Patient Assessment in the field?

[musicislife]

If you have a multi trauma patient, do you do a detailed physical exam in the field on en route to the hospital? The only kind of assessment (for trauma) we were taught was the full detailed one (including pupils, ears nose) is that the "rapid trauma assessment"?

 

[medicdan]

It all depends on the scene, the patient, their condition, distance from hospital, additional resources available, and much more. Assessments don't happen as fluidly or simply as we'd like to present in class, and often multiple things are happening at once.

 

[musicislife]

so if the patient is not critical (stay and play type call)i would do a full detailed assessment?

It all depends on the scene, the patient, their condition, distance from hospital, additional resources available, and much more. Assessments don't happen as fluidly or simply as we'd like to present in class, and often multiple things are happening at once.

 

[medicdan]

no, it really isn't that simple, and we cannot begin to tell you what is best for a patient we know nothing about... no two patients or scenes are identical, and figuring out what to do when comes with experience.

 

[Aprz]

I think the questions he's asking are school/NREMT related. The more experienced and knowledgeable pointed this because they were trying to define terms like "rapid head to toe", "full head to toe", "focus assessment", they said how it varies by text, but these are key terms a lot of EMT text teach and are somewhat unified on now cause of the NREMT.

I feel like I answered this recently.

A rapid head to toe would be everything except the distal extremities. So you'd check the head, neck, chest, abdomen, proximal extremities, and posterior.

For an unreliable patient, you will do a rapid head to toe regardless of it being a trauma or medical scenario and regardless of the mechanism of injury (MOI).

In a medical scenario, if it's a reliable patient, you will do a focus assessment. If it's a unreliable patient (e.g. altered, language barrier), you'll do a rapid head to toe.

If it's a trauma scenario, if it's a significant MOI, you will do a rapid head to toe. If it's a insignificant MOI, you will do a focus assessment.

If time permits during transport, do a full head to toe.

There is another post somewhere around here that goes into more detail and has more feedback from others. I recommend searching for it. It's difficult for me to do this right now because I am typijg this from my phone.

 

[Aprz]

The post is titled "Rapid assessment vs focus assessment" by ScoopNRun, it's on the first page of this section of the forum (BLS Discussion).

http://www.emtlife.com/showthread.php?t=29582

 

[mycrofft]

Sidebar: I find the phrase "stay and play" limiting and amateurish. Just my take on it, I prefer to address it as "Single Combat with DEATH!".

OP: If you find something you need to get to hospital fast, you do the rest enroute. That's why the head is addressed first, find out if their dead or dying and as long as that's not occurring press on with the rapid exam, which is taught discretely and specifically as the rapid assessment or whatever they name it this year.

As a new person you should do the assessment as in the book, and hopefully with someone who isn't as fresh out of the classroom with you.

 

[EMT91]

As far as I understand, it is as the other posters have said; it depends on the situation. Correct me if I am wrong, but having bruises on the arms and a few little cuts on the legs constitutes multiple traumas, but you could assess those in the field as they are not life threats. I went to a patient assessment lab a few weeks back that was put on by a Firefighter Paramedic, and it was very fun and informational; if you would like a copy of the notes from it, PM me and when I get home, I can shoot you a copy of them.

 

[Akulahawk]

While bruises and multiple papercuts may be multiple traumas by strict definition of separate injuries to the body, I would basically lump those into "minor trauma" and continue to look for other, more major trauma.

For the new guy, do your assessment how you were taught. As you progress through your career, you'll start doing things a bit differently, more efficiently for your thought process, and you won't miss anything.

 

[EpiEMS]

I will say that if you were taught the DCAP-BTLS mnemonic, forget it. You know what the individual components are, and you know what is normal vs. what is not, so it's a useless tool, as far as I've seen it. After all, if it looks bad, it very often is.

 

[Akulahawk]

I will say that if you were taught the DCAP-BTLS mnemonic, forget it. You know what the individual components are, and you know what is normal vs. what is not, so it's a useless tool, as far as I've seen it. After all, if it looks bad, it very often is.

Pretty much what he said!

Once you know what "normal" is... when you come across some sign of trauma, it's usually pretty obvious what it is... So when telling someone I'm looking for obvious signs of trauma, I just say that I'm looking for obvious signs of trauma... It's actually self explanatory. DCAP-BTLS is basically just a way to remember those obvious signs so that you can regurgitate those signs to someone testing you.

 

[mycrofft]

Or regurgitate them when your mind goes blank.
Acronyms never were big for me.