Cardiovascular Assessment Flashcards
What is the very first step you take when you walk into the room with the patient?
Using your DRABC (Danger, Response, Airway, Breathing, Circulation), introduce yourself and gain consent from the patient.
Primary Survey - End of Bed Assessment - What are the 5 main things to look out for?
Have a look at the patient and note anything that looks wrong or abnormal. You will have done some of the end of bed assessment when you do DRABCDE.
- Have a look around the room and look for clues within the environment.
- Are they breathing fast or slow? Any increased effort?
- Are they pale/flushed?
- Do they seem distressed?
- What position are they in?
What are the 6 main vital signs and their normal ranges?
- Temperature (36.5c - 37.3c) (Average is 37c)
- Blood Pressure (120/80 mm hg)
- Blood Glucose Level (Before eating: 4.0 - 5.9 mmol/L)(After eating: <7.8 mmol/L) REMEMBER: Diabetes patients will be higher.
- Heat Rate (60-100 BPM)
- Oxygen Saturation (95%+) REMEMBER: COPD patients (88-92%)
- Respiratory Rate (12-20 breaths per minute)
What makes a patient time critical?
What red flags are there to consider in a cardiovascular assessment?
What are the 8 parts of the medical model for taking patient history?
PC - Presenting Complaint (What was the reason you called us today?)
HPC - History of Presenting Complaint (Use SOCRATES)
PMH - Patient Medical History (Do you have any previous medical history?)
PSH - Patient Surgical History (Have you had any previous surgeries?)
DH - Drug History (Are you taking any drugs? Have you got a list? Twice-a-day/Once-a-day? Recreational drugs?) Important: Ask for allergies here.
SH - Social History (Do they smoke/drink? How many a day/week? Do you use any illegal substances?)
FH - Family History (Do your family suffer from anything?)
ROS - Review of Systems
What acronym would you use to get a full patient history of pain, and what does each letter stand for?
SOCRATES
S - Site (Where is the pain? Could you point to it for me?)
O - Onset (When did it start? What is quite sudden or gradual?)
C - Character of Pain (Could you describe the pain for me?)
R - Radiation (Does the pain move anywhere?)
A - Associations (Apart from pain, is there any other other symptoms or problems?)
T - Time Course (Since your pain started, has it got better or worse or stayed the same?)
E - Exacerbating/Relieving Factors (Is there anything that you do that makes the pain worse/better?)
S - Severity (On a scale of 1-10, 1 being the lowest and 10 being the most pain you’ve ever felt what would you say your pain is?)
Additional Question: What are the 10 body systems?
- Integumentary System (Skin, hair and nails)
- Musculoskeletal System - Comprised of: Skeletal System (Bones, joints) and Muscular System (Cardiac, smooth, skeletal muscles)
- Lymphatic System (Red bone marrow, thymus, lymphatic vessels, thoracic duct, spleen, lymph nodes)
- Respiratory System (Nasal cavity, pharynx, larynx, trachea, bronchus, lung)
- Digestive System (Oral cavity, esophagus, liver, stomach, small intestine, large intestine, rectum, anus)
- Nervous System (Brain, spinal cord, nerves)
- Endocrine System (Pineal gland, pituitary gland, thyroid gland, thymus, adrenal gland, pancreas, ovary, testis)
- Cardiovascular (Circulatory) System (Heart, blood vessels)
- Urinary System (Kidney, ureter, urinary bladder, urethra)
- Reproductive System (prostate gland, penis, testis, scrotum, ductus deferens) (mammary glands, ovary, uterus, vagina, fallopian tube)
Review of Systems - What to look out for in each system? Think of questions to ask.
General health - How do you feel compared to normal? How is your appetite? Have you lost/gained weight? Do you feel more tired than normal?
Respiratory (Resp) - Any breathlessness? Colds, coughs, wheezing? Sputum? Colour?
Cardiovascular (CVS) - Any chest pain or breathlessness? Palpitations or dizziness? Any oedema?
