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Paramedic > 118 Mod 1 (Patient Assessment) > Flashcards

118 Mod 1 (Patient Assessment) Flashcards

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1
Q

Steps of Patient Assessment (5)

A
  1. Scene SIZE UP
  2. PRIMARY ASSESSMENT
    (ABC, DE, PRIORITY, TRANSPORT)
  3. HISTORY Taking
    (OPQRST, SAMPLE)
  4. SECONDARY Assessment
    (Vitals, Full Body Exam)
  5. RE - assessment
    (Every 5 or 15)
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2
Q

Glasgow Coma Scale

A

Eye - 1 (doesn’t open) - 4 (Opens)

Verbal - 1 (no sound) - 5 (Normal)

Motor - 1 (no movement) - 6 (Obeys)

     Less than 8 is severe
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3
Q

What is the order of motor development for 0-2 years old

A

lift head, sits up, crawl, walk

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4
Q

The Denver Developmental Growth Chart is

A

used to identify special needs children

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5
Q

Define Pain Threshold

A

LOWEST amount of stim that will causes a sense of pain

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6
Q

Define Pain Tolerance

A

HIGHEST level of pain tolerated

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7
Q

Define Nociceptors?

A

Sensory receptor for pain

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8
Q

Define Visceral Pain

A

Usually felt in abdominal area (not localized)

Internal pain

can radiate

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9
Q

Define Allodynia?

A

Pain due to a stimulus that normally doesn’t provoke pain

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10
Q

Define Fibromyalgia?

A

Widespread muscle pain, triggered by stressful event physical or emotional

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11
Q

Define Peripheral Neuropathy?

What causes it?

A

Weakness, numbness, and pain from nerve damage usually in hands and feet.

Commonly caused by diabetes.

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12
Q

Define Minute Volume?

A

Amount of air in and out of LUNGS each minute

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13
Q

How to you calculate minute volume?

____ x ____ = Minute Volume

A

RESP rate x TIDAL volume = MINUTE volume

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14
Q

Define Tidal Volume

A

Volume of air inspired with each breath

(ex. 500mL / breath)

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15
Q

Sign of Arterial Bleeding

and how/soon do you take care.

A

Usually spurting blood,
Life threat
Tourniquet in less than 30 seconds

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16
Q

Otoscope vs

Ophthalmoscope

A

OTOscope - used to look at the EARS

Ophthalmoscope - used to view the EYES

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17
Q

Anisocoria

A

Asymmetric (unequal pupils)

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18
Q

Mydryasis

A

Wide open pupils (DIALATED)

also stimulants

midbrain injury

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19
Q

Miosis

A

CONSTRICTED - small pupils

also Opioids

pontine injury - affecting pons of the brain hemorrhage

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20
Q

Define Erythema

A

Reddening of the skin (usually patches)

from injury

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21
Q

Postauricular ECCHYMOSIS

A

Battle Signs

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22
Q

Halo Sign

A

CSF

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23
Q

PeriORBITAL Ecchymosis

A

Racoon eyes

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24
Q

JVD indicates

A

Right or Left Ventricular HEART Failure

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25
Q

Tracheal Deviation indicates

A

Late indication of tension pneumothorax

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26
Q

5 parts of the spine

A
  1. Cervical ( 7 )
  2. Thoracic ( 12 )
  3. Lumbar (5)
  4. Sacral
  5. Coccygeal
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27
Q

Define Paresthesia

A

Abnormal sensation (pins and needles)

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28
Q

Not normal breath

A

Adventitious Lung sounds

(no adventitious = normal)

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29
Q

CN1

A

OLFACTORY - Sensory, Smell NOSE

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30
Q

CN2

A

OPTIC - Sensory & Vision TWO EYES 00

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31
Q

CN 3 , CN 4, CN 6

A

Eye Movements EYES

III 3 - OCCULAR Motor - Motor, Eye movement, pupil

IV 4 - TROUCULAR - Eye movement

VI 6 - ABducens - Motor, eye movement

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32
Q

CN 5

A

V 5 - TRIGEMinal - Sensory and Motor - Facial, Tongue, Bitting Chewing (Mastication) MOUTH

