# Patient assessment help.



## onecrazykid108 (Jun 22, 2010)

I am learning patient assessment in class, and I have all the steps memorized, but as we keep going through the skill I keep forgetting my next step.  It is especially bad when the instructor stops me to talk I always get lost and forget where I am and stuff after a pause.

Are there any tricks to learning patient assessment easier?  or tips on becoming more proficient with it?

Thanks


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## medicdan (Jun 22, 2010)

I urge you not to memorize the sheet, but think about why you make the decisions you make... Think about it this way

I. Scene Size Up-- what do I need to know in order to be on scene?
II. Initial Assessment-- Is the patient alive? What is going to kill them in the next 2-3 minutes?
III. Secondary Assessment (Physical Exam, Hx, etc)-- What is going on with the patient? What is going to kill them in the next 5-10 minutes? Provide secondary treatments. 
IV. Ongoing Assessment-- What is going to change with the patient between here and the hospital? Are treatments working? How can I prepare for the hospital (radio report, PCR, etc). 

Does this help you?


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## onecrazykid108 (Jun 22, 2010)

It seems like I would miss stuff if I looked at it that way.  That is helpful though.


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## mycrofft (Jun 22, 2010)

*onecrazykid...*

EMTdan is right, but you need to memorize the list to pass the course. Write flashcards, use any exercises in the book, practice with a frined. Use as much motor activity (actually pretending to do it) as well as reading and writing, muscle memory will sometimes save you and will certainly help you at 3AM in someone's livingroom or the back of an ambulance.


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## onecrazykid108 (Jun 22, 2010)

So basically in the street you don't go through that list?  you just think of the basic sections?


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## medichopeful (Jun 22, 2010)

onecrazykid108 said:


> I am learning patient assessment in class, and I have all the steps memorized, but as we keep going through the skill I keep forgetting my next step.  It is especially bad when the instructor stops me to talk I always get lost and forget where I am and stuff after a pause.
> 
> Are there any tricks to learning patient assessment easier?  or tips on becoming more proficient with it?
> 
> Thanks



Here's what I did.  I started out learning just the first few steps of the sheet.  When I had those down, I kept on adding more and more, until I had the whole sheet memorized.

There were parts that gave me trouble, which I figured out little acronyms for (if you could call them those.  More like little memory games).  For example, in the MA sheets I learned, I could easily get up through the ABCs, but then it was easy to get lost.  So I came up with the acronym/memory trick "TT SABIR DIVA" (for a medical).  It stood for:

Treat for shock
Transport decision
SAMPLE history
Focused/rapid assessment
Baseline vital
Interventions
Re-assess transport decision
Detailed exam
Repeat Initial assessment
Repeat Vital signs
Repeat focused/rapid Assessment

It may not work for you, but try coming up with a memory aid.  That way, when you're doing the assessment and skills in class, you can say to yourself "OK, I just did step x.  In my memory aid, what comes next?"

Also, I would suggest that once you have the sheet memorized, that you go over it at LEAST once a day.  Do it when you wake up or shower, or are driving to class; anytime, as long as you do it.  And when you're doing it, use your memory aid.  That way, when you work on it in class, it will be completely committed to your mind.

Now granted, the sheet is really only good for in-class.  After class, you have to develop your own way.  But even-so, work on UNDERSTANDING the sheet, like Dan was saying.  Ask "why is this here?" "Why do I have to do this now?"  The more you understand, the more you'll remember.

I hope this helps!


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## mycrofft (Jun 22, 2010)

*Learn your list. And listen to my compadres.*

Going back to emtdan's list, sometimes you don't get past step II. ABC's, _*andelez, arriba arriba,*_, arrive at ER.


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## Dominion (Jun 23, 2010)

Not to knock EMT Dan but this is one of the few things I advocate pure memorization on.  Memorize your sheet first, once you have it commited to memory and you can name every thing on it THEN you can apply the critical thinking method.  

Boards are just skills, you need to know those skill sheets to pass.  It's not the best method but we are required to deal with it currently and in my opinion there is no better way to do that than to just memorize the sheet.  Once you are out of class room mode and into the real life situations you will need to apply that somewhat to your job in critical thinking mode to make the nessecary decisions to properly perform your job.


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## Aprz (Jun 23, 2010)

Heh, I started off by giving some tips, but ended up writing a whole detailed thing on doing a patient assessment that was super long (finished writing the inital assessment and was starting on the patient medical history and present history of illness when the forum threw an error saying my post was too long). I am not even sure if it would help you to think like that (I kept rambling on about the difference between the EMT program I attended in Alameda County, but not a student of vs. the EMT program I was a student of in Santa Clara County and how I used the best of both programs). Anyhow... I can post or pm you that if you'd like (I saved it) and instead just going to say the #1 way of getting good at it and memorizing it.

_*Practice! Practice! Practice!*_

As you know, in real life you will probably interrupted as you're trying to do the assessment (e.g. intoxicated mother yelling at you about how to do your job while you assess her kid). If you practice it a googolplex amount of times (and more), you're gonna be like a machine and just get the feeling of it; be in the groove.

Nice to go to study groups, say it outloud to yourself when you don't have anybody to practice on, practice with a giant doll (if you have a sister or have a secret fetish for dolls if you're a guy *shrugs*), pet, whatever... I personally said it outloud to myself all the time and wrote it on paper without looking as many times as I could. There are a gazillion ways to practice.


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## Knightlite (Jun 26, 2010)

Take a look at the National Registry Skill sheets for the Trauma and Medical Patient.  That is the order in which things should be done, at least for your skills test. That should provide you with a good roadmap.

