STATION 1 PA MEDICAL
STATION 1 MEDICAL ASSESSMENT–
Remember ALL your resources – …
VERBALIZE WHAT YOU ARE DOING BUT WHILE YOU ARE DOING IT. SAVES A LOT OF TIME OVER THE COURSE OF THE ASSESSMENT.
DO SAY: I am listening to lung sounds in 2 places OR 4 places, (where ever you are in the assessment - primary or secondary) SAY WHILE YOU ARE DOING IT.
DO SAY: I see her skin as appropriate in color for perfusion and (while feeling) her skin feels warm & dry SAY WHILE YOU ARE DOING IT.
DON’T DO THIS: I’M GOING TO LISTEN FOR LUNG SOUNDS, AND THEN DO IT.
DON’T DO THIS: I’M GOING TO FEEL SKIN COLOR TEMP AND CONDITION, AND THEN DO IT.
Consider C-spine verbally, ASK THEM IF THEY FELL OR BEEN AN ACCIDENT in the last 24 hours. If not then its ruled out.
if they are talking, airway is patent, SAY THAT . then – look in their mouth to make sure and rule out life threat, because if something was there, you would suction, as it would threaten their airway.
REALLY LISTEN TO THE LUNG SOUNDS. STATE WHAT YOU HEAR. Put the scope on the skin. Verbalize that you would expose if necessary, although it will not be, know that some situations might warrant that, for example anaphylaxis – looking for hives (Urticaria) and swelling (Edema).
FEEL THEIR SKIN, IS IT WARM? IS IT CLAMMY? TOUCH THE PT.
FEEL their ankles and feet, say you would remove shoes if necessary for edema assessment
AVPU...Just because they are talking or looking at you, doesn’t mean they are oriented. They may be alert but ask the 3 questions – time, day (of the week) and place to establish orientation. If they can’t successfully do that, they are VERBAL. Intoxicated pts could be alert! But NOT oriented, that is the key.
A good place to get consent is when asking their chief complaint. Ask why they called. Then ask if you can help them today. You can ask them their name here too. Chief complaint √ Consent √ Rapport √
If they have chest pain, ask their medical history (P – Pertinent past medical history), ask if allergic to Aspirin, have any GI bleeds, and if not, give four 81 mg chewable aspirin. (Yes breathing difficulties could be a contraindication for aspirin. If the pt. has chest pain, no difficulty breathing or severe respiratory history, give aspirin, it is the most important. If there is a doubt, meaning that the breathing problems present in a severe fashion and you are that unsure, call med control. Normally not needed, however.)
IMPORTANT. If they have a prescription for NITRO…assure 5 R’s in place. Take blood pressure, if scenario BP is over 120 systolic, ask if they took any ED meds in last 72 hours, ask if they have taken any nitro today and if BP is over 120, no ED meds and not more than 3 doses today, ASSIST THEM WITH THEIR NITRO. Don’t call Med Control. You have to SAY WHY YOU ARE ABLE TO ASSIST THEM (BP, doses, ED meds, assisting). And how often you will reassess their BP (2-3 min.) to assist them with another dose, sublingually, making sure they don’t have any more than 3 doses ( including doses they already took before you got there)
If pt used to have a nitro prescription and it’s gone, you cannot give it from your ambulance. They get oxygen and maybe Aspirin, but not nitro. They can get another prescription later. (ALS) Paramedics and doctors can administer, Basic EMT’s cannot.
And YES you can give both Aspirin and Nitro for a chest pain patient with the above in place.
VERBALLY STATE THE BODY SYSTEM YOU ARE ASSESSING!
For Pulmonary (Respiratory) – Listen to lung sounds in four places, check for pedal edema, verbalize you would use a pulse oximeter to get oxygen saturation level if available. Fluid in the lungs is audible as rales, lower lungs, wheezes in lower lungs. CHF, asthma, COPD, etc.
For Cardiac (Cardiovascular) Listen to lung sounds in four places, check for pedal edema, palpate the chest. Again looking/listening/feeling for fluid. Palpating chest is looking for muscle problems being an additional cause of the pain, and also determining exactly where the pain is; or possibly subcutaneous emphysema, which is felt as an unusual crackling sensation as gas is pushed through the tissues.
Your second general impression is after you have done your interventions. Your pt. stated his pain scale was a 7 back when you asked SEVERITY, now that he has Nitro, Aspirin, Oxygen…what is it now? Has he improved?
You have 10 minutes but DON’T RUSH. You never want your patient (or the proctor, for that matter) to feel like you are flying through an assessment and not providing conscientious care.
relax - you can do this!