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9780766838994

Principles of Patient Assessment in EMS

by ;
  • ISBN13:

    9780766838994

  • ISBN10:

    0766838994

  • Edition: 1st
  • Format: Hardcover
  • Copyright: 2003-02-03
  • Publisher: Delmar Cengage Learning

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Supplemental Materials

What is included with this book?

Summary

A concrete approach to assessing patients and situations in the field that presents the relationship between assessment findings and pathology in an informal yet informative manner. Includes detailed descriptions of physical exams and history-taking methods as relevant to respiratory, cardiac, neurological, abdominal and psychological traumas. Case studies and Web activities are integrated throughout to provide a realistic context and enhance material.

Table of Contents

Preface xix
Teaching and Learning Package xxi
About the Authors xxiii
A Moment of Silence xxv
Overview of Patient Assessment
1(8)
Importance of a Standardized Approach
2(1)
Environment
2(1)
Severity
2(1)
Medical versus Trauma
2(1)
Level of Care
3(1)
Overview of the Six Components of Patient Assessment
3(6)
The Scene Size-up
3(1)
The Initial Assessment
3(1)
The Focused History and Physical Examination of the Trauma Patient
3(2)
The Focused History and Physical Examination of the Medical Patient
5(1)
The Detailed Physical Examination
5(1)
The Ongoing Assessment
5(4)
Listening to Patients
9(14)
Communication
10(3)
Listening
11(1)
Nonverbal Cues
11(1)
Distance
12(1)
Making the Patient Comfortable
13(1)
Approach
13(1)
Introductions
13(1)
Addressing the Patient
13(1)
Establishing Trust
13(1)
Environment
14(1)
Confidentiality
14(1)
Communication Techniques
14(2)
Open-Ended Questions
15(1)
Closed Questions
15(1)
Reflection
15(1)
Clarification
15(1)
Silence
15(1)
Explanation
16(1)
Barriers to Communication
16(1)
Special Challenges in Communicating with a Patient
16(2)
Hearing Impairment
16(1)
Visual Impairment
17(1)
Speech Impairment
17(1)
Foreign Language
17(1)
Developmental Disability
17(1)
Terminal Illness
17(1)
Hostility
17(1)
Anxiety
18(1)
Abuse
18(1)
Multiple Symptoms
18(1)
Lack of Symptoms
18(1)
Overtalkativeness
18(1)
Communicating with Children
18(1)
The Child
18(1)
The Parent or Caregiver
18(1)
Communicating with the Elderly
18(1)
Cultural Considerations Affecting Communication
19(4)
Verbal Factors
19(1)
Nonverbal Factors
19(4)
Sizing Up the Scene
23(18)
Hazards on the Scene
24(5)
Traffic
25(1)
Vehicular Damage
25(1)
Violence
26(1)
Fires and Structural Collapse
26(1)
Electrical Hazards
26(1)
Weather-Related Hazards
27(1)
Hazardous Materials
27(1)
Animals
28(1)
Crime Scenes
29(1)
Body Substance Isolation
29(3)
Mechanism of Injury or Nature of Illness
32(6)
The Resources Needed and the Number of Patients
38(3)
The Initial Assessment
41(14)
First Impressions
42(1)
Mental Status
43(2)
Alert
44(1)
Verbally Responsive
44(1)
Painful Response
44(1)
Unresponsive
45(1)
Airway Status
45(2)
Complex Life-Threatening Airway Obstructions
47(1)
Breathing
47(2)
Circulatory Status
49(2)
Priority
51(4)
Making a Priority Decision
55(14)
The Priority Decision
56(1)
Systems of Prioritizing
56(2)
CUPS
56(2)
Tools Used to Determine Priority
