# Patient Assessment



## EMTalex (Sep 18, 2006)

Does anyone have any tips for nailing patient assessment?


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## sdadam (Sep 18, 2006)

Are you a student and looking to nail your NR? or do you just mean in general?


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## soon2bemt (Sep 18, 2006)

What worked for me is memorization of the NR skill sheet......everybody is different.  I laminated all of my sheets and they went everywhere with me-and I mean everywhere.  The only thing my instructors could talk about the whole five months of basic was memorize, memorize, memorize.....and believe me it worked.  I went through my NR Trauma assessment in about four minutes and my medical in about five or six.  Oh-and practice, practice, practice.  Get one of your classmates or friends to be a "patient" for you so you actually have something to palpate so you aren't just saying it in your head.  If you practice with a classmate-return the favor for him.  Worked for everyone in our class.  Also, if you are still in class, suggest to your instructor to have some practice skills nights during the two weeks before the NR exam.  I'm sure going to your local ambulance service or FD wouldn't be any harm-most people like to help us newbies out.....


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## EMTalex (Sep 18, 2006)

sdadam said:


> Are you a student and looking to nail your NR? or do you just mean in general?



yeah a student hoping to nail my NR, i also have to pass it with flying colors for class, even before i can get to the NR. <_<


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## Epi-do (Sep 18, 2006)

Practice, practice, practice!  The more you do it, the better you will become at it.  All that practice will also help you figure out a general approach that works best for you.  Because all patients and providers are different, what works best for me may not be what works best for you.  

Yes, you need to know the skills sheets so you can pass the test, but at the same time don't become so rigid in your approach that you are a robot in how you go about doing things.  While you do need to remember to do ABC's before doing a head to toe, don't obsess about what order you ask questions in while obtaining your SAMPLE history.  As you talk to your patient, you will establish a rapport with them and they may be more willing to tell you about any allergies or events that led up to the incident than to discuss past history or meds with you because there is something there that they are embarrassed about.  It's ok to follow his/her lead and work your way to the questions about history and meds with those patients.  

Basically, if you study your skill sheets and practice every chance you get, you will do great.  I was a nervous wreck the day I did my practicals, like everyone else in my class.  I did know my stuff though and passed with flying colors.  Just try not to get too nervous or stessed out about it and you will be fine.


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## EMTalex (Sep 18, 2006)

lol, yeah i'm already nervous about my practical exam and its all the way in December. Thanks for the advice mates!


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## c-spine (Sep 18, 2006)

A tip... take it in chunks. Get a copy of the test-sheet thing, and memorize the first 5 things, which is your initial assessment. Then move on to the next part, get that memorized, and put it together with the first, continue on until you have it memorized and practice the hell out of it.


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## EMTalex (Sep 18, 2006)

I know all the steps (well some more than others (trauma)...more studying required) but i think i'm most worried about the senerio the proctor will throw at me


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## fm_emt (Sep 18, 2006)

EMTalex said:


> I know all the steps (well some more than others (trauma)...more studying required) but i think i'm most worried about the senerio the proctor will throw at me



Just remember the most important step of all - RELAX!


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## gradygirl (Sep 18, 2006)

"Forget" (don't _really_ forget) that you're taking a test. Pretend it's an actual patient and an actualy medical or trauma emergency you're responding to, not a dummy/volunteer sitting in a room with a proctor.

Oh, and remember, BSI, Scene Safety, and ABCs. Better yet, memorize the critical fails, that way if you don't nail any of those, you can sail along through the rest of the scenario.


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## MMiz (Sep 18, 2006)

The truth is, I took my NR four years ago and I'm confident I could still pass their practical assessment.  I haven't worked an EMS shift in a looong time, but the pt assessment is one of those things that I used in the field all the time.  I'd say I could do it with my eyes closed, but I'm pretty sure that's an auto-fail.

