From the Guidelines
The best approach for initial patient assessment is the ABCDE method (Airway, Breathing, Circulation, Disability, Exposure), which provides a systematic framework for evaluating patients in any clinical setting. This method is widely accepted and recommended by various guidelines, including the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines 1. Begin by assessing airway patency, ensuring it's clear and unobstructed. Next, evaluate breathing by observing respiratory rate, effort, and oxygen saturation. Then check circulation by measuring pulse, blood pressure, capillary refill time, and assessing for signs of bleeding or shock. Assess disability by evaluating the patient's neurological status using the AVPU scale (Alert, Voice responsive, Pain responsive, Unresponsive) or Glasgow Coma Scale. Finally, fully expose the patient to examine for additional injuries, rashes, or abnormalities while maintaining dignity and preventing hypothermia.
Some key points to consider during the initial assessment include:
- Identifying potentially life-threatening conditions, such as acute coronary syndromes, acute aortic syndromes, and pulmonary embolism 1
- Obtaining a thorough history and physical examination to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of heart failure 1
- Performing initial laboratory evaluations, such as complete blood count, urinalysis, and serum electrolytes, to help guide further diagnosis and management 1
- Using a systematic approach to ensure that life-threatening conditions are identified and addressed in order of priority, preventing oversight of critical issues during the initial assessment.
After completing the ABCDE assessment, proceed to a more detailed history and physical examination tailored to the patient's presenting complaint, as recommended by the European Society of Cardiology 1. This approach will help ensure that patients receive timely and effective care, improving outcomes and reducing morbidity and mortality.
From the FDA Drug Label
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From the Research
Initial Patient Assessment Approach
The best approach for initial patient assessment involves a combination of history taking, physical examination, and laboratory investigations.
- A thorough history taking is essential to gather information about the patient's medical history, symptoms, and lifestyle 2, 3.
- Physical examination is crucial to assess the patient's overall health and identify any potential health issues 4, 5, 2, 6.
- Laboratory investigations may be necessary to confirm diagnoses or monitor the patient's condition 2, 3.
Patient Assessment Components
The components of patient assessment include:
- History taking: gathering information about the patient's medical history, symptoms, and lifestyle 2, 3.
- Physical examination: assessing the patient's overall health and identifying any potential health issues 4, 5, 2, 6.
- Laboratory investigations: confirming diagnoses or monitoring the patient's condition 2, 3.
- Triage and recognizing emergency signs: identifying patients who require immediate attention 5.
Special Considerations
Special considerations are necessary when assessing certain patient populations, such as:
- Children: requiring knowledge of normal variations in anatomy and physiology with growth and development, and including prenatal and birth history, developmental history, immunization history, feeding history, and social history in the assessment 5.
- Patients with heart failure: using the clinical examination to assess the patient's underlying hemodynamic state and guide therapeutic decision-making 6.