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33
Q

CN 7

A

VII 7 - FACIAL - Sensory - Taste, Motor - Facial, Salvation FACE

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34
Q

CN 8

A

VIII 8 - VESTibulocochelear - Auditory - Sensory - Balance and Hearing EARS

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35
Q

CN 9

A

IX 9 - MEDulla OBlongata, Sensory - Taste and Sensation, TOUNGE
Motor - Swallowing and Salvation

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36
Q

CN 10

A

X 10 - VAGUS - Sensory - Throat, and Abdominal
Motor - Swallow and Speech, Cough (Rest and Digest)

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37
Q

CN 11

A

XI 11 - SPINAL - Motor - Head Turn, SHOULDERS

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38
Q

CN 12

A

XII 12 - HypoGLOSSAL - Under tongue Movement - TOUNGE

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39
Q

Afterent vs Efferent

A

Afferent - sensory, signals BACK to the brain

Efferent - motor, signals AWAY from the brain

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40
Q

AAO x 4

A

Person
Place
Time
and EVENTS

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41
Q

What do we use in place of Sternum Rubs for Unresponsive Patients

A

Trapezius Pinch

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42
Q

Define Levine Sign?

A

Clenched fist held over the chest to describe ischemic CHEST PAIN

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43
Q

Stroke vs Bells Palsy Sign

A

Bells - Complete disassociation of facial nerve (no forehead movement)

Stroke - the forehead will still move, upper face even with facial droop

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44
Q

The first set of vitals…

A

should be completed manual

and with Lifepak first set should not be trusted (calibration only)

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45
Q

Signs vs Symptoms

A

Signs - measurable, what you see, Objective

Symptoms - Non measurable, what the patient tells you, their complaints

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46
Q

Vitals should be included in what part of your SOAPE notes?

A

Objective

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47
Q

Hypothermic and Hyperthermic Patients get temp taken?

A

Rectal, for CBT (Core Body Temp)

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48
Q

Normal Body Temp?

A

98.6F or 37C

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49
Q

Carotid Pulse

A

atleast 60 mmHg

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50
Q

Femoral Pulse

A

atleast 70 mmHg

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51
Q

Radial Pulse

A

at least 80 mmHg

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52
Q

Check _______ for unresponsive patient

A

Carotid (at least 60 sys mmHg) and compair to Femoral Pulse

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53
Q

What Systolic Pressure indicates Hypotension

A

Less than 90 Sys

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54
Q

Define Systolic

A

How much pressure exerted against your artery walls when the heart CONTRACTS

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55
Q

Define Diastolic

A

How much pressure exerted against your artery walls when the heart RELAXES

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56
Q

Define MAP (what is normal)

A

Mean Arterial Pressure

Diastolic + 1/3 (Systolic - Diastolic) = MAP

Normal MAP = 70 -100 mmHg

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57
Q

Define STROKE Volume

A

Volume of blood pumped out of the LEFT ventricle (cant be calculated)

(FROM THE HEART)

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58
Q

Define Cardiac Output

A

Amount of blood pumped each minute

STROKE Vol x Heart RATE = Cardiac Output

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59
Q

Define Hypertension Stage 1

A

130-139 Sys or 80-89

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60
Q

Define Hypertension Stage 2

A

Sys 140 (or higher) or Dia 90 (or higher)

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61
Q

Define Hypertension Crisis

A

Sys Higher than 180 and/or Dia higher than 120

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62
Q

Normal SpO2 %

A

94-99

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63
Q

What SpO2 do you give oxygen

A

Anything below 94%

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64
Q

Pulse Oximetry measures

A

How saturated (oxygen) the hemoglobin

Carbon Monoxide can also saturate hemoglobin

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65
Q

What does Pleth Waveform measure

A

STRENGTH of pulse (how hard the pulse)

also irregular heart beat

(Well defined waves = good perfusion)

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66
Q

What does Capnography Measure

A

Measures the CO2 being released using exhalation

Cellular respiration - how well cells are functioning
Body PH
Ventilation Status

Measured in mmHg

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67
Q

What is a normal Blood Glucose,

what 4 people do you check

A

70 - 120 mg/dL

Decaliter

Check all:
1. post seizure,
2. CVA,
3. altered,
4. Peds with Altered, sleepy

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68
Q

What is PERRLA (and how do you check)

A

Pupils , Equal, Round, Reactive, Light, Accomodating (checking one eye, the other does the same)

Check in H pattern for Range of Motion

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69
Q

Pin point pupils indicate

A

OPIATE

or

Pons Section (lower base) of brain injury

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70
Q

Normal Pupil Size?

