Emergency Medicine - 2009
Patient Assessment in Emergency Medicine
Patient Assessment: Overview
General approach: Look, listen, feel, smell
(Inspection, Auscultation, Palpation, Olfaction)
Priorities: • Airway• Breathing• Circulation
History and exam
Focused History
S: Symptoms
A: Allergies
M: Medications
P: Pertinent past medical history
L: Last oral intake
E: Events
More details of Chief Complaint
O: Onset P: ProvocationQ: QualityR: RegionR: Radiation (of pain)R: Relieving factorsS: SeverityT:Time
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
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
Examination
Secondary Survey: History Vital signs:
Pulse rate, quality, location
Respiratory rate and effort
Blood pressure
Temperature
Head-to-toe quick exam
Physical Exam Clues
Pulse:Rapid, full Early bleeding, fear, fever,
exercise, high BPRapid, weak Shock, allergic reaction,
failing heart, dehydrationSlow Airway problem, brain injury,
drug overdose, strokeIrregular Cardiac arrhythmia,
ischemiaNo pulse Cardiac arrest
Physical Exam Clues
Skin:Cool, damp Shock, hemorrhage,
hypoglycemia, allergic rxnCold, dry Exposure to coldHot, wet Infection
Heat exposure / heat strokeHot, dry Heat stroke, infection,
some drug overdosesFlushed Infection, drugs, heat exposureBlue (cyanotic) Hypoxia—check A & B
Physical Exam Clues
Pupils:Dilated, reactive Stimulant drugs
FearDilated, fixed Brain death
Atropine / eye dropsConstricted Narcotics
Pontine strokeUnequal CNS catastrophe
CongenitalGlass eye!
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.