# How to do a better patient assessment?



## beaucait (Feb 18, 2016)

I am only a student, and working as a student I have seen the EMT's on scene, along with ALS and Paramedics, be the ones to do the patient assessment and somewhat push me to the side. What is a good way that I can do a thorough patient assessment?  I enjoy being in the EMS field, will this change once I become a licensed EMT?


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## MonkeyArrow (Feb 18, 2016)

If you're working with an ALS partner, they will (probably) doing the assessment and you will be helping them (ex. taking vitals). If you work on a BLS ambulance where your partner is also an EMT, then you will probably switch off being the attendant and therefore will get to do patient assessments.


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## STXmedic (Feb 18, 2016)

Are you asking how to do an assessment, or whether or not you'll stop liking EMS?

As to performing a better assessment: Learn the book stuff that everyone claims you don't need. The more you know about physio and patho, the more you know what to ask and what to expect. It'll help you direct your questioning. Once you go through paramedic, you'll get much better at it (hopefully). There's just so little substinance to EMT. Right now it'll just be a checklist to go down.

Making it flow and sound like a conversation will come with assessing more and more patients. You may or may not have that opportunity as a basic, depending on where you work.


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## beaucait (Feb 18, 2016)

STXmedic said:


> Are you asking how to do an assessment, or whether or not you'll stop liking EMS?
> 
> As to performing a better assessment: Learn the book stuff that everyone claims you don't need. The more you know about physio and patho, the more you know what to ask and what to expect. It'll help you direct your questioning. Once you go through paramedic, you'll get much better at it (hopefully). There's just so little substinance to EMT. Right now it'll just be a checklist to go down.
> 
> Making it flow and sound like a conversation will come with assessing more and more patients. You may or may not have that opportunity as a basic, depending on where you work.


I am hoping to read my EMT book li


STXmedic said:


> Are you asking how to do an assessment, or whether or not you'll stop liking EMS?
> 
> As to performing a better assessment: Learn the book stuff that everyone claims you don't need. The more you know about physio and patho, the more you know what to ask and what to expect. It'll help you direct your questioning. Once you go through paramedic, you'll get much better at it (hopefully). There's just so little substinance to EMT. Right now it'll just be a checklist to go down.
> 
> Making it flow and sound like a conversation will come with assessing more and more patients. You may or may not have that opportunity as a basic, depending on where you work.


How to do a better patient assessment. I am alright, but have not gotten much practice in due to the Advanced and Paramedics. 
I know I will love EMS, it's already everything I want to do and more.


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## Qulevrius (Feb 18, 2016)

Caitlin Demers said:


> I am only a student, and working as a student I have seen the EMT's on scene, along with ALS and Paramedics, be the ones to do the patient assessment and somewhat push me to the side. What is a good way that I can do a thorough patient assessment?  I enjoy being in the EMS field, will this change once I become a licensed EMT?



Working BLS is actually a better learning experience for a Basic, as opposed to doing ALS assists & being a sidekick for a medic.As a Basic on a BLS rig, you get an actual patient contact and even though you cannot do much due to a miniscule scope of practice, you'll get progressively better and more confident  with what you learned in school. Just remember that pt assessments = interrogations, be methodical and thorough and you'll eventually get a confession.


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## beaucait (Feb 19, 2016)

When I get licensed as an EMT-B, the company I want to be hired through does a required 100 hours of BLS transportations before you get to do much else. That might be a good thing.
 I thought it was kind of weird that I was being thrown on a shift with an Advanced and a Paramedic, and the second part of my shift two Paramedics.


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## STXmedic (Feb 19, 2016)

The nice thing abour being on the unit with a medic when you're new is that you can fall back on them if you don't know what to do. So being with a medic or AEMT isn't bad for a brand new EMT. I might even argue that it should be preferred, at least initially.


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## Qulevrius (Feb 19, 2016)

STXmedic said:


> The nice thing abour being on the unit with a medic when you're new is that you can fall back on them if you don't know what to do. So being with a medic or AEMT isn't bad for a brand new EMT. I might even argue that it should be preferred, at least initially.



I agree, having someone in the crew with a greater level of knowledge/authority is good for a brand new Basic. But then it can go either north or south, depending on tge individual in question. Some people never stop moving forward, while others will happily rely on their partners to carry them through the shift, no matter how long they've been doing their jobs. I tend to see the latter too often, unfortunately.


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## beaucait (Feb 19, 2016)

Qulevrius said:


> I agree, having someone in the crew with a greater level of knowledge/authority is good for a brand new Basic. But then it can go either north or south, depending on tge individual in question. Some people never stop moving forward, while others will happily rely on their partners to carry them through the shift, no matter how long they've been doing their jobs. I tend to see the latter too often, unfortunately.


