Medical Handbook V2
The following includes content you will teach at NMC Training. Ways you can teach these are: Repeating steps, demonstrating the steps, and asking the trainees to demonstrate the procedure.
Leaking this document will result in a blacklist from NMC.
Fundamentals
SAMPLE:
SAMPLE is the process we must follow to receive the patients’ information.
This process should be carried out in every case you receive.
S- Signs/symptoms: (The patient’s chief complaint)
A- Allergies: (What is the patient allergic to?)
M- Medications: (What medications does the patient take? Will it affect any procedures you carry out?)
P- Past Medical History: (Does the patient have any past history related to their health?)
L- Last oral intake: (What was the last thing the patient ate or drank?)
E- Events leading up to this: (What happened to the patient that made them visit the hospital?)
OPQRSTU- Pain Evaluation
OPQRSTU is used to assess the patient and to determine how much pain they are in.
ONSET:
When did the pain start?
PROVOCATIVE:
What makes the pain worse?
PALLIATIVE:
What makes the pain feel better?
QUALITY:
What does the pain feel like? (Aching, Buring, Stabbing, Sore, Etc)
QUANTITY:
How bad is the pain?
REGION:
Where is the pain?
Can you point to it?
RADIATION:
Does the pain move around?
Do you feel the pain anywhere else?
SEVERITY:
The scale of 0-10. 0 being no pain, 10 being the worst pain of their life
TIMING:
When did the pain start?
What were you doing when the pain started?
Is the pain constant or does it come and go?
If the pain is intermittent, when did it last occur?
How long does the pain last?
TREATMENT:
Have you taken anything to relieve the pain?
UNDERSTANDING:
What do you think is causing the pain?
IPPA- Physical Exam
Mnemonic used for physical examination
INSPECTION:
Inspect the area, see anything abnormal (e.g. contusion)
PALPATION:
Feel the area
PERCUSSION:
Tap the area (just say -I’d check percussion) (only do this for the thoracic region or abdominal region)
AUSCULTATION:
Listen to the area using a stethoscope
Not all of these are applicable to certain areas
AVPU- Assessing Consciousnesses
ALERT- Is the patient fully awake alert?
VERBAL- Does the patient respond to verbal stimuli?
PAIN - Does the patient respond to painful stimuli?
UNRESPONSIVE- The patient is unresponsive
(This does not replace a full GCS.)
ABC(DE) - Trauma assesment
AIRWAY:
-
Open patients mouth, check for obstruction (with a laryngoscope)
-
Look, listen, and feel
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Place patient on 15L/min oxygen non-rebreather mask
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Stabilize C-spine with collar, two head blocks either side secured with tape
BREATHING:
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Place pulse oximeter on patients finer
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Look at neck, check for abnormalities
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Palpate trachea and check if it’s central
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Look for crepitus
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Expose the chest and look for external injuries
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Place hands flat on the chest to check if breathing is symmetrical, check the respiratory rate at this point
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Run hands down lower back and check if there’s blood on your gloves
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check chest percussion
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Use a stethoscope, listen for breath sounds
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Check for normal heart sounds
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Read SpO2
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Order a chest x-ray and pelvic x-ray if needed
CIRCULATION:
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Look at patients’ general appearance (well-perfused?)
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Check patients pulse and blood pressure
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Check patients cap refill time (press down on the nail bed)
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Insert an IV into each arm
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Run a bag of warm saline through each IV to maintain patency
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Look for external bleeding
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Order chest x-ray
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Check for abnormalities in the abdomen, pelvis, or legs
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Confirm that the patient is hemodynamically stable
DISABILITY:
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Ask to wiggle toes and fingers (if conscious)
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Obtain a GCS
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Run capillary blood glucose
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Perform A BNT (pupillary response)
EXPOSURE:
-
Expose the patient fully, look for any signs of injury
-
Check patients temperature
-
Place a blanket over the patient to maintain the temperature
Once the patient is stable, move onto the secondary survey
Re-check ABCS frequently
Regards,
xAveryMD, Overseer of Development
Northside Hospital