Primary Assessment Study Guide for the EMT Test

Baseline Information

Vital signs and diagnostic tests provide essential information about a patient’s overall condition, helping EMTs recognize early signs of injury or illness. By assessing key indicators such as pulse, respiratory rate, blood pressure, skin condition, pupillary response, neurologic status, and oxygen saturation, EMTs can determine the severity of a patient’s condition, which can further help to guide their treatment and transport decisions.

Respiration Assessment

Even if breathing appears normal, gas exchange may still be inadequate. In a prehospital setting, using a pulse oximeter is one method for assessing oxygenation. A brief patient assessment of respiration should also include determining the level of consciousness, which can be affected if the patient is hypoxic or if carbon dioxide levels are too high. Skin color, specifically a bluish tint to the skin, lips, and nails, also indicates problems oxygenating.

Here are some terms to know:

• pulse oximetry—noninvasive method of measuring the oxygen saturation of a patient’s blood, indicating how effectively oxygen is binding to hemoglobin and being transported throughout the body; done by applying a pulse oximeter to a patient’s finger, with a normal range being between 95% and 100%

• capnography— measure and graphic display of a patient’s exhaled carbon dioxide levels; provides valuable information about ventilation, circulation, and metabolism; normal range between 35 and 45 mmHg

• end-tidal \(Co_2\)— the measurement of the maximum concentration of carbon dioxide at the end of an exhaled breath

Cardiac Assessment

The initial patient assessment should include assessing their level of consciousness (LOC), and their airway, breathing, and circulation (ABCs). Depending on the symptoms and status, timely actions should be taken. Ensure that an automated external defibrillator (AED) and oxygen are available, if needed, with Advanced Life Support (ALS) backup, if possible.

Here are some terms to know:

• AED—automated external defibrillator; a portable device used to analyze the heart’s electrical activity and deliver an electric shock if it detects a life-threatening ventricular arrhythmia (ventricular tachycardia, ventricular fibrillation)

• CPR process—Assess for the absence of a carotid pulse, in the groove between the larynx and the sternocleidomastoid muscle, for ideally five seconds and no more than ten seconds, simultaneously assessing for breathing. If both are absent, activate the emergency response system and begin CPR. Place the heel of the dominant hand on the patient’s sternum, just below the nipple line. Place your non-dominant hand over the top. Compress at a depth of at least two inches, at a rate of thirty compressions intermittent with two ventilations for five cycles (two minutes). Be sure to switch compressors every two minutes, and apply the AED as soon as it becomes available.

Chest Injury Assessment

It is essential to recognize symptoms and effectively manage injuries and complications to the chest. Injuries can occur from accidental or purposeful blunt or penetrating trauma. This can lead to trauma to the chest wall, ribs, and heart.

The assessment for a patient with a chest injury includes the standard assessment process, along with pertinent negatives and nuances specific to special populations. Special attention should be paid to impacts that are related to the physiology of the injured location. This will aid in observing for signs and symptoms of dysfunction. This may include airway concerns, abnormal breathing mechanics, poor capillary refill, tachycardia, hypoxemia, pneumothorax, and other symptoms based on the type of injury.

Here are some terms and concepts to know:

• hemoptysis—coughing up blood

• paradoxical motion—abnormal movement of a section of the chest wall that moves in the opposite direction of the rest of the chest during breathing

• deadly dozen chest injuries—life-threatening thoracic injuries that can occur due to trauma: airway obstruction, open pneumothorax, tension pneumothorax, massive hemothorax, flail chest, cardiac tamponade, pulmonary contusion, myocardial contusion, traumatic aortic rupture, tracheobronchial injury, diaphragmatic rupture, esophageal injury

Assessment for Bleeding

Patient assessment is the process of identifying and collecting information that will be used to address the patient’s healthcare needs based on their specific situation. The assessment for a patient with external or internal bleeding must be organized, thorough, and conducted in a timely manner.

Here are some terms and concepts to know:

• important/key assessment considerations that are specifically related to internal and external bleeding—identify the source of the bleeding (color, location), estimate blood loss, assess for signs of shock (pale, cool, and clammy skin; rapid HR), abdominal distension/rigidity, vital signs

• AVPU—acronym used to assess a patient’s level of consciousness (alert, verbal, painful, unresponsive)

• DCAP-BTLS—mnemonic used to quickly assess trauma patients for injury; stands for deformities, contusions, abrasions, penetrations/punctures, burns, tenderness, lacerations, swelling

Trauma Assessment

In the case of trauma, the assessment process requires organized, thorough, and timely completion. Focus on identifying injuries through chief complaint, visual clues, vital signs, and symptoms in collaboration with the physical assessment.

