211 Patient Assessment Flashcards
Primary Survey - “C” (first C)
Critical event
Crashing patient
Concerns
Primary Survey - Airway
Unsecured airway?
- Position/manual maneuvers
- Consider adjunct
- Secretions/Stridor
- Suction (also assess cranial nerves and reflexes)
Secured airway?
- Confirm position
- Secured in place
- Cuff pressure
- Secretions/suction
Primary Survey - Breathing
Pneumothorax
Oxygenation/Ventilation
Synchrony
Auscultate
Primary Survey - Circulation
Pulses/pressures
Arrhythmias
Heart sounds
Skin
Primary Survey - Disability
Pupils
AVPU
Sedation
Seizures
Primary Survey - Expose/Equipment
Visual pan scan
Access - central/peripheral
Tubes and lines
Primary Survey - Fluids
Consider volume status
Begin to shock differentiate
Primary Survey - Gas
ABG
(or VBG if that’s all available)
Primary Survey - Hematology
Bloodwork & labs
Primary Survey - Imaging
POCUS
X rays
CTs
MRI
ID statement
Age
Sex
Weight
Height
Working diagnosis
Pertinent PMHx
Medications
Allergies
Neuro assessment
(sedation &/or paralytics on board?)
LOC
GCS
RASS
Brainstem assessment (if ETT) or
Cranial nerve assessment (if no ETT)
Motor and sensory assessment (Spinal cord injury or disease)
Cerebellar Function
Deep tendon reflexes
Babinski’s
Clonus
Scans (CT, MRI etc)
Scales (Hunt-Hess, Fisher, CAM ICU)
Lines and Tubes
Cardiovascular assessment
Pertinent Hx
HR and rhythm
SBP/DBP/MAP (supported by/unsupported)
Pulse pressure
Temperature
CVP
JVD
Cap refill
Mottling
Edema
Skin
Peripheral pulses
Heart sounds
12/15 Leads
Bloodwork
CXR/CT/Echo/POCUS
Pacemaker?
Scales (HEART, TIMI, Killip)
Respiratory assessment
RR
SPO2
ETCO2
WOB
Accessory muscle use
Cough and sputum
Stridor/Grunting/??word dyspnea
Agitation/lethargy/decrease LOC?
Palpation (Crepitus/SC air/flail/fractures)
Breath sounds
ETT info
CXR/POCUS/CT
Chest tubes and drains
Mech vent settings (intubated) or non-invasive settings
ABG (or VBG)
GI assessment
Inspect for
-distention
-masses
-surgical scars
-jaundice
-ecchymosis
-signs of liver disease
Tubes, drains, collection bags
Auscultate bowel sounds
N/V?
Signs (Murphy’s, Cullen’s, Grey-Turner’s)
Abd Xray/POCUS/CT
Lines and tubes (OG/NG/Minnesota/Blakemore/Fecal/Feeds)
Status post procedure
GU Assessment
Identify dehydration
-volume status
-mucous membranes
-peripheral edema
-skin turgor
-passive leg raise
-IVC kissing POCUS
Distended palpable urinary bladder?
Foley info
Total volumes (In’s and Out’s)
Dialysis info
Urinalysis
Labs
Bladder pressure
Reproductive/ObGyn assessment
Dr.’s notes on vag exam if done (don’t do it)
Menses
Pregnancy test
GPTAL
Current pregnancy info
Lactation
Vag discharge
PAP smear
STI Hx
Priapism
Surgical Hx
Drains
Labs (including blood type)
US
MSK/Ortho Assessment
Head to toe (DCAPBLSTIC + compartment syndrome)
Compare R & L on everything
Prosthesis
Baseline ambulation or assistance devices
Radiology
Treatments (cast, half slab, traction, immobilized)
Derm/Integ Assessment
Primary morphology (plaque, macule, patch, papule, nodule, vesicle, pustule, bullae)
Size
Demarcation
Colour
Secondary morphology (dry serum/crusting, erosions, scaling, fissure, cracking, ulceration)
Location
Heme/Onco Assessment
Anemia
Polycythemia
Acquired bleeding disorders
Clotting disorders
Acquired hemolytic anemia
Anti-thrombotics
Complications of malignancy
Infectious Disease
Identify the source
Control the source
Antimicrobial coverage
Endocrine assessment
Thyroid issues
Adrenal issues
Hyperglyemic emergencies
Psych assessment
Emotional state (suicidal, depressed, anxious, agitated, irritable, hostile, reactive, manic)
Mental state (confused, disoriented, cognitively impaired, hallucinating, deluded, thought-disordered)
Behavioural state (threatening or violent to self, others or objects; impulsive; restless; uncooperative with instructions)
Social assessment
Partnership
Dependents
Employed (occupation)
Quality of life
Wishes for life sustaining measures/EOL/palliation
Pertinent religious beliefs
FASTHUGSBID
Feeds
Analgesia
Sedation
Thromboprophylaxis
HOB 30 degrees
Ulcer prophylaxis
Glycemic control
Spontaneous breathing trial
Bowel regimen
Indwelling catheter removal
De-escalation of Abx
What are the 5 reasons for a CCP physical exam?
