-BTLS



Chest:Chest: Have the patient expose the chest (female Have the patient expose the chest (female

keep on bra)keep on bra) Proceed in an orderly fashion comparing side-Proceed in an orderly fashion comparing side-

to-side by inspection, palpation, percussion, to-side by inspection, palpation, percussion, and auscultationand auscultation

Cardiovascular System:Cardiovascular System: Assessment includes: Assessment includes:

PulsesPulses BPBP JVDJVD lung soundslung sounds Heart sounds and PMIHeart sounds and PMI edema (peripheral/pulmonary)edema (peripheral/pulmonary) ECGECG



Abdomen:Abdomen: Normal abdomen is soft, non-tender, Normal abdomen is soft, non-tender,

and without masses or bulgesand without masses or bulges Inspect, auscultate and palpate in orderInspect, auscultate and palpate in order

External Genitalia:External Genitalia: Exam is usually not necessary unless Exam is usually not necessary unless

there is a specific injury or imminent there is a specific injury or imminent childbirthchildbirth

Same sex examiner is often preferredSame sex examiner is often preferred Protect patient modestyProtect patient modesty



Musculoskeletal Exam of the Upper Musculoskeletal Exam of the Upper and Lower Extremities:and Lower Extremities: Assess DCAP-BTLS and ROMAssess DCAP-BTLS and ROM In lower extremities assess reflexes and In lower extremities assess reflexes and

gaitgait Spine:Spine:

Assess normal spinal curves (cervical, Assess normal spinal curves (cervical, thoracic, and lumbar)thoracic, and lumbar)

Note any abnormal curvatures (lordosis, Note any abnormal curvatures (lordosis, kyphosis, or scoliosis)kyphosis, or scoliosis)

Assess ROM and DCAP-BTLSAssess ROM and DCAP-BTLS© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.


Peripheral Vascular System:Peripheral Vascular System: Exam includes: palpation of distal pulse Exam includes: palpation of distal pulse

points, inspection for symmetry, size, points, inspection for symmetry, size, presence of swelling, venous patterns, presence of swelling, venous patterns, color of skin, nail beds, and skin texturecolor of skin, nail beds, and skin texture

Note unusual venous enlargement, Note unusual venous enlargement, absent pulses, pigmentation, enlarged absent pulses, pigmentation, enlarged nodes, rashes, scars, ulcers, and edemanodes, rashes, scars, ulcers, and edema


Nervous System:Nervous System: The components of the neuro exam may be The components of the neuro exam may be

completed concurrently with other completed concurrently with other assessmentsassessments

Organize the exam into 5 categories: Organize the exam into 5 categories: MS and speechMS and speech Cranial nervesCranial nerves Motor systemMotor system Sensory systemSensory system ReflexesReflexes



The Health AssessmentThe Health Assessment Focus on the current state of health, Focus on the current state of health,

past medical history environmental past medical history environmental conditions, and patient’s personal conditions, and patient’s personal habits.habits.

The comprehensive patient history. is The comprehensive patient history. is generally not obtained in the field generally not obtained in the field due to lack of time.due to lack of time.

Use SAMPLE to rapidly obtain Use SAMPLE to rapidly obtain relevant medical info.relevant medical info.


The patient history includes: date, The patient history includes: date, time, age, sex, birthplace, and time, age, sex, birthplace, and occupation, info that is not identified occupation, info that is not identified using SAMPLE.using SAMPLE.

Additional pertinent info includes:Additional pertinent info includes: Who was the source of referral?Who was the source of referral? Who was the source of the history and Who was the source of the history and

how reliable is it?how reliable is it?

The Health AssessmentThe Health Assessment


The Health Assessment The Health Assessment (continued)(continued)

The history of present illness The history of present illness identifies the c/c. The acronym identifies the c/c. The acronym OPQRST is used to elaborate the c/c.OPQRST is used to elaborate the c/c.

The past medical history is a The past medical history is a description of pertinent medical info description of pertinent medical info such as:such as: General state of healthGeneral state of health Childhood or adulthood illnessesChildhood or adulthood illnesses Psychiatric illnessesPsychiatric illnesses Accidents/injuriesAccidents/injuries Major operations and hospitalizationsMajor operations and hospitalizations


The Health Assessment The Health Assessment (continued)(continued)

Environmental conditions and personal habits Environmental conditions and personal habits may offer insight into a patient’s state of health:may offer insight into a patient’s state of health: Med schedules, compliance, allergiesMed schedules, compliance, allergies Tobacco and alcohol useTobacco and alcohol use Drug use and related substancesDrug use and related substances Diet, exercise and leisure activitiesDiet, exercise and leisure activities Screening tests and immunizationsScreening tests and immunizations Sleep patternsSleep patterns Home situation and social statusHome situation and social status Significant others and family historySignificant others and family history Environmental hazards and use of safety measuresEnvironmental hazards and use of safety measures Daily living activitiesDaily living activities Important experiences and religious beliefsImportant experiences and religious beliefs General outlook on lifeGeneral outlook on life


ConclusionConclusion

The comprehensive exam and health The comprehensive exam and health assessment has not traditionally been a assessment has not traditionally been a responsibility of the EMS provider.responsibility of the EMS provider.

It is conducted on a stable patient in a It is conducted on a stable patient in a clinical setting.clinical setting.

Expanded scope of practice may include Expanded scope of practice may include the comprehensive exam and health the comprehensive exam and health assessment.assessment.

This info should help the EMS provider to This info should help the EMS provider to better understand each component and its better understand each component and its application to evaluating the whole patient. application to evaluating the whole patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Principles of Patient Assessment in EMS. Comprehensive Exam and Health Assessment.

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