paramedic care: principles & practice

PARAMEDIC CARE:PRINCIPLES &

PRACTICE

Patient Assessment

The History

The ability to elicit a good history lays the foundation

for good patient care.

Topics History Taking Techniques Active Listening The Comprehensive Health

History

Patient Rapport

Setting the Stage

If a patient’s chart is available, review it before interviewing the patient.

Use this information to gain clues about the patient.

The First Impression

Present yourself as a caring, competent, and confident health care professional.

When you introduce yourself to the patient, shaking hands or offering a

comforting touch will help build trust.

Asking Questions

Use a combination of open-ended and close-ended questions.

Language and Communication

Use appropriate language. Use an appropriate level of

questioning, but do not appear condescending.

When encountering communication barriers, try to enlist someone to help.

Actively listen.

Active Listening Facilitation Reflection Clarification Empathy Confrontation Interpretation Asking about feelings

Sensitive Topics

A paramedic must learn to become comfortable dealing with sensitive topics.

It is important to earn a patient’s trust.

The Comprehensive Patient History

Elements of the Patient

History

Preliminary Data Date and time Age Sex Race Birthplace Occupation

The Chief Complaint

This is the pain, discomfort, dysfunction that caused the patient to request help.

The Present Illness OPQRST-ASPN

Onset of the problem

Provocative/ Palliative factors Quality Region/Radiation Severity Time

Associated Symptoms

Pertinent Negatives

Past History General state of health Childhood diseases Adult diseases Psychiatric illnesses Accidents or injuries Surgeries or hospitalizations

Current Health Status

(1 of 3) Current medications Allergies Tobacco Alcohol, drugs, and

related substances Diet Screening tests Immunizations

Current Health Status

(2 of 3) Sleep patterns Exercise and leisure activities Environmental hazards Use of safety measures Family history Home situation and

significant others Daily life

Current Health Status

(3 of 3)

Important exercises Religious beliefs The patient’s outlook

You should take your patient’s medications with you to the

hospital, when practical.

Review of Systems

A system-by-system series of questions designed to identify problems your patient has not already identified.

Special Challenges (1 of 2)

Silence Overly talkative

patients Multiple

symptoms Anxiety

Depression Sexually

attractive or seductive patients

Confusing behaviors or symptoms

Special Challenges (2 of 2)

Patients needing reassurance

Anger and hostility

Intoxication Crying

Limited intelligence

Language Barriers Hearing problems Blindness Talking with

families or friends

If the patient cannot provide useful information, gather it

from family or bystanders.

Summary

History taking techniques Active listening The comprehensive health

history