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Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 10 – Rapid Physical Exam. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. . Objectives. Describe when the EMS provider would perform the rapid physical exam (RPE).
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Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P
Chapter 10 – Rapid Physical Exam © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives • Describe when the EMS provider would perform the rapid physical exam (RPE). • List factors to consider when removing patient clothing as part of the RPE. • Describe the sequence for evaluation of body parts or regions as part of the RPE. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives (continued) • List pertinent information the EMS provider should gather from family or caretakers when a patient is unable to provide it. • Describe how the EMS provider can best gain proficiency in conducting the RPE quickly and accurately. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction • A rapid PE is completed on the unresponsive medical patient, conscious stroke, intoxicated, or postictal patient. • The RPE is a rapid systematic exam of the following body areas: • Head/neck • Chest/abdomen/pelvis • Back/buttocks • Extremities © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction (continued) • The RPE is similar to the rapid trauma exam (RTE) • The acronym DCAP-BTLS is used to recall assessment points. • Deformities • Contusions • Abrasions • Punctures/penetrations • Burns • Tenderness • Swelling © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Steps in the RPE • Utilize appropriate BSI precautions • Remove any clothing needed to actually look at the skin • Consider environmental conditions • Be considerate for privacy and modesty • Reconsider the nature of illness (NOI) • Be alert for any possible MOIs © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Steps in the RPE (continued) • Systematically evaluate each of the following body areas from head-to-toe: • Head & Neck • Assess for DCAP-BTLS, crepitation and JVD • Do not poke fingertips into fractures or soft spots • Chest • Assess for DCAP-BTLS, paradoxical motion, crepitation and breath sounds • Note any obvious scars from past medical history (e.g.: CABG) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Steps in the RPE (continued) • Abdomen • Assess for DCAP-BTLS, firmness, softness, and distension • Note any tenderness, masses, or bulges • Note any scars as a clue to past medical history • Pelvis • Assess for DCAP-BTLS, pain, tenderness, unstable motion • The pelvis is made up of 3 bones (ilium, ischium, pubis) and the lower spine • The potential for blood loss is great and may mask 1,500 ml © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Steps in the RPE (continued) • Extremities • Assess for DCAP-BTLS, distal pulse, motor function & sensation (PMS) • Assess reflexes, strength and range of motion (ROM) • Posterior • Assess for DCAP-BTLS • This area is often overlooked • Do not roll patient onto a fractured hip or arm! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Following the RPE • Obtain baseline VS • Obtain the SAMPLE history • Consider info from the: family, bystanders, caretakers and first responders • Look for clues on medical history • Consider calling physician if known • Ask about advanced directives • Explain to the family/caretaker what is happening and what to expect next © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Conclusion • Upon completion of IA, if you determine the patient has a medical emergency and is not responsive, the RPE should be done. • The RPE is a systematic exam of the head, neck, chest, abdomen, pelvis, posterior, and extremities. • Time is often a factor • Achieving proficiency takes practice! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
