What is the systematic approach to patient assessment?

You’ve probably heard this phrase thousands of times, and if you haven’t started uni yet, you better get used to it. Because it is going to be DRILLED into you over the next three years.
I’ve crunched the numbers and I’ve poured through all the databases to come up with this short, no nonsense guide to the systematic approach in paramedic practice.

Lets get to it…

The term systematic approach is always thrown around by lecturers and tutors, but what is it?

Basically, it is a structured method or approach that you will use in every single scenario that you do or clinical case that you attend. Meaning, that is it conducted in a very consistent manor across all cases, no matter what the clinical presentation of the patient is.
Having a solid systematic approach is a very important skill to develop early. It will help you to run scenarios or real life jobs with greater efficiency, with less likelihood of missing something crucial or “getting stuck” on scene. Having a good systematic approach will allow you to provide better patient care, and hopefully improve outcomes for both clinical scenarios and real-life patients.

So, how do you “systematic approach’

Let me break it down.
The first thing we do on scene is our primary survey. Our DRABC’s. Non negotiable, always number 1.

D - Danger (To ourselves, our patient and others on scene)
R - Response (Patient responsiveness - AVPU)
A - Airway (Is the patient’s airway patent?)
B - Breathing (Is the patient breathing properly?)
C - Circulation (Does the patient have adequate circulation).  

These are the highest priority items and are considered immediate life threats if either A,B or C is dysfunctional. These are what’s going to kill the patient the fastest. If you find something wrong in the primary survey, fix it.
We took a closer look at this in our primary survey article, click here to access it.

After this step, we are usually guided by the patient’s chief complaint or medical presentations and begin to take a detailed history. However, irrespective of the actual condition, we should follow a standard structure that looks like this.

my personal systematic approach

The key to a good systematic approach is that it should be consistent, it should the same every time, irrespective of the patients presentation. If you ever get lost when running a job or scenario, you can always go back to your system and continue from where you left off. I have found a system that works well for trauma patients that can easily be adapted to most medical cases. It is similar to a head to toe examination and checks off everything that I should be looking for or assessing. I generally only select the points that I believe are relevant to the case. This is what works best for me, but as everyone likes to work a little differently, find something that suits your style.

• DRABC

• Detailed history and vital signs

• Start at the head - question and assess for:
  - ALOC of loss of consciousness
  - Neurological exam
  - Stroke screen
  - Pupils & vision
  - Trauma (haematomas, C-spine tenderness, lacerations etc.)
  - Jugular venous pressure

• Chest
  - Respiratory assessment
  - Auscultation
  - Perfusion assessment
  - Pain assessment
  - 12 lead ECG if necessary
  - Scars or evidence of surgery

• Abdomen
  - Palpation for guarding, rigidity
  - Distention
  - Pain assessment
  - Regular bowel motions and urinary function?
  - Rashes
  - Palpable masses

• Pelvis
  - Pain
  - Haematomas or evidence of trauma
  - Illiac crests of equal height

• Legs
  - Deformities (fractures, shortening/rotation of limb)
  - Mobility
  - Neurovascular observations
  - Oedema

• Arms
  - Deformities
  - Neurovascular observations

For most cases, it is appropriate to pick and choose the most pertinent aspects of the assessment, but if you ever get lost, it’s always safe to work from head to toe.
Once you’ve completed the systematic assessment, you should have a sufficient clinical picture which will guide your treatment goals. Next step is to plan and treat this patients, as per the diagram above. Then reassess, you can never miss anything if you constantly reassess.

Case details:
We are called to 43 year old male at Bunnings Warehouse, patient has slipped on an onion and ?fractured wrist.
Code 2.
NIL back up assigned.

On arrival, patient is seated on a bench in the café holding wrist, appears to be in obvious pain. As we enter the scene, the patient looks up and says “Thanks so much for coming, I’ve slipped and I think that I have busted my arm”. You notice that he is clutching at his right wrist.

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