Assesment

Question 1

Level of consciousness

Answer 1

Speech
  Quantity
  Rate
  Volume
  Articulation
  Fluency
Mood
Orientation
  Time
  Place
  Person
  Event
Memory
  Recent
  Long term
Reliability
   Do I believe the patient
   Does patient have appropriate decision making for consent
   Is the patient oriented
Chief complaint
   Why did you call us
   What is the duration of this episode

Question 2

OPQRST - O

Answer 2

Onset

When did this begin
Was it sudden or gradual

Question 3

OPQRST - P

Answer 3

Provokes

What brought this on
Anything that makes it better or worse

Question 4

OPQRST - Q

Answer 4

Quality

How would you describe your pain or symptoms
Has there been any change in your pain or symptoms since this began

Question 5

OPQRST - R

Answer 5

Region/radiation

Can you point and show me where your pain or symptoms are located
Does the pain move or radiate anywhere else

Question 6

OPQRST - S

Answer 6

Severity

How would you rate your level of discomfort right now 1 to 10
Using the same scale how was your level of discomfort when this began

Question 7

OPQRST - T

Answer 7

Timing

When did your pain or symptoms begin
Is it constant or how does it change over time

Question 8

Setting questions

Answer 8

Is there anything unique to place or events with this episode

Question 9

Treatments question

Answer 9

Have you taken anything to treat this problem

Question 10

Pertinent negatives

Answer 10

Any signs or symptoms NOT present

Question 11

Converges

Answer 11

Moves history from broad to focused to field impression

Question 12

SAMPLE - S

Answer 12

Symptoms and Signs

Any signs / symptoms not present that should be

Question 13

SAMPLE - A

Answer 13

Allergies

Any allergies to meds, food, other things

Question 14

SAMPLE - M

Answer 14

Medications

What prescribed meds
What over-the-counter meds/vitamins/herbs/home remedies
When did u take the last dose/ how much
Do you take all meds as prescribed
Do you have any frequent use OD alcohol, tobacco, or drugs

Question 15

SAMPLE - P

Answer 15

Pertinent past history

What is your general health status
What other similar episodes were there
Is this an acute or chronic illness
What medical care do you currently receive for this illness
"                                                                               " other illnesses
What previous surgeries have you had
Nutritional status
Any psyc history

Question 16

SAMPLE - P(family)

Answer 16

Any pertinent family medical history

Question 17

SAMPLE - L

Answer 17

Last oral intake

Have you taken anything to treat this problem

Question 18

SAMPLE - E

Answer 18

Events

Anything unique to place or events with this episode

Question 19

Vitals - BP

Answer 19

Normal:
90-120/?-80 (Adult)

Hypotensive:

Question 20

Vitals - Pulse

Answer 20

Radial
Carotid
Pedal
Amplification:
Rate:
    Normal:
                   60-100(A), 
                   60-105(11-14), 
                   70-110(6-10), 
                   80-120(3-5),
                   80-130(1-3), 
                   90-140(0-12 mos)
                   120-160(newborn)
       Tachycardia
       Bradycardia
Rhythm:
    Regular
    Alternating
    Irregular
Quality:
    Strong
    Thready

Question 21

Vitals - Respirations

Answer 21

Tidal Volume
   Equal/Left volume only/Right volume only
   Adequate/inadequate
Rate, Rythem, & Quality
    Normal: 
          12-20(11-Adult)
          15-30(6-10)
          18-30(3-5)
          20-30(6 mo-3)
          25-40(0-5 mos)
   Bradypnea
   Tachypnea(rapid shallow)
   Hyperpnea (rapid deep)
   Cheyne - Stokes Breathing(deep and periods of apnea)
   Ataxic (irregular)
   Kussmaul (deep due to metabolic acidosis)
   Sighing (punctuated by deep sigh)

Question 22

Vitals - Temperature

Answer 22

Method 
   Oral (Mercury, digital, IR/other)
   Rectal (Mercury, digital, IR/other)
   Tympanic (Mercury, digital, IR/other)
   Forehead (Mercury, digital, IR/other)

