NREMT EMT 3: Secondary Assessment - Medical History Taking, SAMPLE History, Signs/Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events Leading to Illness/Injury

What This Is

Medical history taking is a crucial step in emergency care. It's like gathering clues to solve a mystery. When you're trying to figure out what's wrong with someone, you need to know their past medical history, allergies, medications, and more. For example, if someone collapses, you might not know if they have a heart condition or are allergic to certain medications. Taking a good medical history helps you make the right decisions and provide the best care.

Key Steps / Core Facts

• Signs/Symptoms: What the person is experiencing right now, like pain, difficulty breathing, or confusion. (SAMPLE)
  • Matters because it helps you understand the severity of the situation.
  • Example: "I have a headache and feel dizzy."
• Allergies: Any substances that cause a severe reaction, like peanuts or bee stings. (SAMPLE)
  • Matters because it helps you avoid using medications or treatments that could make things worse.
  • Example: "I'm allergic to penicillin."
• Medications: Any prescription or over-the-counter medications the person is taking. (SAMPLE)
  • Matters because it helps you understand potential interactions or side effects.
  • Example: "I take blood pressure medication every morning."
• Past Medical History: Any previous illnesses, surgeries, or conditions the person has had. (SAMPLE)
  • Matters because it helps you understand potential underlying conditions.
  • Example: "I had a heart attack 5 years ago."
• Last Oral Intake: The last time the person ate or drank something. (SAMPLE)
  • Matters because it helps you understand potential causes of symptoms.
  • Example: "I ate a sandwich 2 hours ago."
• Events Leading to Illness/Injury: What happened before the person became sick or injured. (SAMPLE)
  • Matters because it helps you understand the cause of the symptoms.
  • Example: "I fell down the stairs and hit my head."
• Vital Signs: Measurements like pulse, breathing rate, and blood pressure. (AVPU)
  • Matters because it helps you understand the person's overall condition.
  • Example: "My pulse is 120 beats per minute."
• Red Flags: Warning signs that indicate a serious condition, like severe pain or difficulty breathing. (OPQRSTI)
  • Matters because it helps you prioritize care and call for help.
  • Example: "I have severe chest pain and can't breathe."

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is having a seizure, turn them onto their side and clear the area around them.
• If someone is choking, perform the Heimlich maneuver (5 quick thrusts).
• If someone is bleeding heavily, apply pressure with a clean cloth or bandage.
• If someone is having a heart attack, call 911 and try to keep them calm.

Common Mistakes

• Mistake: Not asking about allergies or medications.
  • Fix: Always ask about allergies and medications to avoid potential interactions.
• Mistake: Not taking a thorough medical history.
  • Fix: Take a detailed medical history to understand the person's condition.
• Mistake: Not checking vital signs.
  • Fix: Check vital signs to understand the person's overall condition.
• Mistake: Not recognizing red flags.
  • Fix: Be aware of warning signs that indicate a serious condition.
• Mistake: Not calling for help.
  • Fix: Call 911 or alert someone for help if you're unsure what to do.

Quick Practice Scenarios

1. A person comes in with severe chest pain and difficulty breathing. What should you do first?
   • Answer: Call 911 and try to keep them calm.
   • Reason: Severe chest pain and difficulty breathing are red flags for a heart attack.
2. A person has been in a car accident and is bleeding heavily from a wound. What should you do first?
   • Answer: Apply pressure with a clean cloth or bandage.
   • Reason: Stopping bleeding is crucial to prevent shock.
3. A person is having a seizure and is foaming at the mouth. What should you do first?
   • Answer: Turn them onto their side and clear the area around them.
   • Reason: This helps prevent injury and allows them to breathe.

Last-Minute Exam Cram

• Normal pulse range: 60-100 beats per minute
• Normal breathing rate: 12-20 breaths per minute
• Normal blood pressure: 90/60-120/80 mmHg
• SAMPLE history: Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to illness/injury
• AVPU: Alert, Verbal, Pain, Unresponsive
• OPQRSTI: Onset, Provocation, Quality, Region, Severity, Timing, Insurance
• Agonal breathing is NOT normal breathing – start CPR
• A person with a head injury should not be moved unless absolutely necessary
• A person with a severe allergic reaction should receive epinephrine