Nervous system (CNS) - Any headaches or visual disturbance? Numbness or tingling? Any fits? Balance problems? Tremors? Any (new) speech or hearing problems?
Gastrointestinal (GI) - Any episodes of D&V? Any abdominal pain? Any change in bowel habit, or blood in stool?
Genitourinary (GU) - Any change in frequency of urination? Burning or stinging sensation? Blood in urine? Discharge? Last menstrual period? Any risk of pregnancy? Any unprotected sexual contact? (If appropriate to ask)
Bones/muscles/joints (BMJ) - Any new joint pain? Any stiffness or aching? Decreased mobility?
Other - Endocrine problems —excessive thirst, sweating? Intolerance to heat or cold? Bleeding or bruising? Rashes? Any swollen lymph nodes?
Reference - https://www.paramedicpractice.com/features/article/history-taking-assessment-and-documentation-for-paramedics
Primary Survey - Assess Hands & Arms - What are the main 8 things to look out for in the hands/arms? Think of questions to ask for each one.
- Circulation - Are they pale?
- Cap refill - <2 (Prolonged cap refill could be indication of shock)
- Nicotine staining - Do they smoke? What comes with long term smoking? How many a day?
- Splinter Haemorrhage - Blood clots under nail beds (from defective heart valves). Indication of Bacterial Endocarditis.
- Clubbing (Schamroth window test)
- Temperature - What is the temperature of the skin?
- Pulses - Access bilateral radial and brachial pulse (rate, rhythm & volume)
- Cyanosis
Primary Survey - Assess face - What are the main 7 thinks to look for in the face? Think of questions to ask for each one.
- The colour of the face - grey/ashen can indicate a cardiovascular event. Is the colour normal to the patient?
- Cyanosis
- Eyes -
- > Jaundice - Yellow colour in the eyes. Sign of liver failure. With liver failure you may have an element of clotting disorders or protein dysfunction.
- > Arcus Senilis - A white/grey/blue tinge ring in the corneal margin. Sign of hyperlipidaemia.
- > Xanthelasma - White nodules on eyelids. Sign of hyperlipidaemia and high cholesterol.
- >Anaemia - Pallor within eye lids. Sign of low iron. - Malar Flushing - Flushing in the cheeks constantly. Sign of mitral stenosis. Causes by CO2 retention and the resultant vasodilator effect.
How do you assess the JVP and what is the normal ranges? What is it indicative of if enlarged?
- Check pulses in both carotid arteries. IMPORTANT: Not at the same time. Are they beating at the same time with the radial pulse?
- Locate the external jugular vein (runs from the angle of the jaw to the mid-clavicle)
- Lay the patient down to approximately 30-45 degrees. Move the patient head so they are facing away from you. Look for pulsation of the IJV. Measure the point from the sternal notch.
- Normal range is >4cm. Abnormal ranges can indicate an enlarged liver.
Once you’ve assessed the JVP, what should you carefully check for in the neck?
Carotid Bruits - Use a stethoscope to listen for carotid bruits in the carotid arteries. If present can lead to stroke. Listen for turbulent, non-laminar blood flow.
IMPORTANT: Check carefully and do not apply lots of pressure.
Primary Survey - Inspection of chest - What are the 6 main things to look for when inspecting the chest? Think of questions to ask for each one.
- Does the chest have equal, bilateral chest rise?
- Is there normal chest expansion? Any grimace when moving from patient?
- Is there a pacemaker?
- Are there any masses? IMPORTANT: Look for a pulsating mass. DO NOT POKE IT. Indication of a abdominal aortic aneurysm. (Triple A) Blood pressure systolic could be different in each arm. (Difference of 20)
- What colour is the chest? Are they pale? Cyanosis?
- Are there are any chest wall abnormalities?
Primary Survey - Palpation of chest - What is the general rule of palpation?
General rule -
Fingertips = to feel pulsations
Base of fingers = thrills
Base of hands - heaves