Question 23

Vitals - skin

Answer 23

Color
   Flushed
   Jaundiced
   Pallor
   Cyanotic
Moisture
   Dryness 
   Sweating
   Oily
Temperature
   Hot
   Med
   Cool
Turgor
Lesions
    Types
    Locations
   Arrangement
Nails
   Condition
   Cleanliness
   Growth

Question 24

Vitals - Eyes

Answer 24

Size
Equality
Reactive
Acuity
   Clear
   Free of disturbance
Appearance
   Color
   Iris clear
Extraocular movement
   Up
   Down
   Both sides
   Fixed
   Flutter around

Question 25

Physical Assessment - Head and Neck

Answer 25

``` Hair Scalp Skull Face Ears External Ear Ear Canal - drainage (clear, blood, none), (both, right, left) Hearing - present, impaired, absent Nose Deformity Air movement - Full, partial, obstructed Mouth Opens Willingly Jaw Tension - Absent, mild, severe Mucosal Color - Clear, cloudy, green, blood tinged, bloodied Moisture - Dry, moist, draining Upper airway patent Neck Trachea midline Jugular veins distended ```

Question 26

Physical Assesment - Chest

Answer 26

``` Movement / expansion - minimal, mild, excessive Skin color Integrity Wounds Rib stability Presence / absence of pain Lower Airway Auscultation - anterior Tracheal Bronchial Bronchovesicular Vesicular Strider Rails Crackles Snoring Gargling Auscultation - posterior Tracheal Bronchial Bronchovesicular Vesicular Strider Rails Crackles Snoring Gargling ```

Question 27

Physical Assesment - Heart

Answer 27

``` Apical pulse Sounds S1 S2 Arterial pulses - equal, tachycardic, bradycardic, normal Chorotid - full, thready, none Radial - full, thready, none Femeral - full, thready, none Pedal - full, thready, none ```

Question 28

Physical Assessment - Abdomen

Answer 28

``` Color Wounds - Open, Closed Size Symmetry Shape Scars Distention Auscultation Palpation - masses, tenderness, rigidity, Region - URQ, ULQ, LRQ, LLQ ```

Question 29

Physical Assessment - Back

Answer 29

``` Color Wounds - Open, Closed Size Symmetry Shape Scars Palpation - masses, tenderness, rigidity, ```

Question 30

Physical Assessment - Pelvis

Answer 30

Stability

Question 31

Physical Assesment - Genitals

Answer 31

Male Wounds, rashes, external lesions (ask) Drainage (ask) Female Wounds, rashes, external lesions (ask) Drainage (ask) Bleeding or discharges (ask)

Question 32

Physical Assesment - Musculoskeletal (Legs & Feet)

Answer 32

``` Symmetry Range of motion Deformity Skin Color Closed wounds Open wounds Pulses Femeral Popliteal Dorsalis pedis ```

Question 33

Physical Assesment - Musculoskeletal (Arms & Hands)

Answer 33

``` Symmetry Range of motion Deformity Skin Color Closed wounds Open wounds Pulses Brachial Radial ```

Question 34

First Steps

Answer 34

``` Scene safety Personal, crew, patient, Bystanders BSI Number of patients Consider Need for additional resources ALS Truck unit MOI / NOI ```

Question 35

Primary - A

Answer 35

``` Cervical spine Open airway Tidal Volume - adequate, inadequate, bilateral, left, right Rate, rhythm, quality Sounds NPA/OPA Suction O2 ```

Question 36

Primary - B & C

Answer 36

``` Bare the chest Bleeding Medical ID Central & peripheral pulse Skin - moisture, color, temp Additional life threats Shock O2 Capillary refill Evaluate treatment / Priority - Stable, Unstable ```

Question 37

Unstable/High Priority - Trauma

Answer 37

- Focused history & Rapid trauma physical assessment - ``` Spinal stabilization Rapid inspection and palpation DCAP-BTLS Head Neck/collar Chest Abdomen Pelvis Extremities Posterior Baseline vitals SAMPLE (if possible) Rapid packaging Transport Final Steps ```

