Patient Assessment and Clinical Decision-Making
This domain tests structured assessment and clinical reasoning: how you size up a scene, prioritize threats in ABCDE order, form a differential, and decide transport urgency.
Core rules
- Scene size-up before contact: hazards, number of patients, mechanism or nature of illness, and need for additional resources.
- Primary survey: catastrophic hemorrhage control, airway, breathing, circulation, disability (GCS, pupils, glucose), exposure with temperature control.
- Obtain full vital signs, including SpO2, blood glucose, and pain score; repeat after every intervention and at least every 5–10 minutes for unstable patients.
- Use SAMPLE for history and OPQRST for pain. Ask about allergies, medications, past medical history, last meal, and events.
- Reassess the patient, not just the monitor. A stable initial survey can change quickly.
- Decide transport early; in Kuwait call 112 for emergency medical response and follow MOH destination protocols.
Worked example
A 58-year-old man with crushing chest pain is pale and diaphoretic, BP 100/70, HR 110, SpO2 94%. You give aspirin and oxygen to target 94–98%, obtain a 12-lead ECG, and reassess. Because he is unstable and has a suspected ACS, you prioritize rapid transport rather than a prolonged on-scene assessment.
Traps
Anchoring on the first diagnosis; missing hypoglycemia in altered mental status; recording one set of vitals; ignoring mechanism in trauma; and failing to reassess after medication.