That's what I'm afraid of. I do not want to become the EMT who doesn't know what to do because they are always relying on the partner to do everything. I want to be successful and take the lead!


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## NomadicMedic (Feb 19, 2016)

A lot of assessment for non-critical patients comes from being alert, noticing your surroundings and asking the right questions. 

 For example, if I'm talking to a patient who's generally unwell, my partner will usually find and hand me medications. I can start to ask them about their medical history based on the medications that they take. 

 Do you see an oxygen concentrator and tubing running around the house? Chances are they're a COPD patient.  

 Just looking around can give you a lot of clues. 

If I look around the house and see that it's disheveled, I can ask them questions about the last time they ate, if they have help coming in to clean up…  that can give you a good idea as to their mental status. And their level of independence. 

 All important stuff that you need to take note of. 

 The worst thing to do is stage an interrogation. There's nothing I hate more than watching an EMT bark questions at a patient, when they could get a lot more information by having a quiet conversation. 99% of the time there's no hurry… Take your time, be polite, be an active listener. 

 The patient will always tell you what you need to know, you just need to ask the right questions.


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## Qulevrius (Feb 19, 2016)

See, this is how people misinterpret things.  For DEmedic. 'interrogation' means barking out SAMPLE/OPQRST while for me it means to thoroughly investigate and ask the patient the right questions,  ultimately making them tell me what I need to know. Sometimes it's a psychological game when the pt is reluctant or not in the mood to share, and asking the right questions in the right tune, can make all the difference.

This is how I run my assessments (non emergency BLS):

Establish a rapport with the patient 1st, it'll determine how cooperative they will be. Determine LOC/GCS by offering a hand shake, asking for their name, what's the name of the place they live in, how long they lived there et cetera. By this time you'll know LOC, GCS, skin signs, lvl of distress and cap refill time. In the meanwhile the partner either looks for the meds or talks to family members/facility staff. You just have to get into a habit of doing multiple things at once and follow the same pattern for each assessment. Be thorough and methodical,  and everything will eventually fall into place.


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## NomadicMedic (Feb 19, 2016)

Sure, I didn't mean you specifically @Qulevrius. Sorry if it came across that way. However, more often than not I see EMTs running down the SAMPLE list and they're not getting anything back but one word answers. 

In reality, in most cases, a BLS assessment is simply to fill in the checkboxes on the run sheet.

 My point was, have a conversation and know which questions to ask rather than just following a check sheet for questions that may not have any validity or value.


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## beaucait (Feb 19, 2016)

Qulevrius said:


> See, this is how people misinterpret things.  For DEmedic. 'interrogation' means barking out SAMPLE/OPQRST while for me it means to thoroughly investigate and ask the patient the right questions,  ultimately making them tell me what I need to know. Sometimes it's a psychological game when the pt is reluctant or not in the mood to share, and asking the right questions in the right tune, can make all the difference.
> 
> This is how I run my assessments (non emergency BLS):
> 
> Establish a rapport with the patient 1st, it'll determine how cooperative they will be. Determine LOC/GCS by offering a hand shake, asking for their name, what's the name of the place they live in, how long they lived there et cetera. By this time you'll know LOC, GCS, skin signs, lvl of distress and cap refill time. In the meanwhile the partner either looks for the meds or talks to family members/facility staff. You just have to get into a habit of doing multiple things at once and follow the same pattern for each assessment. Be thorough and methodical,  and everything will eventually fall into place.


That's a good way to get a few things out of the way at once. I like that technique. I found it hard to do OPQRST/ SAMPLE to a patient at first because it was choppy because I was not used to it. For example, I had a patient on my ride time, and he was a psychological emergency- they were saying he was suicidal, but through my assessment he said he was not. He wasn't very cooperative or nice by any means, so we got what we could out of him and transported. I see the need and importance for investigating, and for also determining the history of the patient. "Do you have a plan?" he got mad and said "NO!", and said the only reason he felt depressed was because he was not taking his medications.....we didn't even have to ask him for his meds, he just started listing them off.... Meds for anti seizure, meds for PTSD, meds for bi-polar, depression, anxiety, he was on pain killers and had ADHD. That was alot of information at once, however he did not want to be cooperative to any other questions.


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## Qulevrius (Feb 19, 2016)

Yes, verbal judo can work wonders. It's always about how you ask the question, not just what you ask. Counts towards everyone you'll ever come across, including arrogant, non-cooperative nurses...


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## johnrsemt (Feb 19, 2016)

When I worked at busy services as a Medic:  I taught my partners (or helped them fine tune their assessment skills) and then they did all the assessments:  ECF:  I would stop at the desk and get paperwork and report from the staff while my partner went to the patient.   911 (or residence) I would talk to the family members/SO and get info (meds, history, etc) and my partner would do the patient assessment.
There is very little on the assessment that is ALS:  Glucometer, (depending on protocols),  ECG (again protocols).  