58(1)
The Glasgow Coma Scale
58(1)
The Trauma Score and the Revised Trauma Score
58(1)
Triaging and Prioritizing the Burn Patient
59(3)
Triage to Determine Who Rides the Helicopter
62(1)
Triage in Multiple-Casualty Incidents
63(3)
The START System
63(1)
Triage Tags
64(2)
Trauma Centers
66(3)
Baseline and Serial Vital Signs
69(14)
Signs versus Symptoms
70(1)
Traditional Vital Signs
70(5)
Mental Status
71(1)
Respirations
71(1)
Pulse
72(2)
Blood Pressure
74(1)
Additional Vital Signs of Significance
75(5)
Skin Signs
75(1)
Core Body Temperature
76(1)
Eye Movements
76(1)
Capillary Refill
77(1)
Oxygen Saturation
78(1)
End-Tidal Carbon Dioxide
78(2)
Baseline versus Serial Vital Signs
80(3)
The Focused History and Physical Examination of the Trauma Patient
83(6)
Reconsider the Mechanism of Injury
84(1)
Significant Trauma
85(1)
Minor Trauma
86(3)
The Rapid Trauma Examination
89(10)
The Rapid Trauma Examination
90(1)
Steps in the Rapid Trauma Examination
91(8)
Body Substance Isolation Precautions
91(1)
Clothing
91(1)
The Mechanism of Injury
91(1)
Head and Neck
91(2)
Chest
93(1)
Abdomen
94(1)
Extremities
95(1)
Posterior
95(4)
The Focused History and Physical Examination of the Medical Patient
99(8)
Determining Responsiveness
100(1)
The Focused History
100(4)
The Responsive Patient
100(2)
The Unresponsive Patient
102(2)
The Focused Physical Examination
104(3)
The Rapid Physical Examination
107(8)
The Rapid Physical Examination
108(1)
Steps in the Rapid Physical Examination
109(2)
Nature of the Illness
109(1)
Head and Neck
109(1)
Chest
110(1)
Abdomen
110(1)
Pelvis
110(1)
Extremities
110(1)
Posterior
111(1)
Gaining Proficiency
111(4)
The Detailed Physical Examination
115(10)
The Detailed Physical Examination
116(5)
Head
117(1)
Face
117(1)
Eyes
118(1)
Nose
118(1)
Ears
118(1)
Mouth
118(1)
Neck
118(1)
Chest
118(1)
Abdomen
119(1)
Pelvis
120(1)
Posterior
121(1)
Extremities
121(1)
Priority Determines Care
121(4)
The Focused History and Physical Examination of the Respiratory Patient
125(16)
The Focused History
127(3)
The OPQRST History
127(1)
The SAMPLE History
128(2)
The Physical Examination
130(1)
Determining Life Threats
130(1)
General Impression
130(1)
Inspection
130(1)
Auscultation
131(1)
Palpation and Percussion
131(1)
Diagnostic Tools
131(1)
Abnormal Findings
131(2)
Wheezing
132(1)
Stridor
132(1)
Grunting
132(1)
Wet or Dry Lungs
132(1)
Crackles
132(1)
Rhonchi
132(1)
Absent Sounds
132(1)
Pleural Friction Rub
132(1)
Dyspnea
133(1)
Pursed-Lip Breathing
133(1)
The Use of Accessory Muscles and Retractions
133(1)
Nasal Flaring
133(1)
Carpopedal Spasms
133(1)
Breathing Patterns
133(2)
Features of Dyspnea
135(1)
Common Acute Respiratory Conditions
136(5)
Asthma or Bronchospasm
136(1)
Allergies and Anaphylaxis
137(1)
Airway Obstruction
137(1)
Chronic Obstructive Pulmonary Disease
137(1)
Acute Pulmonary Edema
137(1)
Pulmonary Embolism
137(1)
Pneumothorax
138(1)
Pneumonia
138(3)
The Focused History and Physical Examination of the Cardiac Patient
141(18)
The Focused History
143(4)
The OPQRST History
144(2)
The SAMPLE History
146(1)
Physical Examination
147(7)
The Lung Sounds
148(1)
The Heart Sounds
148(1)
Visual Inspection and Palpation of the Chest and Abdomen
148(1)
Use of Diagnostic Tools
