Ongoing Assessment
After obvious life-threatening injuries or illnesses have been discovered and interventions initiated including transportation, the EMT performs a detailed physical examination. During this phase of assessment, the EMT reevaluates the patient for obvious indications of illness that may have been been missed and also looks for less obvious evidence of injury or illness to guide additional interventions. In the conscious patient, the EMT performs a detailed examination on the area of concern identified by the patient. In the unresponsive patient, the EMT examines all body areas in detail. Although the findings and/or interpretations may differ, the same examination in technique is used for both the trauma and medical patient.
Reassess the level of consciousness. Palpate the scalp and look for new or increased areas of swelling, bleeding, or discoloration. Continue to monitor facial expressions and verbal response as a reflection of the patient's level of consciousness. If ear drainage is present, note color, odor, and thickness of drainage. Look for discoloration behind the ears. Nasal flaring could be an indication of respiratory difficulty. Any drainage from the nose should be noted as to color, odor, and thickness of drainage. Look for dentures, loose or broken teeth, or any item that may cause airway obstruction. Note any dryness or odors of the mouth. The lips may demonstrate a color change. Check the eyes for foreign bodies, equal movement, or color change. Pupils should look the same when compared. Normal pupillary responses should be checked. Abnormal responses to light may be the result of cataract surgery or a normal variation. As a rough check for vision in each eye, have the patient count the EMT's fingers, while the EMT's other hand is placed in front of the untested eye but not touching it.
Reassess the neck for vein distention, position of the trachea, swelling, and crepitus.
If the patient requires ventilation, check effectiveness of air movement with the stethoscope. Look for labored breathing such as retractions or abdominal breathing.
Check for new or changing abdominal distention, tenderness, or firmness. Listen to the abdomen with the stethoscope. Determine if bowel sounds are present. Listen for an abdominal bruit, which is a sound made when blood flows through a narrowed blood vessel or through a ballooned-out area (aneurysm) in a blood vessel. Each time the heart beats, it produces a "whooshing" sound heard with a stethoscope placed on the abdomen over the large vessels. In the female patient in the later stages of pregnancy, feel for the enlarged uterus. It may also be possible to feel the fetus move.
Reevaluate the extremities for possible interventions. Examine the nail beds for color changes. Pink is normal, blue may indicate lack of oxygen, and red may indicate carbon monoxide poisoning. Check the perfusion and function of an extremity below (distal) to the injury site. Pulse checks, capillary refill, and temperature of the extremities determine perfusion status.
For most patients, the EMT examines the back when the patient is rolled onto a spine immobilization device or placed on a stretcher. Once the patient is secured to a spinalimmobilization device, reexamination of the back is not possible.
