Raven EMS Education Program Manual
Assessment Physical Exam Evaluation Form

Date:

Student name:

Evaluator name:

Steps:

• Take BSI precautions.
• Explain the procedure to the patient.
• Determine appearance.
• Speaks when approached
• Facial expression
• Skin color
• Eye contact
• Weight (estimated/converted to kg)
• Work of breathing
• Posture and ease of movement
• Odors of body or breath
• Dress, hygiene, and grooming
• Determine speech.
• Quantity
• Rate
• Loudness
• Articulation of words
• Fluency
• Mood
• Determine orientation.
• Person
• Place
• Time
• Event
• Determine memory.
• Recent
• Long-term
• Obtain vital signs.
• Radial pulse: rate and amplification
• Carotid pulse: rate and amplification
• Respirations: rate and tidal volume
• SpO₂
• Blood pressure
• Assess the skin.
• Colors: red, yellow, pallor, cyanotic
• Moisture: dryness, sweating, oiliness
• Temperature: hot or cool to touch
• Turgor
• Lesions: types, location, arrangement
• Nails: condition, cleanliness, growth
• Assess the head and neck.
• Hair
• Scalp
• Skull
• Face
• Assess the eyes.
• Acuity: vision is clear and free of disturbance
• Appearance: color, iris clear
• Pupil: size, reaction to light
• Extraocular movements: up, down, both sides
• Assess the ears.
• External ear
• Ear canal (drainage, clear)
• Hearing (present/absent)
• Assess the nose.
• Deformity
• Air movement
• Assess the mouth.
• Opens willingly
• Jaw tension
• Mucosa color
• Moisture
• Upper airway patent
• Assess the neck.
• Trachea: midline
• Jugular veins: appearance with patient position
• Assess the chest.
• Chest wall movement/expansion
• Skin color
• Closed wounds
• Open wounds
• Rib stability
• Presence/absence of pain
• Auscultate lung sounds (anterior and posterior) and location.
• Tracheal
• Bronchial
• Bronchovesicular
• Vesicular
• Assess the heart and blood vessels.
• Heart: apical pulse
• Sounds: S1, S2
• Arterial pulses: locate with each body area examined
• Assess the abdomen.
• Color
• Closed wounds
• Open wounds
• Size, symmetry, and shape
• Scars
• Distention
• Auscultation
• Palpation: quadrants, masses, tenderness, rigidity
• Assess the back.
• Color
• Closed wounds
• Open wounds
• Size, symmetry, and shape
• Scars
• Palpation: tenderness, rigidity, masses
• Assess the pelvis. Stability
• Genitalia, inquire about:
• Wounds
• Drainage
• Assess the legs.
• Skin color
• Closed wounds
• Open wounds
• Bones (nonangulated)
• Femoral pulses
• Popliteal pulses
• Range of motion: flexion, extension, abduction, adduction
• Assess the feet.
• Range of motion: flexion, extension, rotation
• Posterior tibial pulses
• Dorsalis pedis pulses
• Assess the arms.
• Skin color
• Closed wounds
• Open wounds
• Bones (nonangulated)
• Brachial pulses
• Radial pulses
• Range of motion
• Assess the hands. Range of motion—flexion, extension, supination, pronation, rotation.
• Accepts evaluation and criticism professionally.
• Shows willingness to learn.
• Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).

Passing criteria:

• Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
• Fail.
• Fails to take BSI precautions prior to performing assessment.
• Fails to introduce himself/herself and learn the patient’s name before beginning the interview.
• Did not explain and reassure the patient to allow informed consent.
• Performs assessment in a disorganized manner.
• Fails to assess the patient as a competent EMT or paramedic.
• Exhibits unacceptable affect with the patient or other personnel.
• Performs assessment inappropriately, resulting in potential injury to the patient.

Comments:

Evaluator signature:
Clear

	Relevant. Resolute. Ready.
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