Question 38

Unstable/High Priority - Medical

Answer 38

- Focused history & Rapid medical physical assessment - ``` Inspect and palpate areas of complaint History of present illness - chief complaint SAMPLE (if possible) Baseline vitals Decide treatment based on 5 R's RPMDD Treat per protocol Check interventions / side effects Reassess vitals every 5 minutes Rapid packaging Transport Final Steps ```

Question 39

Stable/Low Priority - Trauma

Answer 39

- Focused history & physical exam (trauma) - ``` Establish chief complaint Inspect and palpate sites DCAP-BTLS Baseline vitals Focused history SAMPLE/OPQRST for pain Treat injury Transport Final Steps ```

Question 40

Stable/Low Priority - Medical

Answer 40

- Focused history & physical exam (medical) - ``` History of present illness - Establish chief complaint Focused history - SAMPLE/OPQRST for pain Focused physical exam Inspect, auscultate, palpate complaint area Baseline vitals Decide treatment based on 5 R's RPMDD Treat per protocol Check interventions / side effects Reassess vitals every 15 minutes Transport Final steps ```

Question 41

Final Steps

Answer 41

- Done Enroute - ``` Detailed physical exam Repeat primary Repeat focused in greater detail Reassess and record vitals Check interventions Ongoing assessment - repeat: primary, focused history physical exam Vital signs Check Interventions - unstable - 5 min, stable 15 min ```

Question 42

Vitals - SpO2

Answer 42

Mild hypoxia Moderate hypoxia Severe hypoxia

Question 43

Vitals - Blood sugar

Answer 43

``` Normal 81-119 Hypoglycemic 60-80 Hyperglycemic 120-140 ```

Question 44

DCAP-BTLS

Answer 44

Deformities Contusions Abrasions Punctures Burns Tenderness Lacerations Swelling

Question 45

General impression data

Answer 45

``` Age Weight Sex Ethnic Origin AVPU - CAO x ? Chief complaint Permission to treat Who called Source of history ```

Question 46

Rule of 9s - Adult

Answer 46

``` Head - 4.5 pere side = 9 Torso - 18 each side = 36 Arm - 4.5 each side = 9 per arm Legs - 9 each side = 18 per leg Groin - 1 ```

Question 47

Rule of 9s - child

Answer 47

``` Head - 4.5 pere side = 9 Torso - 18 each side = 36 Arm - 4.5 each side = 9 per arm Legs - 9 each side = 18 per leg Groin - 1 ```

Question 48

Rule of 9s - infant

Answer 48

``` Head - 9 per side = 18 Chest = 18 Back = 13 Butt = 5 Arm - 4.5 each side = 9 Legs - 7 each side = 14 each leg ```

Question 49

During primary assessment you should check the pulse for

Answer 49

Less than 30 seconds looking for normal, rapid, or slow pulse

Question 50

A rapid pulse rate in a trauma pt or a slow pulse in a pt with chest pain make them a

Answer 50

High priority patient

Question 51

Three patient assessment levels

Answer 51

Stable, potentially unstable, unstable

Question 52

Immediate transport priority is indicated by

Answer 52

If any life-threatening issue cannot be controlled or threatens to reoccur, or there is an altered level of consciousness, Poor general impression, responsive but not following commands, difficulty breathing, shock, complicated child birth, Chest pain consistent with cardio, uncontrolled bleeding, severe pain.

Question 53

Skin condition is assessed in all patients, capillary refill is also assessed in

Answer 53

Children and infants under 6 years

Question 54

Rapid, regular, and full pulse can be the result of

Answer 54

Exertion, fright, fever, high blood pressure, first stage of blood loss

Question 55

Rapid, regular, and thready pulse a sign of

Answer 55

Shock, later stage of blood loss

Question 56

Slow pulse a result of

Answer 56

Head injury, drugs, some poisons, some heart problems, lack of O2 in children

Question 57

A fast pulse in children is a .... Concern

Answer 57

Low concern

Question 58

A slow pulse in children can indicate

Answer 58

Eminent cardiac arrest