9/11/2012
Chapter 12
Focused History and Physical
Examination for
Medical Patients
Slide 1
Overview

Responsive Medical Patients
 Patient History
 Rapid Assessment
 Vital Signs
 Emergency Care
 Unresponsive Medical Patients
Slide 2
Focused History and Physical
Examination: Medical Patients

Every patient receives a focused history and physical exam
Slide 3
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9/11/2012
Focused History and Physical
Examination: Medical Patients

Unresponsive medical patients are treated as are unresponsive trauma patients
Slide 4
Focused History and Physical
Examination: Medical Patients

Proceed to the focused history and physical exam after completing the scene size-up and initial assessment
Slide 5
Responsive Medical Patients
Slide 6
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9/11/2012
Responsive Medical Patients

Assess the patient’s history
 Assess complaints and signs or symptoms
 Use the techniques of physical exam learned in the Focused History and Physical
Examination: Trauma Patients
Slide 7
Responsive Medical Patients
O-P-Q-R-S-T acronym
O nset
P rovocation
Q uality
R adiation
S everity
T ime

The O-P-Q-R-S-T acronym is useful for remembering what questions should be asked.

Not all the questions will always have to be asked, nor will they need to be asked in this order.

O-P-Q-R-S-T is primarily used to evaluate pain but can also be used for other medical conditions.
Slide 8
O PQRST Acronym

O nset
 What was the patient doing when the signs/symptoms started?
Slide 9
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9/11/2012
O P QRST Acronym

P rovocation/ P alliation
 What makes the signs and symptoms better or worse?
Slide 10
OP Q RST Acronym

Q uality
 The patient’s description of the symptom
Slide 11
OPQ R ST Acronym

R adiation
 Is there radiation of the symptoms?
Slide 12
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9/11/2012
OPQR S T Acronym

S everity
 An opportunity for the patient to quantify the pain
 Typically done with a 1-10 scale
• The Wong-Baker Scale
Slide 13
OPQRS T Acronym

T ime
 How long have the signs and symptoms been present?
Slide 14
Responsive Medical Patients
 Remember that a physical exam is required for all patients
 In the responsive patient, assess the body systems associated with the chief complaint
Slide 15
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9/11/2012
Responsive Medical Patients
D-C-A-P-B-T-L-S acronym
D eformities
C ontusions
A brasions
P enetrations
B urns
T enderness
L acerations
S welling
Reminder of injuries and signs of injuries to look for while assessing.
Slide 16
Responsive Medical Patients

Assess the head, as necessary
Responsive Medical Patients
 Assess the neck, as necessary
Slide 17
Slide 18
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9/11/2012
Responsive Medical Patients

Assess for JVD, as necessary
Responsive Medical Patients

Assess the patient’s chest, as necessary
Slide 19
Responsive Medical Patients

Assess the breath sounds
Slide 20
Slide 21
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9/11/2012
Responsive Medical Patients

Assess the abdomen, as necessary
Slide 22
Responsive Medical Patients

Assess the four quadrants of the abdomen, as necessary
Slide 23
Responsive Medical Patients

Assess the pelvis
Slide 24
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9/11/2012
Responsive Medical Patients

Assess the lower extremities, as necessary
Responsive Medical Patients
 Assess pulse, motor, and sensation in the lower extremities, as necessary
Slide 25
Responsive Medical Patients

Assess the upper extremities, as necessary
Slide 26
Slide 27
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9/11/2012
Responsive Medical Patients

Log-roll the patient and assess the posterior, as necessary
Slide 28
Patient History
Slide 29
Patient’s History

Assess SAMPLE History
S Signs and Symptoms
A Allergies
M Medications
P Past medical history
L Last oral intake
E Events leading to injury or illness
Slide 30
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9/11/2012
Vital Signs
Slide 31
Vital Signs
 Assess baseline vital signs
 Breathing


Skin
Pupils
 Blood pressure
Slide 32
Emergency Care for
Unresponsive Medical Patients
Slide 33
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9/11/2012
Unresponsive Medical Patients

Complete a rapid head-to-toe assessment, as in the Focused History and Physical
Examination: Trauma Patients
Slide 34
Summary

Responsive Medical Patients
 Patient History
 Rapid Assessment
 Vital Signs
 Emergency Care

Unresponsive Medical Patients
Slide 35
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