History

[billycorgi]

Hello,

Everyone probably has their own way and time on to when to do a history taking on a patient. When is the best time to take a patient history? During or after a primary assessment? Before loading the patient in the ambulance? During the ride to the hospital? usually it would have to do with what is going on with the patient if its a medical or trauma call. Im assuming that a practitioner would take a patients history on scene if its a chest pain call for example so one could administer asa, nitro etc while on scene. Hearing other EMS practitioners examples or experiences would be great!

 

[NomadicMedic]

A history is always fluid. And it's not as simple as asking 20 questions.

Start with the questions you need answers to right now, and then, as time allows, ask questions to fill in the blanks. I've found the best method is to be an active listener. Let your next question dovetail from the patient's last answer.

If you need to redirect, say when a patient starts telling you every medical ailment they've ever suffered, simply restate the last pertinent item and redirect, "so, Mrs Jones... Let's stop for a moment and go back to the chest pain you were talking about, have you had any pain like that recently?"

You should be able, by asking direct questions and actively listening, to obtain a fairly detailed history in a just a few minutes. And it's a good way to pass the time in the truck on the way to the hospital.

 

[STXmedic]

What's a primary assessment include again?...

I ask questions about what's currently going on, then I usually find out medical history immediately afterwards- to see if there's anything in their history that could explain their current issue.

It really is patient and situation specific, though. The textbook makes it seem like everything is a step-by-step structure. Assessing your patient should be very fluid, and may jump back and forth a bit from what the book dictates as the correct order. It'll come with exposure. The more patients you assess, the more fluid you'll become.

Again, I type too slowly... What DE said

 

[Mariemt]

A history is always fluid. And it's not as simple as asking 20 questions.

Start with the questions you need answers to right now, and then, as time allows, ask questions to fill in the blanks. I've found the best method is to be an active listener. Let your next question dovetail from the patient's last answer.

If you need to redirect, say when a patient starts telling you every medical ailment they've ever suffered, simply restate the last pertinent item and redirect, "so, Mrs Jones... Let's stop for a moment and go back to the chest pain you were talking about, have you had any pain like that recently?"

You should be able, by asking direct questions and actively listening, to obtain a fairly detailed history in a just a few minutes. And it's a good way to pass the time in the truck on the way to the hospital.

This

 

[CriticalCareIFT]

I am not sure of your experience. However if you are just starting out I would recommend doing the standard assessment in order as your were taught in class. Truly it is a dynamic process and very patient/situation/condition/knowledge/ specific and sensitive. However when you are starting out stick to the basics and with experience it will change.

 

[Mariemt]

It never hurts to add with belly pain :
Last time they pooped
Last period for females.

You won't believe how many times older people can't poop and they have belly pain from it.
Also on a geriatric patient, altered status with negative stroke signs, normal bgl, ask family about history of UTIs.

 

[JPINFV]

It never hurts to add with belly pain :
Last time they pooped
Last period for females.

As well as "any chance you can be pregnant? Are you sexually active? Do you use protection? What type? Any vaginal bleeding or discharge?"


It's amazing how often ladies will deny any chance they can be pregnant, and then admit to being active within the past month without any contraception.