Any paramedic knows how important a thorough patient assessment is to your overall treatment strategy. And when you’re dealing with a respiratory emergency, the assessment becomes even more critical, because every second counts. The sense of urgency often causes mistakes to be made. Let’s examine five common mistakes that are made during a respiratory assessment and how you can avoid such pitfalls.
One of the first things you are taught concerning any type of assessment is to be systematic in your approach. This is why the “head-to-toe” survey is so critical. By approaching the patient the same way each time, you avoid a scattershot approach to assessment. You are also less likely to be sidetracked. When you encounter an immediate life threat—say, an obstructed airway—correct the threat and then pick up where you left off. Even if you successfully relieve the obstruction, you may miss a secondary threat (like a pneumothorax!) if you don’t resume your assessment.
Don’t let a dramatic injury or condition distract you from completing your assessment. Yes, scalp wounds can bleed profusely, but they are still just scalp wounds. Have someone hold direct pressure and keep going! Amputations are also an eye-catching injury but you cannot take a chance of missing a tension pneumo that goes undetected because you forgot to resume your assessment.
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Don’t just visually examine your patient for signs of respiratory distress (work of breathing, positioning, retractions); be sure to listen and feel as well. Listen as you approach the patient and then use your stethoscope to thoroughly assess ALL lung fields. Are there wheezes? Stridor? Absence of lung sounds? All these can indicate a serious respiratory emergency. Be sure to place your hands on the patient and feel for subcutaneous emphysema and equal chest rise. Applying all your senses to your assessment will increase the thoroughness of your exam.
Along with your stethoscope and senses, use the rest of your available equipment to conduct a thorough assessment. This includes pulse oximetry, capnography, cardiac monitor, and ETCO2 detector. Each of these devices will provide valuable information concerning your patient’s respiratory status. Another vital piece of respiratory equipment to ALWAYS have on hand is your portable suction unit!
Respiratory emergencies pose a unique challenge to rescuers: The patient may be unable to communicate effectively if his or her airway or breathing is impaired. If your patient is conscious and able to talk, this may not be an issue. But if your patient’s airway is severely compromised, or they are losing consciousness, you had better choose the most pertinent questions to ask first, because communications will likely be hampered.
Don’t waste time chitchatting—get to the heart of the emergency as quickly as possible! If family members or someone knowledgeable about the patient’s history is available, they may be a better choice for questioning than taxing a patient who is fighting for air. Use good judgment when it comes to the demands you place on your patients.
Each patient assessment offers the opportunity to jump-start an effective treatment plan. And when it comes to respiratory emergencies, a thorough assessment will save you and your patient valuable seconds.
Editor's Note: This blog was originally published in April 2017. It has been re-published with additional up-to-date content.