Principles of Patient Assessment in EMS

1. Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

2. Chapter 11 – Detailed Physical Examination © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

3. Objectives • Describe the patients on whom the EMS provider should perform a detailed physical examination (DPE). • Explain when the EMS provider would perform a DPE. • Describe how and why the approach to the DPE is modified for children. • List the three general types of closed soft tissue injuries that the EMS provider may discover during an examination. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

4. Objectives (continued) • Describe the various types of open soft tissue injuries that the EMS provider may discover during an examination. • List the body areas and specific assessment points for each. • Explain how the acronym DCAP-BTLS may be useful during the DPE. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

5. Objectives (continued) • Provide an example of when the DPE would not be performed by the EMS provider. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

6. Introduction • The detailed physical exam (DPE) is a complete head-to-toe exam for the non-life or limb-threatening conditions. • The DPE is performed on trauma patients with a significant MOI. • The DPE is usually completed during transport unless there is a delay. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

7. Detailed Physical Exam • For most patients assess in a head-to-toe direction. • For young children the toe-to-head approach is used to decrease fear and anxiety. • Soft tissue injuries discovered are classified as “opened” or “closed.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

8. Closed Soft Tissue Injuries • Contusion • Hematoma • Crush injuries © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

9. Open Soft Tissue Injuries • Abrasion • Avulsions • Incisions • Lacerations • Punctures/penetrations • Amputations • Impaled objects • Major artery lacerations • Crush injuries © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

10. Examine the Following Areas: • Head • Assess for DCAP-BTLS and crepitus • Common injuries are contusions and lacerations, which bleed profusely • Face • Assess for DCAP-BTLS, crepitation and symmetry • Palpate facial bones for stability • Vision problems can result from instability © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

11. Examine the Following Areas: • Eyes • Assess for DCAP-BTLS, pupil response, and eye movement • Note any discoloration in the anterior chamber and around the eye (Raccoon’s eye) • Nose • Assess for DCAP-BTLS, and fluid drainage • Drainage may include blood or CSF • For patients that are immobilized, drainage may become an airway obstruction © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

12. Examine the Following Areas: • Ears • Assess for DCAP-BTLS and fluid drainage • Allow fluids to drain • Mouth • Assess for DCAP-BTLS, crepitation, loose or broken teeth, swelling or laceration of the tongue or throat, unusual odors, discoloration, and drainage • Assess need for suction or airway adjuncts © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

13. Examine the Following Areas: • Neck • Assess for DCAP-BTLS, crepitation and JVD • May be necessary to open c-collar to assess, maintain manual stabilization • Chest • Assess for DCAP-BTLS, crepitation, symmetry and paradoxical motion • Listen to breath sounds • Note any scars • Apply chest compression to reveal rib fractures © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

14. Examine the Following Areas: • Abdomen • Assess for DCAP-BTLS, guarding, rigidity, masses/bulging (pulsing or firm) or distension • Prior to palpation, listen for absence of bowel sounds (if feasible) • Ask the patient about distension or bloating • Do not touch any masses • Note any scars • Consider females of child bearing age to be pregnant © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

15. Examine the Following Areas: • Pelvis • Assess for DCAP-BTLS, crepitus, and stability • Apply pressure on pelvic ring and pubic synthesis • Reconsider the MOI for possible pelvic injury • Posterior • Assess back and buttocks for DCAP-BTLS and crepitation • When patient is on a long board prior to the exam, use fingers to reach under © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

16. Examine the Following Areas: • Extremities • Assess for DCAP-BTLS and distal PMS • Compare side to side and assess for strength and reflexes • Assess the range of motion (ROM) • With major degloving injury or amputation assess for bleeding • Crush injuries have the potential for immediate complications when crush is a lengthy time © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

17. Priority Determines Care • The DPE is conducted: • Only if time permits • Usually enroute to the hospital • When the patient’s condition is critical the priority should be: • Necessary interventions • Serial initial assessments • Transport © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

18. Conclusion • The DPE is a thorough head-to-toe exam of the trauma patient who has significant MOI. • The approach differs for children (toe-to-head). • The DPE is completed enroute to the hospital if time and personnel permit. • Report all findings to the next care giver and carefully document your findings. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.