A

3-5 mm

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71
Q

In the SOAPE notes where would you put Pain Scale

A

Subjective

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72
Q

Patient is having asthma attack, you hear whimsical whistling, What sound do you expect?

A

Wheezing

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73
Q

Listen to lung sounds atleast ____ places

A

8

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74
Q

You listen for Sound over the 2nd intercostal space at the midclavicular line (One of the 8 places)

A

Bronchovesicular

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75
Q

For head trauma what manuver would you use to open airway

A

jaw thrust, OPA

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76
Q

GCS ___ or less is a Trauma

A

13

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77
Q

Asking if anything makes pain worse is “OPQRST”

A

Provocation

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78
Q

Where is your spleen

A

LUQ

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79
Q

Patient is in shock and has inadequate tissue perfussion this is called

A

Hypoperfusion

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80
Q

What are the places for breath sounds

A

Tracheal - over trachea
Bronchial - just over the clavicles (2)
Bronchovesticular - 1st and 2nd intercostal spaces and back
Vesticular - lower, most of the lung field, front and back

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81
Q

Define Rales

A

Crackles, fluid in the lungs

CHF and Pneumonia

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82
Q

Define Rhonchi

A

Snoring (low pitch sound)

Fluid in larger airway

COPD, Pneumonia

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83
Q

Define Stridor

A

High pitched, Squeaking or whistling sound

in or just below voice box

(occurs during BOTH inspiration and expiration)

Due to obstruction in upper airway

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84
Q

Define Wheezing

A

High pitched whistling sound made while breathing
(DURING EXPIRATION)

Asthma or Bronchitis

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85
Q

Define difference between Authoritarian and Authoritative Parenting

A

Authoritarian - no freedom

Authoritative - sets rules but also allows freedom

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86
Q

Define Barotrauma

A

increased pressure, too much pressure in lungs

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87
Q

Define Hypercapnia

A

Increased carbon dioxide levels in bloodstream

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88
Q

13 - 17 years of age

A

Adolescents

89
Q

Define Aneurysm

A

A swelling or enlargement of part of a blood vessel, resulting from weakening of the vessel wall

90
Q

What type of Reasoning looking for approval from peers

A

Conventional reasoning

91
Q

18-40 years old

A

Early Adult

92
Q

Define Atherosclerosis

A

Disorder in which cholesterol and calcium build up in walks of blood vessels, forms plaque and may lead to blockage of blood flow

93
Q

Define Postconventional Reasoning

A

Child bases descisions on own conscience

94
Q

Define PRE conventional reasoning

A

child acts PRE to punishment to get what they want

95
Q

3-5 years old

A

pre schoolers (after toddlers 1-3)

96
Q

Define Withdraw

A

final phase of infants response to situation crisis, signs of apathy and bordom

97
Q

Trust and mistrust

A

from birth to 18 months, gain trust of parents if world is organized and routine

98
Q

1 - 3 years of age

A

Toddlers

99
Q

Define Moro Reflex

A

when infant is caught off guard, opening arms wide

100
Q

Define Rooting Reflex

A

When newborns cheek is touched, they turn toward the touch

101
Q

What part of fontanelles indicate dehydration

A

Anterior

102
Q

Infant becomes scared of strangers at ____ months

A

7

103
Q

Filtration of kidneys declines by _____ between 20 and 90

A

50%

104
Q

Bleeding can empty into voids in older brain, which is what type of hemorrhage

A

Subdural

105
Q

Define Hypercapnia

A

capacity of lung decrease, residual volume increase

106
Q

What type of reasoning is learned by school age children

A

Conventional

107
Q

Name and Define the 4 Infant Reflexes

A

Moro - startled infant, wide arms
Palmar - Grabs when placed in PALM
Rooting - Turns head when cheek is touched
Sucking - Touch lips, infant will suck

108
Q

SAMPLE

A

Signs and Symptoms
Allergies
Medications
Pertinent Medical History
Last Oral Intake
Event

109
Q

Two substances responsible for the buildup of plaque

A

Calcium and Cholesterol

causing Atherosclerosis (buildup in coronary vessels)

