NREMT EMT 3: Secondary Assessment - Reassessment, Trending Vital Signs, Re-Evaluating Interventions

What This Is: Reassessment

Reassessment is like checking the GPS on your phone – you need to make sure you're on the right path and adjust your route as needed. In emergency medicine, reassessment means checking vital signs and re-evaluating interventions to make sure you're providing the best care possible. For example, imagine you're treating a patient with chest pain. You start with oxygen and pain medication, but their heart rate is still high. You need to reassess their condition and adjust your treatment plan to get their heart rate under control.

Key Steps / Core Facts:

• Trending vital signs: Checking vital signs (heart rate, blood pressure, breathing rate, oxygen saturation) over time to see if they're improving or getting worse. (e.g., "Is the patient's heart rate going up or down?")
  • Why it matters: Vital signs can change quickly in an emergency, and reassessing them helps you adjust your treatment plan.
  • Example: A patient's heart rate was 120 beats per minute (bpm) when you arrived, but it's now 140 bpm – you need to adjust their medication.
• Re-evaluating interventions: Checking if the treatments you're providing are working and making adjustments as needed. (e.g., "Is the oxygen mask helping the patient breathe better?")
  • Why it matters: Interventions can have unintended consequences, and reassessing them helps you avoid harming the patient.
  • Example: You're providing oxygen to a patient with respiratory distress, but their oxygen saturation is still low – you need to adjust the oxygen flow rate.
• AVPU (Alert, Voice, Pain, Unresponsive): A mnemonic to assess a patient's level of consciousness. (e.g., "Is the patient alert, responding to voice, or in pain?")
  • Why it matters: AVPU helps you quickly assess a patient's level of consciousness and adjust your treatment plan.
  • Example: A patient is unresponsive to voice and pain – you need to start CPR.
• OPQRSTI (Onset, Provocation, Quality, Region, Severity, Time, Insurance): A mnemonic to assess a patient's symptoms. (e.g., "When did the patient's symptoms start, and how severe are they?")
  • Why it matters: OPQRSTI helps you quickly gather information about a patient's symptoms and adjust your treatment plan.
  • Example: A patient's chest pain started 30 minutes ago and is severe – you need to start with pain medication.
• Red flags: Danger signs that indicate a patient's condition is worsening. (e.g., "Is the patient's heart rate going up, or are they becoming more unresponsive?")
  • Why it matters: Red flags help you quickly identify patients who need more aggressive treatment.
  • Example: A patient's heart rate is over 150 bpm, and they're becoming more unresponsive – you need to start CPR.
• CPR compression depth: At least 2 inches – like pushing down a soda can. (e.g., "Is the CPR compression depth at least 2 inches?")
  • Why it matters: Proper CPR compression depth is crucial for effective CPR.
  • Example: A patient's CPR compression depth is only 1 inch – you need to adjust the compression depth.
• CPR rate: 100-120 compressions per minute – like a metronome. (e.g., "Is the CPR rate 100-120 compressions per minute?")
  • Why it matters: Proper CPR rate is crucial for effective CPR.
  • Example: A patient's CPR rate is 80 compressions per minute – you need to adjust the rate.
• Oxygen saturation: 90-100% – like a healthy blood oxygen level. (e.g., "Is the patient's oxygen saturation 90-100%?")
  • Why it matters: Proper oxygen saturation is crucial for effective oxygen therapy.
  • Example: A patient's oxygen saturation is 80% – you need to adjust the oxygen flow rate.

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 (5-10 quick thrusts).
• If someone is having a heart attack, call 911 and provide any information you can about their symptoms.
• If someone is having a severe allergic reaction, call 911 and provide any information you can about their symptoms.

Common Mistakes:

• Mistake: Not reassessing vital signs regularly.
  • Fix: Check vital signs every 5-10 minutes to ensure you're on the right path.
• Mistake: Not adjusting interventions based on reassessment.
  • Fix: Reassess interventions regularly and adjust them as needed to ensure they're working.
• Mistake: Not recognizing red flags.
  • Fix: Be aware of danger signs and quickly identify patients who need more aggressive treatment.
• Mistake: Not providing proper CPR compression depth.
  • Fix: Ensure CPR compression depth is at least 2 inches to ensure effective CPR.
• Mistake: Not providing proper CPR rate.
  • Fix: Ensure CPR rate is 100-120 compressions per minute to ensure effective CPR.

Quick Practice Scenarios:

1. A patient is having a heart attack and is receiving oxygen. Their heart rate is 120 bpm, and their oxygen saturation is 90%. What should you do first? Answer: Reassess their oxygen saturation and adjust the oxygen flow rate if necessary. Reason: The patient's oxygen saturation is low, and adjusting the oxygen flow rate may help improve it.
2. A patient is having a severe allergic reaction and is receiving epinephrine. Their symptoms are worsening, and they're becoming more unresponsive. What should you do first? Answer: Start CPR and call for additional help. Reason: The patient's symptoms are worsening, and they're becoming more unresponsive – CPR is necessary to ensure they receive adequate circulation.
3. A patient is having a seizure and is receiving oxygen. Their seizure is lasting longer than 5 minutes, and they're becoming more unresponsive. What should you do first? Answer: Turn them onto their side and clear the area around them. Reason: The patient's seizure is lasting longer than 5 minutes, and they're becoming more unresponsive – turning them onto their side and clearing the area around them may help prevent injury.

Last-Minute Exam Cram:

• Normal heart rate: 60-100 bpm
• Normal blood pressure: 90-140/60-90 mmHg
• Normal breathing rate: 12-20 breaths per minute
• Normal oxygen saturation: 90-100%
• CPR compression depth: at least 2 inches
• CPR rate: 100-120 compressions per minute
• AVPU: Alert, Voice, Pain, Unresponsive
• OPQRSTI: Onset, Provocation, Quality, Region, Severity, Time, Insurance
• Agonal breathing is NOT normal breathing – start CPR
• A patient's heart rate going up or down can indicate a worsening condition
• A patient's oxygen saturation below 90% may indicate inadequate oxygen therapy
• A patient's breathing rate above 30 breaths per minute may indicate respiratory distress