Highlander Help

EMT NOTES

Patient Assessment (Chapter 8) continued




Medical Assessment



 








  • Chest pain complaint:
    • Auscultate (listen to) lung sounds on back (6 points)
    • look at feet for swelling (edema)-indicative of poor circulation
    • palpate chest for tenderness-helps to determine whether pain is muscular or internal/cardiac in nature

 

   

Lung Auscultation Points


  • Neurological complaint
    • check pupils
    • check extremities for motor/neural ability
    • check mouth for wounds-to see if slurred speech due to wound or neurological cause
    • check groin for loss of bowel control

  • Unresponsive–focused history and physical exam
    • rapid physical exam
    • baseline vital signs
    • consider requesting ALS
    • history of present illness-from friends/family/bystanders if unresponsive
    • SAMPLE history and OPQRST


  • Effect of humid weather on health problems:
    • volume of calls related to respiratory illness increase.  People with respiratory illness have a harder time breathing in humid weather.



Trauma Assessment

  • Look for Significant MOI (Adults):
    • rollover of vehicle
    • vehicle-pedestrian collisoin
    • penetration to head, chest, abdomen
    • unconscious or altered state
    • ejection from car
    • fall greater than 20 feet

  • Look for Significant MOI (Children):
    • bicycle collision
    • fall greater than 10 feet

  • Injury to extremity only considered trauma if above the knee
    • injury to arms not considered trauma

  • Always suspect hidden injury

  • Vehicle collision-three collision concept
    1. vehicle and object/other vehicle
    2. person and vehicle
    3. internal collision-movement of organs and brain in body


  • Look at interior of car for clues of hidden injury
    • may show where/how patient struck vehicle
      • Look for bent gas pedal, steering wheel, cracked windshield, cracked rearview mirror, bent dashboard, etc.

  • Car injury patterns:
    • "Up and over"-person goes up and over steering wheel.  Expected head, neck, chest, or pelvic/femur injuries
    • "Down and under"- person slides under wheel.  Expected leg, back injuries. 

  • Find someone at bottom of staircase/ladder:
    • assume that they fell from top, unless told otherwise

  • Detailed Exam
    • Patient condition determines whether detailed physical exam is necessary
    • Removal of clothing ("Trauma=Naked")
    • Only done when Airway, Breathing, and Circulation are stabilized

    

Case Study 1

Students from a college in Ohio make a trip out to the beach.  One of the boys dives into shallow ocean water and hurts his neck.  He complains of pain and tingling in extremities, but gets up and walks over to lay on his towel.


EMT walks by and overhears them talking about the boy's neck injury.  He immediately stabilizes the neck and asks about the injury, determining that it is a significant MOI (Mechanism of Injury). EMT persuades boy to go to hospital.  X-ray results find that he has a C2 vertebrate fracture.  If he had gone home and gotten into car or moved neck, he would have severed his spinal cord and died.  


Determining significant MOI was vital, even though kid has no significant complaint.  This saved the boy's life.  

C-spine neck immobilization

Case Study 2

Car crash with father, wife, and 3 y.o child.

Father is out of car and keeps telling EMT's that he is OK and insists that they care for his family instead

Father turns neck and immdiately drops dead–turns out he had a significant neck injury and severed his spinal cord upon turning his neck.


This also demonstrates the importance of determining MOI.  If the EMT's had identified a C-spine injury and immobilized his neck, he may have lived.