110
Q

2 most Common infections for toddlers and school age

A

Gastro distress

Upper resp tract infection

111
Q

Another word for Double Vision

A

Diplopia

112
Q

Define Iatrogenic

A

Related to a side effect or complication of medications or other medical treatment

drug side effect

113
Q

Define Korotkoff Sounds

A

Sounds related to blood pressure measurement that are heard by stethoscope

114
Q

Define Kyphosis

A

Outward curve of the thoracic Spine (hump back)

115
Q

Define Mottling

A

A blotchy pattern of the skin, sign of severe hypofusion and shock

116
Q

Define Murmur

A

An abnormal whooshing sound heard over the heart that indicates turbulent blood flow around a CARDIAC VALVE

117
Q

Guarding indicates ________

A

Peritoneal irritation

tissues in abdomen wall

118
Q

Define Cerumen

A

Ear Wax

119
Q

Define Bruit

A

An abnormal whooshing sound of turbulent blood flow,
through narrow CAROTID arteries usually

120
Q

Define Beck Triad

A

Narrow pulse pressure with
muffled heart tones with
JVD with cardiac tamponade (compression of the heart with fluid surrounding) bp drop

usually caused by penetrating chest trauma

121
Q

2 Signs of Cardiac Arrest

A

Cyanosis and Absent pulse

122
Q

3 Signs of Heart Failure

A

Edema of both ankles

JVD while sitting

S3 gallop sound

123
Q

3 Signs of Skull Fracture

A

Ecchymosis around eyes

Battle Signs

CSF around ear

124
Q

Define Lordosis

A

Exaggerated inward curve of the lumbar area (lower back)

125
Q

What are the parts of History Taking from Alert Patient

A

Age Weight, who called

CC - why, duration

OPQRST - onset, prov, quality, radiate, sevr, time

SAMPLE - signs, aller, meds, past hx, LOI, Events

Surgeries, Nutritional status, Drugs, Family Hx, Psych

126
Q

Organs in

RUQ

LUQ

A

RUQ - GALLBLADDER, Intestines, LIVER (RIGHT) - GIL

LUQ - Pancreas, Intestines, STOMACH, SLEEN - PISS

127
Q

What’s the difference between

Stroke Volume

Minute Volume

Cardiac Output

Tidal Volume

A

Stroke vol - volume of BLOOD pumped out of the left ventricle

Min Vol - amount of AIR in and out of sungs each min

Cardiac Out - amount of BLOOD pumped each min

Tidal Vol - amount of AIR moved in/out of lungs each resp cycle

128
Q

What are the valves of the heart

A

Aortic Valve

Mitral Valve

Pulmonary Valve

Tricuspid Valve

129
Q

Veins flow blood ________ the heart

A

De-Oxygenated blood TO the heart

130
Q

Arteries flow blood ________ heart

A

Away from the heart

131
Q

Where does blood come into the heart first (upper)

A

The superior vena cava,

head neck, upper limbs, and chest

132
Q

What is the goal of the primary assessment

and 4 parts

A

to identify and treat immediate life threats

General Impression
Mental Status
ABC
Priority and Transport possible

133
Q

What is the standard of care

A

what a reasonable paramedic would do in the same situation

134
Q

From the Vena Cava where does blood go?

A

To the Right Atrium

135
Q

from the Right Atrium the blood goes

through which valve first?

to where?

A

The. tricuspid valve, (it has 3 flaps)

to the. Right ventricle

136
Q

After the lungs, the blood comes back to the heart through

______________

A

the pulmonary veins

137
Q

From the pulmonary veins blood enters the ________

A

Left atrium

138
Q

From the LEFT Atrium the blood then goes through ___________ to the __________

A

Left Ventricle through the MITRAL (BI-CUSPID) VALVE

139
Q

Leaving the heart the blood leaves the Left Ventricle through the ______________ entering the _________

A

Aortic Semilunar Valve, entering AORTIC Arch

140
Q

What are the Steps of the Heart

A

from veins Deoxygenated blood enters the RIGHT ATRIUM, through vena cava

Blood enters right ventricle through TRICUSPID VALVE

Blood then goes through Pulmonary valve and enters Pulmonary artery

Blood is then sent to lungs for gas exchange

Oxygenated blood returns to the heart via PULMONARY VEINS entering the Left Atrium

