Patient Assessment
What this domain tests
Assessment items test a structured sequence: scene size-up, primary assessment, secondary assessment, and reassessment. The exam checks whether you can find immediate threats, gather targeted history, and repeat findings after intervention.
Core rules
- Scene size-up: safety, number of patients, mechanism or nature of illness, and needed resources.
- Primary assessment: general impression, chief complaint, ABCDE, and a transport decision. Reassess unstable patients about every 5 minutes and stable patients about every 15.
- History: OPQRST for pain, SAMPLE for background. Physical exam uses DCAP-BTLS for trauma and focused exams for medical complaints.
- Vital signs: adult heart rate 60–100, respirations 12–20, systolic pressure around 90–140, SpO2 at least 94%. Infants normally breathe faster and have rates near 100–160.
- Auscultation: stridor is upper airway, wheeze is lower airway, crackles suggest fluid. Recheck after every intervention.
Worked example
An 82-year-old is confused and afebrile, with a heart rate of 118 and dry mucous membranes. You complete the primary assessment, find no immediate airway threat, obtain a glucose and 12-lead, take a SAMPLE history from family, and reassess after giving oxygen. The reassessment, not the first set of vitals, reveals whether the patient is improving.
Traps
Skipping the reassessment, treating the monitor instead of the patient, and accepting a single normal oxygen saturation in a patient with poor perfusion are frequent errors.