Here is a link where you can download them for free:

http://www.nremt.org/nremt/about/exam_coord_man.asp#BSkillSheets

Try to understand why you are doing things in the order that you are do them.


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## 8jimi8 (Jun 26, 2010)

onecrazykid108 said:


> I am learning patient assessment in class, and I have all the steps memorized, but as we keep going through the skill I keep forgetting my next step.  It is especially bad when the instructor stops me to talk I always get lost and forget where I am and stuff after a pause.
> 
> Are there any tricks to learning patient assessment easier?  or tips on becoming more proficient with it?
> 
> Thanks



If you get paused in your train of thought, put your hand down on the last thing that you assessed.  If you got to the neck and checked everything and then the instructor asks you," what's crepitus?"  then you put your hand on the last thing you assessed, the neck, answer the question and continue moving down from head to toe.  As you practice assessing people more and more, the steps you memorized will just become a guideline that you no longer reference.  Try to get to the point where you don't repeat the list in your head, rather you list the items you are looking for and ruling out as you go.  Good Luck


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## feldy (Jun 27, 2010)

i would have to say...just keep running through the skill sheets. Write down the steps over an over again. Unfortunately not all of the skill sheets are common sense (while they should be) which is why some people have a hard time and mix a few steps up. Definately memorizes the first few steps b/c they are the same for med and trauma.
Scene Safety
BSI
NOI/MOI
# of pts.
ALS
C-spine
General impression

Then chief complaint
Loss of consciousness (or not)
ABCs

Just take each step at a time. And i know this helped me through class but find a group of people (or just one) that you feel comfortable with and run through assessments over and over again. Switch of being the EMT and the pt. If you are the pt. you will see how it is done on you.


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## Medic50321 (Jun 27, 2010)

BSI / Scene Safe
# of patients
Call for additional Resources
NOI/MOI
C-spine considerations
ABC's
Oxygen, Hi Flo NRB 15LPM
Initial Assessment
SAMPLE
OPQRST
BPRGAPS
Focused Assessment
Call hospital for orders as necessary
Load


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## MrBrown (Jun 28, 2010)

A good understanding of anatomy, physiology and pathology is your best friend here, seriously, combined with experience.

Quite simply a quick gross assessment of vital signs is the first thing we do which means whether your patient is conscious and orentaited, if they are breathing and oxygenated, what sort of blood pressure and perfusion do they have and what (if any) are thier immediate life threats.

If I walk up to a job and say "hello I am Brown, I'm one of the helicopter doctors, this is Oz he is my sidekick and we are here to take you to see the Wizard in our flying contraption" to which the patient responds "bugger off, I want Dorothy as my flight attendant and not a bunch of convicts in orange prision jumpsuits" then I know I am dealing with somebody who is orentaited to place and person, has a patent airway and at least an acceptable pulse and blood pressure.

At this stage am I interested in what the pulse rate, respiratory rate and blood pressure are? No, I simply want to observe if my patient is dead or dying or traumatically injured.

Marco level exclsuions of things which are going to kill your patient very quickly is my goal here.  Are they bleeding severely? Do they have massive cardiogenic shock? Have they been stabbed and now a large piece of knife is sticking out of thier intestines?

No, ok great, so what exactly happened? Ask your patient, MPDS strikes again so ask "exactly what happened?" and this gives you a good idea of where to look next.  Did they get hit by a car? Have they been having crushing chest pain for two hours? Have they fallen over and traumatically injured themselves? 

If you are assessing somebody who has been run over by a car you are looking for head and brain injury, fractures, abdominopelvic injuries, haemopneumothoracies, spinal injury and things of that nature.  Nana who has had chest pain for two hours needs to be asked about onest, previous history, severity, radiation, medications, find out a cardiac rhythm etc

Trauma is quite simply really, its fairly obvious what has happened however medical problems can be multi factorial in etiology or pathology and often present rather vaugely.  Somebody who has a guts ache might have appendicits, a perforated bowel, a kidney stone or ate too many of Brown's chocolate cookies.  This is where your pathological knowledge is a bloody godsend.

You may want to take a few observations at this point, its probably a good idea.  I mean after all it might help to exclude those patients who do not need a flying wanker called Brown knocking them out and sticking a tube in thier throat, right?

I cannot stress enough how important careful and accurate observations (especially a Glascow coma score) are.  They can provide subtle clues which can help you differentiate between a patient who is OK and somebody who is beginning to get quite crook and might need Brown and Oz to swan dowm in thier red and yellow flying machine dressed in orange jumpsuits and stick a tube down thier throat.

If you wish to try and get simplistically sequential I suppose it would go something like this 

Here's one I prepared earlier 



> Primary Survey
> 
> • Airway: examine for and establish an adequate airway.
> Consider the possibility of cervical spine injury, but the airway takes priority.
> ...


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## Sandog (Jun 28, 2010)

This may sound silly, and not sure if it will work for you but, I had this same section last week. What I did was this;

While I was out of the room my wife took her 3 foot Tickle me Elmo doll and set up a scenario, ie. placing Elmo in a certain position, setup the environment such as beer bottles around Elmo (Sorry parents) etc. She would then have me go through my routine as she verified that I followed our checklist. I don't know why but having the Elmo doll really helped me think about things. My wife got creative and placed hanging wires in the spot which meant danger. So for me, having a person help me practice was real helpful. We did several iterations to make sure I had it down pat.

Good luck, and BTW, here is a real cool link for us students.
http://academicskill.com/emt/index01.htm


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