Patient Assessment and Clinical Decision Making
Core concepts
The assessment sequence should be second nature: scene size-up, primary assessment (general impression, mental status, airway, breathing, circulation, disability, exposure), secondary assessment (history, focused exam, vital signs), and reassessment. Know the components of a thorough history, including OPQRST for pain and SAMPLE for background. Understand how to form and test a differential diagnosis, how to prioritize interventions using an ABC-first framework, and how to use trend data (repeat vitals, mental status changes) rather than single snapshots. Familiarity with clinical decision rules (e.g., when to transport versus treat on scene) and documentation standards is expected.
Traps in questions
Questions often reward the "next best step" rather than the definitive diagnosis. Distractors frequently offer a treatment before the assessment step is complete, or suggest a diagnosis inconsistent with the vital sign trend. Be careful with normal-range vital signs in a deteriorating patient-trends and mental status often override a single reassuring number. Pediatric and geriatric patients present atypically; do not apply adult thresholds blindly.
Rule of thumb
When a scenario asks what to do next, ask yourself: have I completed the primary assessment and addressed immediate threats? If not, that is the answer. If threats are addressed, the next step is usually to obtain a focused history and exam that will change management.