So for more lols, I'll tell you some more since I am pretty bored.
At one of the two schools I attended, they wanted me to immediately to determine c-spine if it can be cleared "Did you fall? Did you blackout? Do you hit your head? How did you fall?" to clear my partner from manual c-spine. They also wanted my partner to immediately take baseline vitals for me, and later on in the assessment, ask my partner what they got. Sometimes they wanted me to be very specific and tell my partner I want a heart rate, respiratory rate, and blood pressure. So if your school is like that, do that. I don't like that, but it's whatever.
Depending on your school, your order could be the typical SAMPLE -> physical exam -> vital signs -> ongoing assessments, or the order can change based on whether the call is medical or trauma, if it's a significant MOI or not, or if the patient is reliable or not. If that's the case, the order they taught me was
Unreliable patient and/or significant MOI
1. Rapid physical exam
2. Vital signs
3. SAMPLE
Reliable medical patient
1. SAMPLE
2. Focused physical exam
3. Vital signs
Insignificant MOI trauma patient
1. Focus physical exam
2. Vital signs
3. SAMPLE
I'm not sure if the order matters to the NREMT for this. I personally always did it in the above order. This may vary by school too. This is going by the Nancy Caroline books or whatever they are called I think.
Pretty standard order though (without considering MOI and/or reliability of the patient is) is SAMPLE: Signs & Symptoms, Allergies, Medications, Past Medical History (PMH or PMHx), Last oral intake, and Events leading up to calling 9-1-1. To get signs and symptoms (mainly symptoms at this point since you are talking to the patient, but they might tell you about some signs e.g. sputum), you are going to ask OPQRST, PASTE, PASTEMED, OLD CARTS, PODD, etc. We have an acronym list somewhere on this forum where I mentioned what these means and people have different variations of them, look it up. You might ask things like "Has this happened before? Did you see a doctor for it? What did he have to say about it?" or ask more close ended questions and very specific things that aren't about pain or shortness of breath like the two acronyms they teach in EMT school like "How long was the patient seizing for? What did it look like? Did he fall?" See what I mean? For altered mental status, or for strokes more importantly, it's gonna be important to ask when was the last the time the patient was seen normal. I highly recommend looking up the AHA criteria for clot buster treatments for strokes and STEMIs "Has he had a stroke recently?", "Is he on any blood thinner medications?", etc, that's gonna be huge to relay to the hospital in your report and save time, don't delay transport for those guys more than what you have to, and for the stroke patients, I recommend transporting with somebody who can be a representative for the patient at the hospital and also be a witness that the hospital can hear from saying when was the last time they were seen normal (this is more huge in real life than in testing and the NREMT, but I want you to start thinking about it, and it might be nice to include in testing anyhow although you want to consider that you are being timed). For allergies, ask about what happens when they are exposed to that allergen. For medications, ask about over the counter, prescription, recreational, herbs, and supplements. For past medical history, correlate it with the medications they take. The patient might say they don't have any medical conditions, but when you ask which medications they are taking, they'll say "Atenolol, Coumadin, Valium, blah blah blah" so obviously they do have some sort of history. You can clarify it "What do you take those for?". For now, not knowing home medications will be a requirement at your school, but it's gonna help with obtaining a history if the patient says they have none, or if they are altered, check their drug cabinet in the bathroom. I think last oral intake is only really a big deal with hypoglycemic emergencies, I've heard it's a big deal if the patient is gonna get surgery, but I am not sure how true that is. Events leading up to might be merged with signs and symptoms, and events in your initial assessment. Usually at this point, I also ask age in the testing scenario. In real life, age is one of the first few things I ask.
There are different physical exams. There is focused, look at the area of complaint, or more importantly, assess for pertinent positives and negatives e.g. if the person is complaining about chest pain, an okay thing to do is check only the chest, but a pro student is probably gonna check the head for nasal flaring, pursed lips, facial expression, jugular venous distension (JVD), neck veins, platysmal indrawing, symmetrical rise and fall of the chest, breath sounds, intercostal retraction, signs of trauma (DCAPBLSTIC), pacemaker, nitro patch, pedal edema, discoloration at or below the chest and check the patient's blood pressure on both sides cause they are trying to rule in or out angina, an myocardial infarction (MI), shortness of breath (SOB), congestive heart failure (CHF), and a thoracic aneurysm. There is more, but that's just the basics of it! See how it's a focused assessment at least? Most people think focus is just one region, but it's really just looking for signs to rule in or our what you think it is so any part of the body.
A rapid physical is like a full, but only the kill zones, so pretty much only the distal extremities are left out. You check the full head, neck, chest, abdomen, pelvis, proximal extremities, and posterior.
And then a full physical. You will typically do this during your ongoing assessment while transporting, but a lot of people just do the full during the physical exam in their test, and they practice this in school like that. Before each region, you will verbalize "Looking for DCAPBLS, feeling for TIC" except at the abdomen it's "Looking and feeling for DCAPBTLS". A lot of schools don't even use DCAPBLSTIC, they'll say DCAPBTLS for each region instead.