149(5)
Features of Chest Pain
154(1)
Common Cardiac Conditions
155(4)
The Silent Myocardial Infarction
155(1)
Shortness of Breath
155(1)
Congestive Heart Failure
155(1)
Cardiac Syncope
155(4)
The Focused History and Physical Examination of the Patient with a Neurological Problem
159(22)
The Focused History
160(4)
The OPQRST History
160(2)
The SAMPLE History
162(2)
The Physical Examination
164(7)
Mental Status
164(1)
Cranial Nerve Assessment
165(3)
Assessment of Motor Response
168(1)
Assessment of Sensory Response
169(1)
Assessment of Coordination and Reflexes
169(1)
Use of Diagnostic Tools
170(1)
Features of a Neurological Emergency
171(1)
Common Neurological Conditions
171(10)
Stroke
171(1)
Altered Mental Status
172(1)
Seizure
172(2)
The Patient Complaining of a Headache
174(1)
The Patient with a Traumatic Brain Injury
175(2)
Neurogenic Shock
177(4)
The Focused History and Physical Examination of the Patient with Abdominal Pain
181(18)
The Focused History
182(5)
The OPQRST History
182(1)
The SAMPLE History
182(5)
Physical Examination
187(4)
Observation
187(2)
Auscultation
189(1)
Palpation
189(1)
Percussion
190(1)
Use of Diagnostic Tools
191(1)
Types of Abdominal Pain
191(1)
Features of Abdominal Pain
192(1)
Common Causes of Abdominal Pain
193(6)
Acute Abdominal Pain Requiring Emergency Surgery
193(1)
Pain Associated with Gastrointestinal and Genitourinary Conditions
194(5)
The Focused History and Physical Examination of the Patient with a Behavioral Problem
199(16)
Common Classifications of Psychiatric Disorders
200(1)
Features of Emotional or Psychological Disorders
201(1)
General Appearance
201(1)
Intellectual Function
201(1)
Thought Content
201(1)
Physical Complaints
201(1)
Motor Activity
201(1)
Speech and Language
201(1)
Body Language
202(1)
Mood
202(1)
Assessment of the Patient with a Psychological Disorder
202(6)
Scene Safety
202(1)
The Focused History
202(1)
The OPQRST History
203(2)
The SAMPLE History
205(1)
The Mental Status Examination
206(2)
Common Calls for Behavioral Emergencies
208(2)
Depression
208(1)
Mental Illness
208(1)
Substance Abuse
208(1)
Suicide Attempts
208(1)
Pleas for Help or Attention
209(1)
Assisting a Transportation
209(1)
Medical Conditions That Mimic Behavioral Disorders
210(1)
Stress and the EMS Provider
210(5)
The Assessment Approach for the Pediatric Patient
215(18)
The Focused History
216(6)
The OPQRST History
217(1)
The SAMPLE History
217(3)
Taking Pediatric Vital Signs
220(2)
The Physical Examination
222(3)
The Approach for the Newborn
222(1)
The Approach for the Neonate and Infant
222(2)
The Approach for the Toddler
224(1)
The Approach for the Preschooler
224(1)
The Approach for the School-ager
225(1)
The Approach for the Adolescent
225(1)
Trauma
225(1)
Medical Emergencies
226(3)
Additional Medical Emergencies
228(1)
Special Needs and Technology-Assisted Children
229(4)
Airway Devices
230(1)
Vascular Access Devices
230(1)
Ostomies and Feeding Tubes
230(3)
The Assessment Approach for the Pregnant Patient
233(16)
Normal Anatomical and Physiological Changes of Pregnancy
234(3)
The Focused History
237(3)
The OPQRST History
237(1)
The SAMPLE History
237(3)
The Physical Examination
240(2)
Vital Signs and Skin Color and Condition
241(1)
