In this video, we will review the principles and procedures for patient reassessment. This concept is important not only for National Registry testing stations, but for your success as a quality patient care provider. Reassessment is one of the most important components to practicing good thorough pre-hospital medicine. Think about it this way, you complete your primary and secondary assessment of your patient and put them into the ambulance to get them to the hospital. Now, you don't just face forward and ignore the patient for the rest of the ride, right? You should be comfortable with constantly reassessing your patient and this video will help you hone in on that process. We've discussed in prior videos how to perform initial assessments. Generally to, these assessments are classified by trauma or medical assessments, as they each had different priorities. Once you've identified the problems with your patient and have to develop and plan to transport, treatment begins and then patient reassessment begins. The goals of reassessment or to be aware of the changes in your patient's condition. These changes can be improvement in condition, deterioration in condition, or an unchanged status. This awareness is even more important if pre-hospital treatments have been applied as you need to assess if they've helped your patient or if perhaps more intervention is needed. For EMTs and services where transport times can be prolonged due to distance for traffic for example, reassessment may be to reassess vital signs and reestablish communication with your patient. For example, asking your patient, "How are you doing, has anything changed?" This may elicit important reassessment information. Reassessing vital signs in most stable transport should occur at least every 15 minutes. In more critical patients at least every five minutes or after any significant intervention including medications or procedures. This establishes a vital signs trend or objective data to qualify the status of your patient during the pre-hospital treatment and transport. You would want to know if your trauma patient's blood pressure went from 120 over 80 to 70 over 40, right? This can indicate a serious change in their status and if you do not reassess your patient, this may be missed. This trend is important to pre-hospital providers to continue care that is helping and to discontinue or alter care that is not effective. In addition to a vital sign treading, you'll want to repeat primary assessments. Reassess for a presence or absence of a new chief complaint. You'll also want to evaluate your interventions and deem them to have helped, hurt or provided no change in patient condition. When in doubt, just start from the top again. You don't have to introduce yourself, but start from the ABCs if your patient's condition changes. One of the biggest mistakes we can make as providers is to assume we know what is going on. If something changes that doesn't make sense, don't keep doing what you're doing before, start over. In your assessment you'll want to remember how your patient appeared upon initial contact known as the baseline. Assess your patient's level of consciousness, airway, breathing, circulation, and compare all that to baseline. Worsening finding should trigger a change in treatment or transport. For example, you may want to request advanced life support, increase your transport mode to a and sirens transport, or alter your destination to a hospital capable of more advanced care. Most importantly, you'll want to relay to your destination facility that the patient's condition has worsened so that they are better prepared for your arrival. It is imperative to relay any negative changes that may have occurred including iatrogenic ones, meaning ones caused by the provider. Let's say for example that you administered a sublingual nitroglycerine tablets to your chest pain patient and upon reassessment their blood pressure is dangerously low. Let's say too that they are now less responsive than on your initial assessment. You'll want to take measures to help improve their current condition. But also consider why this happened. Was this a particular response that was expected. Why or why not. We all know in this case that nitroglycerin leads to hypotension, but maybe a contraindication was overlooked. Anything coming to mind? With nitroglycerin, we must ask if the patient has taken a vasodilator medication commonly used for erectile dysfunction or ED before administering nitroglycerin, the consequence of mixing the two is a profound or long-lasting hypotension. Upon reassessment, you have determined that your patient is worse off and you realize this is because you forgot to ask if they've taken a vasodilator medication. Although this was indeed an error, relaying this information to the receiving hospital is imperative to ensure your patient improves, and all of this information is information that can be gathered during your reassessment, otherwise, it would have been missed. In health care, we must always be honest and forthright as integrity is essential to quality patient outcomes. By this time, you are likely more comfortable with your assessment and scene safety, PSI, nature of the illness, number of patients, level of alertness, ABCs, history, and secondary assessment. Add to this assessment, intervention, and reassessment. The more critical your patient and the more you are doing for them the more frequent your re-evaluations will need to be. You will always want to know if your interventions are working or if your patient is changing. The more specific information gathered by the EMT prior to arrival at the hospital, will allow for a better transition of care at the receiving facility and hopefully a better outcome for your patient. The goal here is to incorporate reassessment into your practice so that it too becomes second nature and is not even something you have to think about. While it may not be as in-depth a thorough as your primary or secondary assessments, it is an important tool in his gathering as much information as you can to better care for your patients.