Here are some concepts to know:

• components of the patient assessment—rapid head to toe assessment beginning at the patients head/face assessing for bleeding/hair matting (DCAP-BTLS), neck (front and back), clavicles, sternum, assess for bilateral chest rise and fall, ribs, abdominal, pelvis, genitals, lower extremities (pulse motor sensory), upper extremities (pulse, motor, sensory), back

• important/key assessment points specifically related to injury of the neck/throat, chest, head, and abdomen—assessment of the neck should include palpation of the cervical spine for any step off, assessment of the throat for stomas, medical alert tags, tracheal deviation, jugular vein distension, the chest for subcutaneous emphysema, DCAP-BTLS, lung sounds, head for bleeding/hair matting, and abdomen for any distension, rigidity, pain, or pulsating masses

Burns Assessment

The burn patient assessment requires not only indicating the degree of severity but also noting the patient’s age, as additional considerations apply if they belong to a special population category.

Neurological Assessment

A primary assessment for a neurological emergency should be done to determine if any life-threatening conditions are present. Since neurological conditions can affect breathing, airway management is a top consideration. Getting the patient’s history may also provide clues to the problem.

Gastrointestinal Assessment

Some gastrointestinal emergencies can lead to internal bleeding and cause life-threatening symptoms, including low blood pressure.

Temperature-Related Injury Assessment

It is important that an emergency team prepares to prevent personal harm by limiting exposure and wearing appropriate gear to match the elements. Normal patient assessment should be completed.

• cold exposure assessment—Before beginning the assessment and when appropriate for the patient’s clinical situation and environmental options, carefully move the patient (without having them walk) to a sheltered or indoor environment. Remove wet clothes and replace them with dry blankets. Cover frostbites with thick, sterile cotton gauze. Avoid friction, massaging, or rubbing of any frozen area, ingestion of stimulants, and smoking.

• heat exposure assessment—Before beginning the assessment, manage the environment to prevent further injury by moving the patient to a cooler or shaded area (as appropriate), operating a fan, and/or dampening the skin. Perform a skin assessment to evaluate the condition, turgor, moisture, and temperature.

Infectious Disease Assessment

Patients with infectious diseases are assessed in the same manner as other medical patients. Patients with an infectious disease can present with many different symptoms including fever, SOB, vomiting, and ALOC. Be sure to follow your agency’s policies for sterilizing equipment after treating an infectious patient.

Epidemics and Pandemics

A pandemic involves a global outbreak of a disease. A disease or illness is considered an epidemic if the number of people affected exceeds what is expected. To reduce the further spread of an infectious disease, it’s vital to take precautions, such as using personal protective equipment, disposing needles properly, and sterilizing medical equipment used to treat patients.

Other Common or Serious Communicable Diseases

There are numerous communicable diseases that EMTs and paramedics encounter. Common conditions with which to become familiar include meningitis, tuberculosis, influenza, herpes, HIV, and hepatitis. Understanding how each disease is transmitted is an important aspect of the job. For example, influenza can be transmitted through droplets or through contact. HIV can be transmitted through contact with blood or sexual contact. Hepatitis can be transmitted through various routes, including sexual contact, blood, and contaminated food. Herpes is contracted through close personal contact with someone who has an infection.

Here are some concepts to know:

• herpes simplex—viral infection spread through direct contact with infected skin, mucous membranes, or bodily fluids; presents as cold sores or blisters around the mouth and face or on the genitals

• influenza—contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes lungs; spread mainly through respiratory droplets; signs include fever, chills, cough, sore throat, runny nose, muscle aches, and fatigue

• meningitis—inflammation of the meninges; can be caused by bacteria, virus, fungus, or parasite; can be spread through respiratory droplets or close contact; signs include sudden fever, severe headache, neck stiffness, nausea, vomiting, and photophobia

• tuberculosis—contagious bacterial infection caused by mycobacterium tuberculosis; primarily affecting the lungs but potentially involving other organs; spread through airborne droplets, and signs include persistent cough, fever, night sweats, fatigue, weight loss, and chest pain

• whooping cough—(pertussis) highly contagious respiratory infection caused by bacteria primarily affecting the respiratory tract and known for severe coughing fits; spread through respiratory droplets; signs include coughing spells, nasal congestion, low-grade fever, and fatigue

Other Global Issues

There are many important global health issues to be aware of. Since global health issues are vast and can change over time, it’s impossible to be familiar with every condition. But it’s useful to understand a few of the most common ones. For example, Ebola is an infectious disease with symptoms such as diarrhea, fatigue, and fever. A patient suspected of Ebola should immediately have a mask placed on their face to prevent the spread of the disease.

Another condition to be aware of is Middle East respiratory syndrome coronavirus (MERS-CoV). The illness was first found in Saudi Arabia, but in recent years cases have also been diagnosed in the United States and Europe. The condition can cause diarrhea, fever, muscle aches, and cough. It is important to know if a patient has traveled internationally, since certain infections and germs may be most common in specific parts of the world.

Here are some concepts to know:

• Middle East respiratory syndrome coronavirus—viral respiratory illness caused by coronavirus, spread through close contact with an infected person’s respiratory secretions or droplets; signs include fever, cough, shortness of breath, and diarrhea

• Ebola—severe, often fatal illness caused by infection with the Ebola virus; known for causing widespread internal and external bleeding; spread through direct contact with blood or bodily fluids