- Confirm a diagnosis
- Refute a diagnosis
- Find new pathology
- Therapeutic (in Rico’s words: “lay hands on them” lol)
- Trendsetting
List the levels of the Richmond Agitation and Sedation Score
+4 = Combative (immediate danger to staff)
+3 = Very agitated (pulls on tubes/catheters, aggressive behaviour)
+2 = Agitated (frequent non-purposeful movement, vent dysynchrony)
+1 = Restless (Anxious or apprehensive, not aggressive or vigorous movements)
0 = Alert and calm
-1 = Drowsy (>10 secs awakening, eye contact to voice)
-2 = Light sedation (<10 secs awakening with eye contact to voice)
-3 = Moderate sedation (movement but no eye contact to voice)
-4 = Deep sedation (no response to voice, movement to physical stimulation)
-5 = Unarousable (no response to voice or physical stimulation)
How to test Cerebellar Function?
Rapid alternating movements.
E.g. “touch my finger then touch your nose” repeatedly on R and L side.
E.g. heel to shin (slide down to ankle) repeatedly, R and then L
What is a negative and positive Babinski’s sign and what does a positive indicate?
Negative: Toes flex
Positive: Dorsiflexion of big toe + toes fanning
Indicates intra-cerebral disease
What is clonus and what does it indicate?
Grab patient’s hand or foot and flex it, then let it go. Watch for involuntary, rhythmic movement
What is the Hunt Hess Scale and what is it used for?
Classification of patients with intracranial aneurysms according to surgical risk
What is the Fisher scale and what is it used for?
System of classifying the amount of subarachnoid hemorrhage on CT scans. Useful for predicting the occurence and severity of cerebral vasospasm.
What is the CAM ICU scale and what is it used for?
Score to help monitor patients for the development or resolution of delirium in the ICU.
What specific bloodwork is pertinent to the CVS assessment?
Troponin I HS
CK
BNP
What imaging is relevant to the CVS assessment?
Chest Xray (cardiomyopathy, cardiomegaly, dilated mediastinum)
CT chest
Echo (EF%)
POCUS (RUSH, E-FAST)
What is the HEART score and what is it used for?
Predicts 6-week risk of major adverse cardiac events.
What is the TIMI scale and what is it used for?
Risk score that estimates mortality for patients with unstable angina and NSTEMI
What is the Killip classification and what is it used for?
Classification system that quantifies severity of heart failure in ACS and predicts 30-day mortality
What imaging is pertinent to our respiratory assessment?
Chest XRay
POCUS
Chest CT
What are signs of liver disease
Spider nevi
Gynecomastia
Dilated abdominal veins
Ascites
Testicular atrophy
Coagulopathy
What is Murphy’s sign and what does it indicate?
- Have patient take and hold a deep breath while palpating the R subcostal area. If pain occurs on inspiration when the inflamed gallbladder comes in contact with examiner’s hand > positive Murphy’s sign
- indicates acute cholecystitis
What is Cullen’s sign and what does it indicate?
- Peri-umbilical bruising and superficial edema.
- indicates internal hemorrhage
What is Grey-Turner’s sign and what does it indicate?
-Atraumatic abdominal ecchymosis, specifically bruising in the flanks
- Indicates acute pancreatitis
What imaging is pertinent to the GI/GU/Abd assessment?
POCUS (intraperitoneal free fluid)
Abd Xray
CT abdo
What lab findings are pertinent to the GU assessment?
Urine osmolality
Urine sodium
Creatinine
GFR
Urea levels
Urine culture
What does the ATMIST format stand for?
Age (age, name, DOB)
Time (onset of S/S, time of injury)
Mechanism (MOI or medical complaint)
Injuries (Injuries/exam findings)
Signs (V/S, GCS)
Treatment (Tx given)
Format of a TA report
- Identify self and role
- Give location
- ID statement
- Destination and out of hospital time
- Give assessment findings
- Give problem list and plan
List the 12 cranial nerves and whether they are sensory, motor or both
- Olfactory - Sensory
- Optic - Sensory
- Oculomotor - Motor
- Trochlear - Motor
- Trigeminal - Both
- Abducens - Motor
- Facial - Both
- Vestibulocochlear - Sensory
- Glossopharyngeal - Both
- Vagus - Both
- Accessory - Motor
- Hypoglossal - Motor
Cranial Nerve assessment
- Test smell (CN 1)
- Test visual acuity w/ Snellen chart, test pupil equality, size, shape and constriction (CN 2, 3)
- Test eye movements and eye position (CN 3, 4, 6)
- Pain and light touch sensation of face, open and close jaw against resistance, corneal reflex (CN 5)
- Test motor function of facial muscles and look for asymmetry by raising eyebrows, frown, smile, close eyes tightly, puff cheeks (CN 7)
- Test balance, test auditory acuity with tuning fork (CN 8)
- Test for difficulty swallowing, have patient say “ah” and observe if uvula remains midline, gag reflex (CN 9, 10)
- Shrug shoulders against resistance (CN 11)
- Examine protruded tongue doing rapid side to side movements, listen to patient’s word articulations (CN 12)
