401067 Paramedic Practice 1 Week 3

Introduction to systems of care for patient assessment and management

“For most diagnoses all that is needed is an ounce of knowledge,

an ounce of intelligence, and a pound of thoroughness”

Anon.

Patient assessment

Physical examination

History taking

REGARDLESS OF PERCEIVED ACUITY

Systematic Structured

Reproducible Consistent

Patient assessment must be

LOW ACUITY CASES MAY BE HIGH IN COMPLEXITY

Don’t be lulled into apathy or shortcuts just because:

1. What you have been called to sounds benign or non-urgent

2. The patient presents on initial visual assessment to be well

Biomedical model of patient assessment

Biological / physiological

Traditional paramedical approach to patient assessment

Bio-psycho-social model

Physiological

Psychological Social / personal

Patient

Where does patient assessment and care start?

Chief Complaint Metro. Ops Reg. Ops Total

Falls 4,581 2,697 7,278

Sick person (non-specific

diagnosis

4,206 2,437 6,643

Chest pain (non-traumatic) 4,010 2,175 6,185

Breathing problems 3,639 1,919 5,558

Unconscious/Fainting (near) 3,212 1,605 4,817

Psychiatric/Abnormal

behaviour/Suicide attempt

2,005 1,068 3,073

Abdominal pain/problems 1,960 977 2,937

Traffic/transportation incident 1,540 709 2,249

Traumatic injuries (specific) 1,337 869 2,206

Overdose/poisoning (ingestion) 1,571 607 2,178

Haemorrhage/laceration 1,251 746 1,997

Convulsions/seizures 1,237 721 1,958

Assault/sexual assault 1,054 512 1,556

Stroke (CVA) 861 490 1,351

Heart problems/AICD 792 316 1,108

Unknown problem (man down) 652 387 1,039

Back pain (non-traumatic or non-

recent trauma)

625 378 1,003

Other complaints 4,053 2,260 6,313

Chief complaints (total) 38,586 20,873 59,459

MPDS problem categories

NSW Ambulance, 2013

Response priorities

Scene assessment = patient assessment (`mechanism of injury’)

Scene assessment

Then you find your patient…

Systematic approach to patient care

• Patient care algorithm

Wardrope at al 2008

Wardrope et al 2008; NSW Ambulance 2014

S.O.A.P.E.D.D. S – subjective information

O – objective information

A – analyse findings

P – plan you actions

D – determine capacity and competency

E – explain treatment, options and risks to patient

D – decide on most appropriate disposition

A systematic approach to patient assessment

Considerations when taking a history…

Explanation

Empathy

Active listening

Sensitivity

Patient privacy

Rapport Emotional

intelligence

Non-judgemental

Relevance

Key components of history taking

Social Hx

Chief complaint / presenting symptom

Allergies

Previous illnesses /

treatments

Hx of chief complaint / presenting symptom

Family Hx

Medications

Sexual Hx Geriatric Hx

Menstrual Hx

Paediatric Hx

Systems review

Systems review

Neurological

Cardiovascular

Respiratory Gastrointestinal / urinary

Musculoskeletal

C.H.A.M.P.S.S C – chief complaint

H – history/nature of chief complaint

A – allergies

M – medications

S – social/personal history

P – previous medical history

S – systems review

A systematic approach for standard history taking

S.O.C.R.A.T.E.S S – site

O – onset

C – character

R – radiation

T – timing

A – alleviating factors

E – exacerbating factors

Assessing the chief complaint or symptom

S – severity

Lecture summary • History taking is critical to establishing a provisional diagnosis

• History taking must be structured and systematic

• History taking should be combined with objective assessment (patient examination) prior to determining a course

of treatment or formulating a provisional diagnosis

• You, as the paramedic must control the history taking process – don’t let the patient lead you away from your structured routine

• Ask follow up question to clarify or get more information – don’t be happy with just any old answer

• History taking requires great communication and interviewing skills , both verbal and non-verbal

• Write it down or you will forget – a glove is not sufficient. A notepad is essential

Double-lecture week

• The face to face lecture is still on, so see you there!