This way it taught the basics I worked with to do better job when they are not with a medic, and better partners to a medic


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## johnrsemt (Feb 19, 2016)

as for Patient assessment:   The first minute or 2 on scene:
as you walk into the room look at the patient, (skin color, diaphoresis);  as you are walking towards the patient:  talk to them  "Hello, my name is John, what is your name?":  LOC, Breathing.   When you get to the patient, take a 5-10 second pulse:  No rate; but it will tell you if it is fast or slow, regular or irregular,  and if the patient skin is dry or diaphoretic,  warm or cool.

within a minute you have a decent assessment; and well on the way of knowing if the patient is 'sick or not sick'


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## Jim37F (Feb 19, 2016)

You can also talk to the EMTs and Medics and ask them directly to do more patient assessments. At my last department the Paramedics were in house with us and while they'd typically ask all the questions and whatnot on scene (while us EMTs took vitals, hooked up the monitor and did the BLS skills as needed) if you talked to them, they'd let you start the assessment on the patient  (i.e. be the one asking the questions). They'd be right there ready to guide you, or jump in if you got hopelessly lost, or if the patient was a critical patient. 

Even the EMTs that have been there a while did that you could tell they were really out of practice running assessments so it's always good to just ask your lead medic, practicing is really the only good way to get better.


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## SpecialK (Feb 20, 2016)

The skills of physical examination and diagnostic reasoning are ones built over time, on a foundation of detailed knowledge of anatomy, physiology and pathology.  

If you know how what you are looking at works, what is normal and what is abnormal and why so then the rest falls into place. 

This is what I was told years ago and it has been probably the best, and most true, advice I was ever given.


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## Jon (Feb 26, 2016)

I think @DEmedic hit the nail on the head. The best assessments involve just talking with the patient, developing rapport, and getting the information you need.

SAMPLE and OPQRST are semi-useful mnemonics, but too often I see an EMT or student, face in the clipboard, asking short questions and being happy with a short answer.

Use open-ended quesitions. Focus on things they say, but more than anything, let THE PATIENT talk to you.


As for being able to do assessments when on an ALS truck... talk with your preceptors. If they are any good at precepting, they should be able to let you work through assessments, even on ALS patients (the assessment doesn't really change)... and then they perhaps interject now and then. Now, if that happens, don't be offended, either.


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## Tigger (Feb 27, 2016)

It's a balance between getting a rapport that allow you to get the information you need while also being able to redirect the question. Think of the SAMPLE and OPQRST acronyms as something you need to be able to fill out by the time you get to your destination. That's the bare minimum you need, but how you get it does not have to be in that order. I think the most obvious example is asking the patient what sort of medical history they have and then easily transitioning into medication questioning using the history as the bridge. That way it feels like a conversation instead of you just barking questions at the patient one after another. Use their answers to form your next question.


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## StCEMT (Feb 27, 2016)

As you do more, you will also learn what questions to ask based on what you see. You will have plenty of "That probably would have been good to ask" moments and tuck it away for the next time you come across it. It's a mix between OPQRST/SAMPLE and more specific questions to help you get a better idea of what you are looking at.


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## Akulahawk (Feb 28, 2016)

I really don't to OPQRST/SAMPLE questions any more unless I absolutely have to. FWIW, half the time I have no idea why my patient is in one of my rooms in the ER beyond "leg pain" or "cough." I just look at the census board, notice that I have a new patient and off I go to assess my new patient. I pretty much start each contact the same way. "Hi, I'm Akulahawk, and I'll be your nurse for today. What brings you in to the ER today?" I'll then let the patient talk about their problem. I'll ask some clarifying questions along the way and I'll usually ask about pain, nausea/vomiting, dizziness, shortness of breath, tingling or numbness, problems with peeing/pooping (GI or GU problems, just to check other systems that aren't related to the complaint. The meat of the questions really happen when I'm doing a more focused assessment on a particular system that is likely involved with a given complaint. The more you know about A&P and pathophys, the more specific you'll be able to ask questions about various problems. You should, if possible, hang around nearby when one of the providers does their evaluation because sometimes you'll notice questions that are good ones to ask...


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## SpecialK (Feb 28, 2016)

I do not think SAMPLE and PRQST are helpful, generally, the individual components are helpful in certain situations (particularly PQRST for pain) but in general I think they are an extremely poor way to take a history.

Becoming good at history taking (and examination) is a learnt skill built on a foundation of knowledge of anatomy, physiology and pathology.  

There is no practical way to boil it down to an acronym.


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## titmouse (Mar 23, 2016)

As many stated above you will learn what to ask from what you see. If you have any doubts do it as you learned in school. The list from top to bottom, its fail proof.


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