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Principles of Patient Assessment
in EMS

Chapter 9 – Focused History and
Physical Exam of the Medical
Patient
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

Objectives
 Describe the approach for obtaining a
focused history from a responsive medical
patient.
 Explain how the EMS provider might
obtain a focused history from an
unresponsive patient.
 Provide examples of positive findings and
pertinent negatives for a medical patient.

Objectives (continued)
 Describe how the two acronyms OPQRST
and SAMPLE are used to obtain essential
medical history information.
 List the components of the focused
physical exam (PE) for the medical
patient.

Objectives (continued)
 Describe how the approach to the PE of a
responsive medical patient differs from the
approach to the unresponsive patient.

Introduction
 In the absence of trauma it is most likely a
medical complaint
 Determine the chief complaint
 Responsive patients – begin SAMPLE &
FH, get the history of present illness
 Positive findings
 Pertinent negatives

FH & PE Medical Patient
 Determine if the patient is responsive
 Reasonable response
 Can interview patient if they are
responsive
 Establish rapport and obtain consent

The Responsive Medical Patient
 CC
 OPQRST
 SAMPLE
 Focus PE on specific body system:
 Respiratory or cardiac
 Neurological or behavioral
 Abdominal or obstetrical
 Geriatric or pediatric

Questions to Ask
 CC – Why was EMS called?
 O – When did symptoms/ CC begin?
 P – What seems to provoke it (ie: exercise,
fever)?
 Q – How do you describe the sensation (ie:
crushing, stabbing, pressure…)?
 R – Where is the pain & where does it go? Does
anything relieve it?
 S – How would you rate this experience on a
scale of 1 to 10?
 T – When did it start?

Responsive Medical Patient:
SAMPLE Examples
 S – nausea, vomiting, blurred vision
 A – drugs, insects, plants, environmental
 M – lasix, potassium, insulin, penicillin
 P – recent surgery, CABG, pacemaker,
diabetes
 L – meal, drinks, meds
 E – stress or emotional event

Responsive Medical Patient:
Additional Steps
 Focused PE (guided by the CC):
 Respiratory
 Cardiac
 Neurological
 Behavioral
 Abdominal
 Geriatric
 Pediatric
 Multiple body systems evaluated as
needed (skin, muscles, circulatory, GI…)

The Unresponsive Medical Patient
 Begin with the PE, then talk
 Perform a rapid physical exam (RPE)
 Get baseline VS
 Consider other tests:
 EtCO2
 Pulse oximetry
 Temperature
 ECG
 Blood sugar

Speak to The Family & Bystanders
 Ask about SAMPLE history
 Ask about patient’s
general health status
 Ask for list of meds
 Ask about advanced
directives
 Take one family member
along to the hospital

Look for Clues!
 Vial of Life
 Medic alert bracelet, necklace, or anklet
 Global Med-Net service
 Look in the refrigerator for meds
 Have the police look for a wallet card
 Look for meds and check them in your
pocket reference

Conclusion
 The FH & PE follows one of two pathways
depending if the patient is responsive or
not responsive.
 The order of steps in the FH & PE of the
medical patient depends on the patients
responsiveness.
 The exam is either rapid, in the patient
who is not responsive, or focused in the
responsive patient.

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Principles of assessment for ems chapter 09

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