6. Patient Assessment: Overview
General approach:
Look, listen, feel, smell
(Inspection, Auscultation, Palpation, Olfaction)
Priorities:
• Airway
• Breathing
• Circulation
History and exam
7. Focused History
S: Symptoms
A: Allergies
M: Medications
P: Pertinent past medical history
L: Last oral intake
E: Events
8.
9. More details of Chief Complaint
O: Onset
P: Provocation
Q: Quality
R: Region
R: Radiation (of pain)
R: Relieving factors
S: Severity
T: Time
10. Examination
Primary Survey:
Airway: Open airway? Snoring? Struggling?
Breathing: Is patient breathing, in distress?
Circulation: Pulse present? Active bleeding?
Skin perfusion?
Disability: Unresponsive? Paralyzed?
Major deficits?
Exposure: Remove or look under clothes
11. Level of Consciousness
A: Alert
V: responds to Verbal stimuli
P: responds to Painful stimuli
U: Unresponsive
Alternative descriptions:
Lethargic, obtunded, stuporous, comatose
Glasgow Coma Scale
12. Examination
Secondary Survey:
History
Vital signs:
Pulse rate, quality, location
Respiratory rate and effort
Blood pressure
Temperature
Head-to-toe quick exam
13. Physical Exam Clues
Pulse:
Rapid, full Early bleeding, fear, fever,
exercise, high BP
Rapid, weak Shock, allergic reaction,
failing heart, dehydration
Slow Airway problem, brain injury,
drug overdose, stroke
Irregular Cardiac arrhythmia, ischemia
No pulse Cardiac arrest
14. Physical Exam Clues
Skin:
Cool, damp Shock, hemorrhage,
hypoglycemia, allergic rxn
Cold, dry Exposure to cold
Hot, wet Infection
Heat exposure / heat stroke
Hot, dry Heat stroke, infection,
some drug overdoses
Flushed Infection, drugs, heat exposure
Blue (cyanotic) Hypoxia—check A & B
16. Reassess the patient…
Symptoms: What patient tells you
Signs: What you find on exam
Serial exams are crucial!
Reassess patient after each
intervention, and recheck vital signs
every 5-10 min.