I suggest doing it over... and over... and over again.  When you get sick of it, do it ten more times... then again.


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## Ridryder911 (Sep 18, 2006)

I always tell my students to verbalize and use hands on approach as if they were teaching patient assessment. 

Now which is better? I am checking the head, for injuries such as battles signs, PEARLA" or  "I am checking for battle signs, which is bruising behind the ears on the mastoid process, which is an indicator for a basilar skull fracture", "Looking and examining the eyes, not only equal and reactive but the speed if reactivity, as well checking for potential foreign bodies, sclera for jaundice, conjunctiva color, gray which could be an indicator for hemorrhage and shock..." 

I would suggest write everything one can potentially observe and find, and rehearse and re-rehearse over and over again. Where you actually know how and what to assess... remember after identifying and acknowledging "crucial areas, and appropriate treatment, rapid transportation".. you can hone into a detail assessment.. If one impresses the evaluator, they might overlook mistakes you had made... as well they see the same routine assessment over and over as well.. so seeing something new and sharp is impressive. 

Good luck,
R/r 911


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## EMTalex (Sep 18, 2006)

yeah, i think that i've got trauma nailed. I just need to keep practing on medical.


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## Ridryder911 (Sep 19, 2006)

Same thing for medical.. only you have more material to cover. For example how many things you can assess on the abdomen? Do you recall the order of inspecting the abdomen?........... 

Such as inspection, auscultation, then palpation in the opposite side of chief complaint of pain...

As a NREMT examiner, I always like to see those that represent they have knowledge in patient assessment. Since, this should be the most important station.. if one cannot assess, they cannot detect injuries or illness and make an accurate diagnosis...
R/r 911


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## EMTalex (Sep 19, 2006)

whats kinda difficult for me is what questions i need to ask the patient based on what i see. its just alot of memorisation.


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## sdadam (Sep 19, 2006)

Well, my advice would actually be to keep in mind that you are taking a test, and that you know exactly what the evaluator is grading you on, because you have a copy of the assessment sheet that they will be looking at as you do it. 

If your test isn’t till Dec. then I would guess that you may not have gone in to all of the parts of the assessment in depth yet, so although it is great to start studying for it as early as possible, remember that you will spend time learning S&S of specific things, and going over SAMPLE and OPQRST, as well as DCAPP/BTLS. So don’t get to overwhelmed this early in the game, concentrate on making sure that you know the things that you have already spent time going over in class (Scene Survey, Initial Assessment, etc.) so that as you pick up the skills in the rest of pt. assessment you don’t have to keeping coming back to those, I saw a lot of people in my class that knew S&S of everything in the book but forgot a few simple things and failed. 

For me what worked really well was to write out the steps of the pt. assessments on paper, I just kept doing that until I could re-create the score sheet from scratch. My memory is all visual so that works great for me, flash cards too, but everyone learns a different way so you have to find what works for you.

And keep asking for info, I picked up a ton of great tricks from reading these boards!


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## sdadam (Sep 19, 2006)

oh PS I noticed in another post that you are in San Diego, I am too, where are you taking your classes?


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## EMTalex (Sep 19, 2006)

Palomar College! you?


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## sdadam (Sep 20, 2006)

I got mine at palomar too. Good program, what days and times do you have class? I've been meaning to stop by and see bruce.


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## EMTalex (Sep 20, 2006)

Thats cool mate!

umm Tuesdays and Thursdays 9-11:50


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## FireStrut (Sep 21, 2006)

*We have started our pt assessment in class tonight. This is the first time I have laid hands on a dummy pt for trauma and boy did I freeze up. By the end of class I was doing ok, so I was glad about that. I am going to make some copies of these sheets and wherever I go then these papers will go. This stuff is hard but at the same time it is fun too. I think I will be saying SAMPLE and DCAP-BTLS in my sleep.*


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## c-spine (Sep 22, 2006)

It's tough the first few times. I was the same way. I had my sheet in front of me with all the things I need to do for like... the first 2 months....lol. I would suggest memorizing it piece by piece; that's how I learned it. But that's just me. 

