I need some help with patient assessments

[fallout]

Another technique for practicing assessment is to find someone in your class and ask them to pretend to be a patient. It does not have to be some life threatening or emergent situation. The point of the exercise is to aid you in building a systemic method of patient assessment. The SAMPLE and OPQRST pnemonics are a useful beginning, but be careful not let those pnemonics limit your assessment.

My personal method goes something like this.

Hi, I'm <your name here>, what is going on today?

That will usually illicit some response such as "I have been vomiting for the last week."

Then, start asking questions and performing physical exams that will aid in narrowing down the origin of why they might be vomiting. This would include the OPQRST.

Generally I do my past medical history after the history of the current illness. This would include the SAMPLE.

Some medics believe that assessment and history taking is all about them talking to the patient. I believe that not to be the truth. I prefer to listen and ask questions that guide the assessment towards narrowing down what disease process the patient is experiencing. I find that the patient tends to give way more detail that way.

As others have stated, quality assessment comes from education, practice and experience.

[Asysin2leads]

sportygirl,

first off, welcome to the city. I applaud you on wanting to further your knowledge on one of the most important, yet most overlooked, parts of prehospital care.

I think you have a few problems. One of the first is that you're nervous and a bit shy. Its okay. It happens. Walking into stranger's houses and asking them personal questions takes a bit of getting used to. You might want to practice doing something that puts yourself at ease, which is just as important at putting the patient at ease. You might want to try starting off with a standard greeting which reminds both you and your patient why you are there. "Hi, I'm ------, and I'm going to ask you a few questions" is a good one because it sets up the patient with your line of questioning and also reminds you of what you're supposed to be doing. Sometimes my mind still goes blank and when it happens, I usually talk to the patient about what I'm doing and why, not only to let them know but also to remind myself.

Secondly, it works far better to remember what you're supposed to be asking if you have a concept of why you're asking it. OPQRST is really geared towards cardiac/chest pain presentations, but if you think about it logically, they are really just common sense questions that you would need to know when someone is ill. How long has it going on? Does anything make it better or worse? What does it feel like? etc.

SAMPLE is the standard medical history that everyone gets when entering the ER. The Big Five are name, DOB, social security number, medications, allergies. Medications are particularly important because they many times are also the patient's medical history in a nice neat package.

Lastly, I would suggest the next time you are in the ER to spend all 8 hours sitting in triage doing nothing but taking medical histories.

Good luck!

[explenture]

I practiced assesments on my dogs...using Review dispatch, over view scene, C Spine, Level of Consciousness, Airway, Breathing, Circulation, Deformities, Expose.....then either rapid trauma, heat to etc. and then SAMPLE/OPQRST.

I'd say the best questions are those that are harder to answer ie not do you have a cough, but is the cough productive or how long have you had the cough.....where is the headache in your head....etc.

[nsmedic393]

I know when i was a student, especially a PCP student, i had difficulty nailing down my patient assessment to the point where it was fluid, comfortable and effective. My main complaint was that i knew that there was a difference in parroting the SAMPLE OPQRST assessment that we had all practiced over and over in class and how a competent experienced medic did their patient assessment.

I remember wishing that i could just once or twice sit back and watch my preceptors do their thing instead of always being the one out front stumbling along trying to find my own way through it. Thats why now when i preceptor a student i usually offer to do the patient assessment a couple of times while they listen and watch.

I know that my patient assessment is way different from what was taught in school, i like to quickly get at anything big that has a chance to iimmediatelykill the patient and then work out into the smaller more finite issues that may be the cause of their current medical condition, but thats just me and i ddon'tfault students for for having their own style of patient assessment as long as is effective.

If i were you i would ask to simply watch your preceptors do it as they normally would without you a couple times. You may pick up little tricks or techniques or styles that they employ and then you can take that and incorporate it into your own style.

[tniuqs]

I remember wishing that i could just once or twice sit back and watch my preceptors do their thing instead of always being the one out front stumbling along trying to find my own way through it. Thats why now when i preceptor a student i usually offer to do the patient assessment a couple of times while they listen and watch.

I know that my patient assessment is way different from what was taught in school,

Yes agreed my fur lined jockstrap friend, long time ! :twisted:

In the educational facilities there must be a repeatable way to teach a logical approach, in time and with a good Preceptor/Mentor, as NSmedic points out this will become second nature, it will not happen overnight either it takes experiance.

The thing that sticks in my craw is a "Trainer" throws the Student to the wolves, right from the get go .... then uses the shred technique to teach the student .... meh.

The good Mentor will model first and through example, then discuss the finer points, this is the technique employed by most teaching MD's, a system by system evaluation: C/F, O/A, PMHX, Rx, CNS, CVS, END, PULM, ABDO you get the drift.

I can categorically state that there are just too many folks out there in EMS land that really have no medical "logical" some with a deliquent gene yet have great hearts, this can be of paramount significance down the road in their careers. If the student has (albeit harsh) graduated to field evaluation with this serious flaw "ie sans logic" unidentified then it is a failure of the school bottom line, not everyone is cut out for this field.

That said reviewing OP commentary I am lead to believe your concern is primarily a confidence issue. I reflect on my First Paramedic Preceptor who always asked these questions:

So what's happening here ?

Practice "Active Listening !"

And for the golden cookie award ask just the patient "What do you think is wrong" many many times they will tell you exactly what the real problem is! Its amazing ! :wink:

cheers

ps My preceptor was from New York City, Yonkers in fact the son of a butcher and a great human being, but talked really funny. :shock:

[MedicNorth]

Sporty - if it the nerves that are getting to you to mess up the assesment, then I think it would be an excellent idea to completely memorize the sequence, if there is a written script in your course, and then practice, practice, practice. Practice on friends, family, other students; run it through your head from memory as you lie in bed, drive around; write it down from memory every chance you get. If you don't have an assessment script, there are plenty of them around.

On that note - a memorized sequential pattern is NOT an assessment - it is simply a guide that should get you the answers you need if you listen, but it tends to be a good starting point - get into the routine, and the nerves become less an issue. Eventually you will adapt it to suit your needs and style, but for the preceptors and examiners, the big issue will be completeness.

The other advice here - Watch and listen others as they do theirs. This is great advice, but it can be very enlightening to observe other students as well, and them help each other by discussing what was good, what needed improvement or expansion. The big requirement here would be the discussion - never be afraid to ask WHY something was done.

Good luck to you - your attitude towards learning by asking here is laudable - I think you will do well.