EMT-Basic Exam: The Basics of Patient Assessment - Physical Exam

The condition of the patient—trauma or medical—will determine the type of focused history and physical examination the patient receives from EMT-Basics. Remember, treating unresponsive patients is very different from treating alert or conscious patients. Although rare, you should always be prepared to treat a completely unresponsive patient. Tests like the EMT-Basic will include multiple questions about completing the focused history and physical exams for both medical and trauma patients.

Tip: If a patient needs oxygen, you may place him or her on a device to assist breathing once the initial assessment is complete and before you begin the physical examination.

1. Responsive Patients
Many medical and trauma patients will be responsive during the physical exam, but the type of examination you perform will vary. The processes of gathering a patient’s history, performing the rapid-trauma assessment, and assessing a patient’s vital signs will vary depending on the patient you are treating.

a. Medical Patients
Responsive medical patients receive an objective assessment. The information for the objective assessment comes from the patient—what he or she verbally tells you combined with what his or her body tells you. You should also complete a subjective assessment, which contains information from friends, family, and witnesses.

While gathering focused history from responsive medical patients, ask about the onset, provocation, quality, radiation, severity, and time. Many EMT-Basics use the acronym OPQRST to remember which questions to ask the patient and/or bystanders. After OPQRST, you’ll need to gather SAMPLE information. This acronym stands for signs and symptoms, allergies, medications, past medical history, last intake of food or drink, and events leading to the patient’s present condition.

As you gather OPQRST and SAMPLE information, you should complete a rapid head-to-toe assessment, spending the most time on the areas related to the patient’s chief complaint. Keep in mind that an injury you’re assessing today may have occurred days, weeks, or even months ago. Ask your patient if he or she recalls any discomfort in that area in the past. If a patient experiences pain as you press on an area, don’t repeat the action.

After you complete the assessment, assess the patient’s baseline vital signs. This involves checking the patient’s skin, pupils, blood pressure, circulation, and breathing. Administer oxygen to any patient who has trouble breathing. If the patient needs emergency care, you can examine vital signs in the ambulance during transport. If you cannot immediately transport a patient who’s having trouble breathing, you should continue administering oxygen and transport the patient as soon as possible.

b. Trauma Patients
Gathering OPQRST and SAMPLE information and performing rapid assessment is more challenging when working with trauma patients because of the high-pressure emergency environment and the injuries to the patient. Trauma patients with simple or serious injuries receive a focused history and a physical examination directed specifically to the injured area. Patients with a high-risk MOI or an unknown MOI receive a rapid head-to-toe trauma assessment regardless of visible injuries. This assessment will expose any hidden or possible internal injuries. High-risk MOIs that involve hidden (internal) injuries often include the following:

- A fall of more than 20 feet
- Ejection from a moving vehicle
- Penetration to the head, chest, or abdomen
- Vehicle rollover
- High-speed vehicle collision
- Motorcycle accident
- Vehicle-pedestrian collision
- Patient with altered mental status

Remember to stabilize or immobilize all trauma patients with suspected neck, back, or head injuries before performing other tasks or attempting to move the patients. Treat these patients as though they have experienced a spinal injury. When performing the rapid-trauma assessment, examine and palpate the patient for injuries using the acronym DCAP-BTLS. These letters stand for deformities, contusions, abrasions, penetrations or punctures, burns, tenderness, lacerations, and swelling. Take a head-to-toe approach with this assessment, starting with the head and working your way down the patient’s body.

Tip: If you notice that a previously stable patient’s condition is declining, call for immediate transport.

2. Unresponsive Patients
All unresponsive medical patients should receive treatment similar to unresponsive trauma patients. This includes a rapid head-to-toe trauma assessment to reveal any hidden or life-threatening conditions. You should stabilize all unresponsive patients and treat them as though they have a spinal injury. Provide high-flow oxygen using a nonrebreather mask if necessary.
Because the patients cannot answer your questions about their medical history or tell you where they are experiencing pain, you will have to trust family, friends, or witnesses to give you honest answers to your OPQRST and SAMPLE questions. You can obtain this information while your partner performs the physical exam and checks the patient’s vital signs. If the patient is alone, you won’t be able to complete these questions until the patient becomes responsive.

Related Topics You Should Review:
- Detailed steps of the OPQRST and SAMPLE
- Evaluating specific body parts, such as the neck, pelvis, and abdomen
- Gathering history from and performing physical exams on children
- Working in a multitiered response system
- Evaluating patients without a specific MOI
- In-depth physical examinations
- Assessing baseline vital signs