Changes Assessed during Visualization
241(1)
Changes Assessed during Palpation
241(1)
Changes Assessed during Auscultation
242(1)
Fetal Assessment
242(2)
Fundal Height
243(1)
Fetal Heart Rate
243(1)
Fetal Movement and Uterine Contractions
243(1)
Complications Associated with Pregnancy
244(5)
Ectopic Pregnancy
244(1)
Diabetes
244(1)
Blood Pressure Disorders and Other Third-Trimester Complications
245(1)
Prehospital Delivery
245(4)
The Assessment Approach for the Elderly Patient
249(14)
Physiological Changes of Aging
250(3)
The Senses
250(1)
The Immune System
251(1)
The Endocrine System
251(1)
The Gastrointestinal and Genitourinary Systems
251(1)
The Renal System
251(1)
The Cardiovascular System
251(1)
The Respiratory System
251(1)
The Nervous System
252(1)
The Integumentary System
252(1)
The Musculoskeletal System
252(1)
Vital Signs
252(1)
Psychological Status
253(1)
The Focused History
253(3)
The OPQRST History
253(1)
The SAMPLE History
253(3)
The Physical Examination
256(1)
Medical Assessment
256(1)
Psychological Assessment
256(1)
Social Assessment
256(1)
Assessment of Functional or Physical Limitations
256(1)
Use of Diagnostic Tools
257(1)
Common Diseases among the Elderly
257(2)
Heart Disease
257(1)
Hypertension
257(1)
Pulmonary Disease
257(1)
Diabetes
258(1)
Thyroid Disease
258(1)
Alzheimer's Disease
258(1)
Parkinson's Disease
258(1)
Cancer
258(1)
Nonacute Causes of Confusion
258(1)
Trauma
259(4)
The Ongoing Assessment
263(10)
Beginning the Ongoing Assessment
264(9)
Repeating the Initial Assessment
264(1)
Reassessing and Recording Vital Signs
264(2)
Repeating the Focused Assessment
266(1)
Checking Interventions
267(6)
Comprehensive Examination and Health Assessment
273(38)
Using the Senses
274(1)
Inspection
274(1)
Auscultation
274(1)
Palpation
274(1)
Percussion
274(1)
The Comprehensive Examination
275(33)
Mental Status
275(2)
General Survey
277(1)
Vital Signs
278(1)
The Integumentary System
278(2)
Head, Eyes, Ears, Nose, and Throat
280(7)
The Chest
287(3)
The Cardiovascular System
290(5)
The Abdomen
295(1)
The External Genitalia
296(1)
Musculoskeletal Examination of the Upper Extremities
297(1)
Musculoskeletal Examination of the Lower Extremities
298(3)
The Spine
301(2)
The Peripheral Vascular System
303(1)
The Nervous System
303(5)
The Health Assessment
308(3)
Putting It All Together
311(12)
Advocacy
312(2)
Patient Advocacy: A Lesson Learned the Hard Way
313(1)
The Assessment Algorithm in Action
314(9)
A Shiny New Mountain Bike
314(1)
A New Garden
315(1)
Bobcat on the Run
316(7)
APPENDIX A ASSESSMENT POCKET TOOL
323(2)
APPENDIX B STANDARD ABBREVIATIONS
325(6)
APPENDIX C SKILLS SHEETS FOR FOCUSED ASSESSMENTS
331(8)
Focused Respiratory Assessment Skills Sheet
331(1)
Focused Cardiac Assessment Skills Sheet
332(1)
Focused Neurological Assessment Skills Sheet
333(2)
Focused Abdominal Assessment Skills Sheet
335(1)
Focused Mental Status (Behavioral) Assessment Skills Sheet
336(1)
Focused Obstetric Assessment Skills Sheet
337(2)
APPENDIX D PRACTICAL EXAMINATION SKILL SHEET FOR PATIENT ASSESSMENT
339(3)
APPENDIX E EMERGENCY INFORMATION FORM FOR CHILDREN WITH SPECIAL NEEDS
342(2)
APPENDIX F ANSWER KEY TO REVIEW QUESTIONS
344

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