Blood enters Left Ventricle through MITRAL VALVE

Blood exits left ventricle through the AORTIC SEMILUNAR VALVE

AORTA distributes oxygenated blood to the body arteries

141
Q

Define Somatic Pain

A

Localized pain,

usually felt deeply

142
Q

Define Referred Pain

A

Pain perceived in one place, other than true source

143
Q

When do you give a NON REBREATHER and how much oxygen

A

Signs of inadequate breathing,
cool, clammy,
short of breath,
chest pain,
Severe injuries
ALTERED

12-15 Ltrs

144
Q

Indication for BVM

A

Very Diaphoretic
Unresponsive
Shallow ventilation
Diminished lung sounds
CYNOTIC
Noises

RESP over 30

15lts

145
Q

When would you CPAP a patient? 7 reasons

A

Fluid in lungs (pulmonary edema)
COPD
Bronchospasms - ASTHMA
Toxic Inhalation
Drowning
Flail Chest
Pneumonia

Should be used on ALERT Patients who can follow commands, rapid breathing and a pulse ox less that 90%, no airway compromise, no nausea, no facial trauma. Hypotension less than SYS 90.

PEEP Set to 5-10cm

15ltrs?

146
Q

Babinski Reflex

A

Reflex stimulated on plantar of foot

147
Q

Anisocoria

A

Unequal pupils

148
Q

Diplopia

A

Double Vision

149
Q

Erythema

A

Redness due to capillary dilation

150
Q

Consensual Response

A

Contralateral pupil responds

151
Q

Intraperitoneal

A

Inside the abdominal cavity

152
Q

Ascites

A

Fluid build up in the abdominal cavity

153
Q

Peristalsis

A

Rhythmic movement of food through alimentary canal

154
Q

Adolescents

A

13-18 years old

155
Q

Middle Adult

A

41-60 years old

156
Q

Early Adult

A

19-40 years old

157
Q

Olfactory

A

Sense of smell

158
Q

Optic

A

Sense of sight

159
Q

Oculomotor

A

Movement of eye, pupil & eyelid

160
Q

Trochlear

A

Movement of eye downward & inward

161
Q

Trigeminal

A

Touch of mouth & face/chewing

162
Q

Abducens

A

Movement of eye lateral

163
Q

Facial

A

Movement of Face/Tears/Saliva

164
Q

Vestibulocochlear (Auditory)

A

Sound/Hearing/Balance

165
Q

Glossopharyngeal

A

Swallowing/Sensation of Mouth & Pharynx

166
Q

Vagus

A

Sensation and Movement of Pharynx, Larynx, Parasympathetic innervation of Thorax and GI System

167
Q

Spinal Accessory

A

Movement of Head Shoulders

168
Q

Hypoglossal

A

Movement of Tongue

169
Q

Arteries and Veins explain

A

Arteries (red) carry oxygen and nutrients AWAY from your heart, to your body’s tissues.

The veins (blue) take oxygen-poor blood back to the heart.

170
Q

How would you modify a ped assessment? ( 3 ways)

A

Toe to Head

Involving Parent to hold

Use toys

171
Q

Name 5 Hollow Organs

A

1.Gall Bladder
2. Esophagus
3. Large Intestines
4. Stomach

  1. Duodenum

GELS-D

172
Q

Name 4 Solid Organs

A
  1. Liver
  2. Spleen
  3. Pancreas
  4. Kidneys
173
Q

Define Ortho-Static Hypotension

A

A fall in blood pressure when changing to a standing position.

Also known as posteral hypotension (Dehydration)

Drop in 20 Systolic
and
Increase in 10 Diastolic
and
Increase in 20 HR

174
Q

When Left Ventricle Contracts it gives blood to _________

A

The Carotid Pulse (The Body)

175
Q

When Right Ventricle Contracts it gives blood to _________

A

The Lungs

176
Q

S2 Heart sound

A

is the Dub Sound

The SEMI LUNAR VALVE closing

Aortic and Pulmonic

177
Q

When a Patient Denies or Doesn’t Exhibit. This is a _____________

A

Pertinent Negative

178
Q

What is the First Vital Sign Change in Hemorrhagic Shock

A

The HR goes up to compensate for fluid loss

179
Q

Name 4 Parts of the Circulator Assessment

A
  1. BP
  2. Skin/Temp
  3. Cap Refill
  4. Pulses
180
Q

What does Pale Skin Indicate?

