NREMT EMT 3 Secondary Assessment Pertinent negatives and positives

What This Is: Pertinent Negatives and Positives

Pertinent negatives and positives refer to the process of identifying and evaluating the patient's condition by looking for clues that indicate the severity of their illness or injury. This is crucial in emergency medicine, as it helps EMTs and medical professionals make quick decisions about treatment and transport. Think of it like a traffic light: green means go, yellow means caution, and red means stop. In medical terms, a "positive" finding is something that indicates a problem, while a "negative" finding is something that suggests everything is okay.

Key Steps / Core Facts:

• Chief Complaint (CC): The patient's main reason for seeking medical help. Why it matters: helps EMTs understand the patient's symptoms and prioritize treatment. Example: "I have chest pain."
• History of Present Illness (HPI): The patient's story about their symptoms. Why it matters: helps EMTs understand the patient's symptoms and identify potential causes. Example: "I've had chest pain for 2 hours."
• Vital Signs (VS): Measurements of the patient's heart rate, breathing rate, blood pressure, and temperature. Why it matters: helps EMTs assess the patient's overall condition and identify potential problems. Example: "The patient's heart rate is 120 beats per minute."
• Pertinent Positives: Clues that indicate a problem. Why it matters: helps EMTs identify potential causes of the patient's symptoms. Example: "The patient has a history of heart disease."
• Pertinent Negatives: Clues that suggest everything is okay. Why it matters: helps EMTs rule out potential causes of the patient's symptoms. Example: "The patient has no history of allergies."
• Red Flags: Danger signs that indicate a serious problem. Why it matters: helps EMTs prioritize treatment and transport. Example: "The patient is experiencing difficulty breathing."
• AVPU (Alert, Voice, Pain, Unresponsive): A mnemonic to assess the patient's level of consciousness. Why it matters: helps EMTs determine the patient's level of alertness and prioritize treatment. Example: "The patient is unresponsive."
• OPQRSTI (Onset, Provocation, Quality, Region, Severity, Time, Insurance): A mnemonic to assess the patient's symptoms. Why it matters: helps EMTs understand the patient's symptoms and identify potential causes. Example: "The patient's chest pain started 2 hours ago and worsens with deep breathing."
• SAMPLE (Size, Alliance, Mechanism, Allergies, Past medical history, Last oral intake): A mnemonic to assess the patient's medical history. Why it matters: helps EMTs understand the patient's medical history and identify potential causes of their symptoms. Example: "The patient has a history of diabetes and takes insulin."

What Laypeople Can Do:

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is experiencing difficulty breathing, help them sit up and stay calm.
• If someone is experiencing chest pain, help them stay calm and call 911.

Common Mistakes:

• Mistake: Failing to ask the patient about their medical history. Fix: Ask the patient about their medical history to understand their symptoms and identify potential causes.
• Mistake: Failing to assess the patient's vital signs. Fix: Assess the patient's vital signs to understand their overall condition and identify potential problems.
• Mistake: Failing to identify red flags. Fix: Identify red flags to prioritize treatment and transport.

Quick Practice Scenarios:

• A patient comes in with a history of heart disease and is experiencing chest pain. What should you do first?

Call 911 and ask the patient about their symptoms.

• A patient is experiencing difficulty breathing and is unresponsive. What should you do first?

Check the patient's airway, breathing, and circulation (ABCs) and call 911.

• A patient comes in with a history of diabetes and is experiencing numbness in their extremities. What should you do first?

Assess the patient's vital signs and ask about their last meal to understand their symptoms and identify potential causes.

Last-Minute Exam Cram:

• ⚠️ Agonal breathing is NOT normal breathing – start CPR.
• Normal heart rate is 60-100 beats per minute.
• Normal blood pressure is 90-120/60-80 mmHg.
• ⚠️ A patient with a history of heart disease should be transported to the hospital immediately.
• The patient's medical history is a crucial part of the assessment process.
• ⚠️ A patient with difficulty breathing should be transported to the hospital immediately.
• The patient's vital signs should be assessed every 5-10 minutes.
• ⚠️ A patient with a history of allergies should be given epinephrine if they experience an allergic reaction.
• The patient's symptoms should be documented in their medical record.