I kinda expect a EMT basic full physical exam to be something like
Head, Eyes, Ears, Nose, and Throat (HEENT): Look for head and facial symmetry, check for blood when palpating, Battle's sign/Racoon eyes, sclera white, pupils 4 mm equal, reactive, round to light 2 mm, and accommodate (look up accommodate, people usually don't know what this is and don't assess it, but they still say it), check for injury or debris in the eyes, contact lenses, cataracts, do they follow movement equally, moist or dry, nystagmus, nasal flaring, singed nares, foreign objects, blood, cerebral spinal fluid (CSF) in nose or ears, burn around mouth (I forget how to word this all of the sudden, what people usually say at least), symmetry of the tongue (are the making an O sign or Q sign? Just kidding... a little), bit tongue, foreign objects or blood in the mouth, oral hydration, and if teeth are intact.
Neck: Trachea midline, subcutaneous emphysema, stoma, medic alert tag, JVD, accessory muscle use (platysmal indrawing or strenocleidomastoid), neck veins distending.
Chest: Supraclavicular indrawing, intercostal retraction, pacemaker/AICD, nitropatch, equal rise and fall, assess breath sounds (bare minimum 2 breadths midclavicular from clavicle and about 6th intercostal space (ICS) midaxillary is what I was taught), excessive chest movement, subcutaneous emphysema also.
Abdomen: Distention. Is it soft and non tender? Pulsating mass (I was told not to touch it if it's pulsating). Palpate in the 4 quadrants or 9 regions (learn the 9 regions if you don't know it, it'll help you relay more exactly where the pain is and better form a differential diagnosis (DDx), which isn't the final diagnosis (Dx) doctors make and not the whole "we don't diagnose" thing). I hear Cullen's sign thrown around and McBurney's point mentioned sometimes.
Pelvis: Urinary/Fecal incontinence, priapism, rectal or vaginal bleeding if applicable.
Extremities: Check for track marks, and assess CMSTP: capillary refill, motor, sensory, temperature, pulse. I've seen a lot of variations of CMSTP e.g. CMS, PMS, etc. A lot of times, C is circulation instead. Look for medical alert tags on wrist and feet. Check for pedal edema at the feet. Sometimes I hear clubbed fingers tossed in. You can toss in equal grip test too and pronator drift if you suspect stroke (palm face up when you have them hold up their hand)s in front of them for 10 seconds and their eyes closed).
Posterior: Symmetry and sacral edema. Breath sounds paravertebral from above the scapula, mid scalpula, and below it I think is the easiest way for me describe it, not over the bone.
In regard to breath sounds, there are a bunch of spots so what I am saying may not apply to what your school teaches. In fact, one school I went taught only 4 spots and looked at me like I was crazy for doing 6 spots on the back, and the other school taught 6 spots. I think Bates' Guide to Physical Exam and History taking has like 14 spots on the back, lol. Your goal is mainly general area like listening to the apical, middle lobe, and the base of the lungs. I hear back is gonna be easier to hear, but personally, I like listening to the front more.
For vital signs, I was taught heart rate, respiratory rate, and blood pressure at one school, but at another school, taught heart rate, respiratory rate, blood pressure, pupils, skin signs, and capillary refill. Personally, I like to think CTCTC with skin signs: color, temperature, condition, turgor, and capillary refill (so I consider capillary refill a part of skin signs), usually hear "moisture" instead of "condition". Another handy acronym I have heard is PRBELLS (look it up in that acronym list I mentioned earier) for VS, but I use it more for ongoing assessment. Also for the pulse, you should get the rate, rhythm, and quality. For respirations, rate, rhythm (check out things like Cheyne-Stokes, Biots, etc), effort at minimum, I include audible sounds, and one of my schools wanted me to say something like "good tidal depth". I think I pretty much covered everything else with vital signs. Don't forget to ask what your partner got for baseline if you had them do that.
Treat acccordingly, transport, is it gonna be with or without red lights and sirens, which hospital are they going to, if the patient is critical, reassess every 5 minutes, if not, every 15 minutes, and you are gonna reassess at least ABCs, LOC, VS, and reassess your treatment, is it helping or not. If time permits, do a full physical.
At the end of the scenario, you give a report to the proctor. When I was going to school, I just gave the report with the patient's age, gender, chief complaint, SAMPLE, pertinent positives and negatives in physical exam, and vital signs.
I started getting lazy in the middle of this, lol, but I still do hope it helped.
Edit: And quickly looking to see if I missed anything or any mistake, I noticed in my first post, I didn't mean to say "50-year-old male", I'd say something that's an estimate and obvious is one like "a male who looks like he's in his 50s", or something like that. They are probably gonna ding you at school for guessing exact age.