A

Poor Perfusion

(Blood shunting to go to core)

181
Q

What lung sound would you expect with Croup

A

Stridor - High Pitched Crowing Sound

182
Q

Define Difference between Delirium vs Dementia

A

Delirium - Sudden onset

Dementia - Over time

183
Q

What does checking eyes in a H pattern show?

A

Extra ocular movement, Cardinal gaze

184
Q

What 2 lung sounds would you expect with Pneumonia

A

either Rhonchi or Rhales

185
Q

How would a child react to a Babinski test on feet

A

Foot would extend (backward)

ADULT: Grasp (if not then suspect spinal injury)

186
Q

As we get older what happens to your

BP, HR, and Resp

A

BP - goes up

HR - goes down

Resp - goes down

187
Q

What is the formula (trick) to know good SYSTOLIC for a 9 year old?

A

70 + (AGE x 2)

188
Q

What GCS score for: Opens eyes to Pain

A

2

189
Q

What GCS score for: Incomprehensible Speech

A

2

190
Q

What GCS score for: Grabbing Hand (Localizing pain)

A

5

191
Q

Patient in supine and snoring. How would you fix airway

A

Head Tilt Chin Lift

(TRAUMA: Modified Jaw Thrust)

192
Q

Sleen is where

A

LUQ (far Left)

PISS

193
Q

Duodenum

A

The first part of the small intestine leading to the jejunum (connected to the stomach) then the ileum

Duodenum

Jejunum

Ileum

194
Q

What sound do you expect for Asthma

A

Wheezing

195
Q

What sound do you expect for COPD

A

Rhonchi

196
Q

What sound do you expect for CHF

A

Rhales

197
Q

3 Measurements for Lungs

A

Minute Volume - amount lungs in/ex hale in 1 min

Resp Rate - number of breaths in 1 min

Tidal Volume- the volume of air with each breath

198
Q

3 Measurements for Heart

A

Stroke Volume - vol of blood from left vent each sys contraction

Cardiac Output - amt of blood pumped in a min

Heart Rate - heart beats per min

199
Q

Decorticate vs Deceribate

A

DeCORticate - flexing the ARMS (toward core), extending the legs

Decerebrate - extension of BOTH arms and legs

200
Q

Name/Define 7 Breathing Patterns

A
  1. KUSSMUAL’s - tachypnea, DKA, Renal failure
  2. CHEYNE STOKES - increase and decrease with periods of apnea - ICP, brain injury
  3. Ticipnic/ Tachypnic - Fast - Fever, Anxiety, SHOCK

4 . BIOTS - rapid, deep resp, with short pause - CNS, head injury, spinal meningitis

  1. APNIC - Absence of breathing - Head injury, stroke, Dead
  2. AP NEU STIC - prolonged inspire with short expire - Brain stem lesion
  3. EUPNEA - NORMAL
201
Q

What’s the worst Score you can give a LAMS test

A

5

(0-5)

202
Q

6 Parts of the Primary Survey

A
  1. Gen Impression
  2. LOC (GCS)
  3. ABC (Disability, Exposure)
  4. CC, Life Threats
  5. Priority
  6. Transport
203
Q

CAB before ABC when

A

CAB for unresponsive patients

204
Q

AVPU

A

Alert and oriented

Verbal stimuli

Pain

Unresponsive

205
Q

What does the Gall Bladder do

A

Stores bile

(under liver, RUQ)

206
Q

Where is the Appendix

A

RLQ

(bottom Right)

207
Q

What does the Liver do

A

Makes Bile, Filters Blood (clotting)

208
Q

What does the Pancreas do

A

Makes enzymes for digestion (and hormones)

(under stomach LUQ)

209
Q

Define S1 Sound

A

LUB

Closure of the mitral and tricuspid valves

210
Q

What cavity stores the Bladder

A

Pelvic Cavity

211
Q

What is responsible for fight or flight

A

Adrenal Glands (sits on kidneys)

212
Q

Another word for Abdominal

A

Peritoneal

213
Q

Normal respiratory for a (healthy) newborn

A

40

214
Q

Normal systolic BP for (healthy) newborn

A

70

215
Q

Normal HR for newborn

A

130

216
Q

Normal HR for 6 y/o

A

100

217
Q

Normal respiratory for a 6 y/o

A

20

218
Q

Normal systolic BP for a 6 y/o

A

Paramedic (24 decks)

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