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Unresponsive medical patient

  1. Determine that the patient either is unresponsive or have altered mental status.
  2. Rapid medical assessment.
  3. Baseline vitals.
  4. Position patient.
  5. SAMPLE.
  6. Transport.
  7. Detailed physical exam in the ambulance enroute to the hospital.
  8. Ongoing assessment.


  1. Determine that the patient is alert and orientated.
  2. Ask questions: complaints and OPQRST.
  3. SAMPLE.
  4. Focused medical assessment.
  5. Baseline vitals.
  6. Transport decision.
  7. Detailed physical exam either on scene or inside the ambulance enroute to the hospital.
  8. Ongoing assessment.

Rapid medical assessment

  • In 2-2.5 minutes, rapidly assess from head to toe for signs of medical problems.
  • Do not dismiss the possibility of trauma. Look for trauma signs.
  • For most medical problems, all you can do is manage basic ABCs.
    • Establish airway.
    • Treat inadequate breathing by PPV and O2.
    • Manage bleeding by applying pressure and dressing.
  • Head
    • Asymmetry: facial droop and unequal pupils are signs of stroke.
  • Neck
    • JVD (jugular vein distention): heart failure.
    • Tracheal tugging: obstruction in bronchi.
    • Use of neck muscles for breathing: signs of inadequate breathing possibly due to asthma, emphysema, pneumonia... etc.
  • Chest
    • Retractions, use of accessory muscles, diminished breath sounds: possible asthma, emphysema, pneumonia... etc.
    • Crackles upon auscultation: capillary pressure forcing fluid into the lungs. Possible congestive heart failure or pneumonia.
    • Wheezing upon auscultation: constriction of bronchiole smooth muscles. Possible asthma, allergic reaction, emphysema or congestive heart failure.
  • Abdomen
    • Pain, tenderness, rigidity, distension: internal bleeding, infection, appendicitis or peritonitis. Assess rebound tenderness by the Markle test (what for reaction as patient drops from a tip-toe position).
    • Palpable pulsating mass in the midline of the abdomen is a sign for aortic aneurysm (weakened area of the abdominal aorta).
    • Extremely distended abdomen: pregnant or suffering from ascites (fluid build up in abdomen).
  • Pelvic region
    • Distention or tenderness in the pelvic region, complaints of lower abdominal pain and missed menstrual periods: suspect ectopic pregnancy in females of child-bearing age. Patient in danger of shock due to bleeding within the abdominal cavity.
  • Extremities
    • Check for PMS.
    • Look for edema (swelling): excessive edema indicates congestive heart failure, fluid overload, or DVT (deep vein thrombosis).
    • DVT is when a blood clot forms in a deep vein, which may break off and travel into the lungs to cause a pulmonary embolism. Symptoms include shortness of breath, pain, redness or swelling to one calf, and pain in the when pulling back the leg toward
  • Back
    • Inspect for discoloration, edema and tenderness.
    • Edema in the sacral region in bedridden patients indicates possible congestive heart failure.
    • Edema in the hands or feet for non-bedridden patients indicates possible congestive heart failure.

Position patient

  • If no artificial ventialtion is needed, position the patient in the recovery position (on his or her side) to prevent aspirations.
  • If artificial ventilation is needed, place the patient in the supine position.

Focused medical assessment

  • Focus on the area of complaint and those associated with it.
  • If the complaint is nonspecific, then perform the head-to-toe rapid medical assessment.