Just remember - practice a lot.


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## Ridryder911 (Sep 22, 2006)

Research has shown and proven that mnemonics are helpful in test time and when trying to learn for testing, however; they show as well most do not remember or only partially remember them within one year.

That is why I only teach them for testing purposes only. Terms such as DCAP, CUPS, etc.. are okay, but does not really emphasize the need, and in-detail of assessments. As well, DCAP (a BTLS) term is regional, as we in my area does not use the BTLS rather we use PHTLS, which is identical in theory. 

I truly believe assessments can only improve on practicing and then practicing on real patients. Sure utilize anything that will improve your skills, but then hone onto them as they should get more detailed. Remember assessment is the only way to detect injuries on unresponsive patients. 

R/r911


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## joemt (Sep 24, 2006)

BTLS is Burns, Tenderness, Lacerations, Swelling.. not the BTLS course... what does PHTLS stand for in Assessment Rid?


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## Jon (Sep 24, 2006)

joemt said:


> BTLS is Burns, Tenderness, Lacerations, Swelling.. not the BTLS course... what does PHTLS stand for in Assessment Rid?


The BTLS acronym is taught in the BTLS course.... I think PHTLS teaches it differently.


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## joemt (Sep 24, 2006)

Ahhh it is also taught in a multitude of EMT-B texts... therein lies my confusion... doesn't matter how they learn it to me though.... as long as they know how to complete an effective assessment, it's all pretty much the same.
Jo


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## DT4EMS (Sep 25, 2006)

PHTLS means "Pre-Hospital Trauma Life Support" it is the course not an aconym within it.

BTLS is a course which is Basic trauma Life Support and they have ATLS which is Advanced Trauma Life Support.

We accept both BTLS and PHTLS in our area, but we teach PHTLS at our facility.


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## joemt (Sep 25, 2006)

yes, but when discussed in the Patient Assessment Realm.. BTLS = Burns, Tenderness, Lacerations & Swelling... and is used in the mneumonic DCAP-BTLS.... DCAP = Deformities, Contusion, Abrasions, Punctures/ Penetrations.  I can understand the confusion of all of this though.

And Kip.... we're pretty heavy into BTLS up (and over) here, but I'm familiar with PHTLS as well... ATLS is a Physician based course, and we don't see a lot of Pre-Hospital providers with this level of training.

Jo


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## DT4EMS (Sep 25, 2006)

Yeppers......  I'm very familiar with DCAP-BTLS. 

All medical directors of EMS systems in Missouri must have ATLS. I think most ER Docs are supposed to have it as well. 

We don't offer it here. 

I was aswering your question s to what did "PHTLS" stand for in pateint assesment. I have never heard it before  "in" a patient assesment setting. Not to say it doesn't exist.......... just never heard of it.


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## joemt (Sep 25, 2006)

Sorry.... I seem to be having SERIOUS comprehension issues the last couple of days.... just ignore anything crazy I may say... (by the way, I knew what PHTLS stood for as a program... was thinking that Rid may know a cool new mneumonic for it that was being used in conjunction with Patient Assessment).

Jo


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## DT4EMS (Sep 25, 2006)

joemt said:


> Sorry.... I seem to be having SERIOUS comprehension issues the last couple of days.... just ignore anything crazy I may say... (by the way, I knew what PHTLS stood for as a program... was thinking that Rid may know a cool new mneumonic for it that was being used in conjunction with Patient Assessment).
> 
> Jo




If anyne will have a cool mneumonic for something it will be him! 

And.................... no worries Girl! I think we are all a little light headed right now.............. I am soooooooooooo covered up at work with all of the AHA changes and tryng to get all of the staff up to date...........plus EMT and Medic core (refresher) classes............. I'm pooped!


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