ASSESSING THE PATIENT
By this time in the course, you’ve learned the basics about most body systems. Explanations have been given about the anatomy and physiology of the human body, how it works and what it looks like when it isn’t working correctly. You have also had the opportunity to learn how to acquire the basic vitals signs. Now is the time to put all that knowledge together. It is time to assess the patient as a whole.
When helping a sick or injured patient, you want to investigate in a systematic fashion. We will teach you to do a head- to-toe, focused, patient exam. This allows you to evaluate all body systems, glean pertinent information from the patient, noting areas of concern while preventing you from focusing on one thing.
For instance, if a passenger incurs a head trauma due to turbulence, you may notice profuse bleeding from the person’s nose. Instead of focusing on the amount of blood, you need to focus head-to-toe and find all the injuries the patient may have. Focusing on the nose may cause you to miss a concussion, spinal cord injury or the patient’s altered level of consciousness.
SAFETY FIRST
During the focused patient examination, remember your safety is first priority. You should be, at a minimum, wearing disposable gloves and eye protection. Every patient, every time. It is also helpful if other crew members are available. They can help write information down, contact the PIC, calm other passengers and relay information to Aircare Access.
HANDS-ON ASSESSMENT
Beginning with life-threatening treatment priorities, establish the CABs of patient care. If your patient has no heart beat and is not breathing, a dislocated finger is really no longer important. Always begin by assessing the CABs. This can be as easy as asking your patient, “Are you OK? May I help you?” If the patient is conscious and responds, you have already established the CABs.
If your patient does not respond or is unconscious, your exam may not proceed very far. Spend the next few moments trying to figure out why the patient is unconscious. Utilize family, friends or other passengers to establish recent history and events that led up to this.
If your patient is conscious, the next step is to determine the chief complaint. This complaint may be pain, it may be dizziness, it may even be a “funny” feeling as some patients can’t really put into words what they are feeling. If the patient is not in an emergent situation; e.g., is breathing and has a pulse, ask more about the chief complaint. “How long have you felt this way?”; “What brought this on?”; and “Has this happened before?” are all crucial questions to ask. If the patient is unable to respond, utilize family, friends or bystanders and find out what they noticed.
Examine the patient head to toe, looking for specific details. A trauma patient exam will always include looking for blood, pain or deformity as well. If trauma is involved, treat obvious injuries as you go.
HEAD - physically palpate (feel with your hands) the patient’s head; front, back, sides and top. Note any deformity, pain or bleeding. Look at the patient’s face. Is it symmetrical? Do both eyes look the same? Utilizing a pen light, quickly shine the light in one eye, remove the light and note how the pupil responds. Normal reaction would cause the pupil to become very tiny with the presence of bright light, then gradually increase to normal size.
Check each eye independently and note your findings. Pupils that do not respond indicate some type of illness or injury. Ask the patient to smile and frown, ensuring both sides of the mouth work together. Ask the patient to bite together. If the patient’s bite does not feel normal, this can be a sign of jaw or dental trauma. This is also the perfect time to evaluate the patient’s skin, noting temperature, color and dampness. Lastly, use the pen light and look in and behind the patient’s ears. You will be looking for bruising behind the ear and blood or other fluids draining out of the ear.
NECK/CERVICAL SPINE - During this assessment you will look for pain, deformity, stiffness or bleeding. You should also take note of any medical alert necklaces. Using your gloved hands, gently palpate the back of the patient’s neck. You are trying to note deformities. If you do not feel any, GENTLY press against the patient’s cervical spine and ask if there is any discomfort. If you are certain the patient has not been involved in any trauma, ask the patient to gently turn his or her head from side to side. Any stiffness or discomfort will show up here. Make a note of any findings.
CHEST - Ask the patient if he or she is feeling any chest pain, heaviness or difficulty breathing. Many
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