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CCP 211 Patient Assessment 🩺 Flashcards

1
Q

base items in a neurological assessment that must be reported on every patient (this is all you can generally assess in an intubated patient)

A
  1. LOC (GCS/RASS)
  2. Pupils (size/shape/reactivity/accommodation)
  3. Corneal Reflexes (present or absent)
  4. Cough (present/absent, strength)
  5. Gag (present/absent)
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2
Q

Cranial nerves 1-12

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Troclear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
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3
Q

Assessment for CN I (olfactory)

A

“Can you smell this” or “do you have any problems with your smell”

Official test is to hold up a jar of coffee or some such item

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4
Q

Assessment for CN II (optic)

A

“Can you see this”

Visual acuity, peripheral vision (Snellen Chart)

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5
Q

Assessment for CN III (oculomotor)

A

Open eyelids. Eye movement up and in (Perform H test)

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6
Q

Assessment for CN IV (trochlear)

A

Eye movement down. (Perform the H test)

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7
Q

Assessment for CN V (trigeminal)

A

Facial sensation x 3 “TRIgeminal”. Sensation at top, middle, bottom of face . compare right vs left

MIXED motor/sensory

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8
Q

Assessment for CN VI (abducens)

A

Eye movement lateral (Perform the H test)

motor

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9
Q

Assessment for CN VII (facial)

A

“smile, show me your teeth. Raise your eyebrows” looking for facial symmetry

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10
Q

Assessment for CN VIII (vestibulocochlear)

A

“Can you hear this”

Hearing bilaterally, balance (assessing for vertigo)

pure sensory

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11
Q

Assessment for CN IX (glossopharyngeal)

A

taste on the tongue (sensory), swallowing (motor)

mixed motor/sensory

wiggle the tube/deep suction

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12
Q

Assessment for CN X (vagus nerve)

A

swallowing reflex (motor)/parasympathetic response via vagus nerve (sensory)

mixed motor/sensory

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13
Q

Assessment for CN XI (accessory nerve)

A

have the patient shrug their shoulders up and down

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14
Q

Assessment for CN XII (hypoglossal nerve)

A

stick out your tongue, move your tongue around (motor)

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15
Q

order of systems in a systems based report

A

TRAILER STATEMENT

  1. CNS
  2. CVS
  3. Respiratory
  4. GI/GU
  5. MSK/Derm (if applicable)
  6. Endocrine (if applicable)
  7. OB/GYN (if applicable)
  8. Infectious Disease
  9. Lines/Tubes/Labs
  10. PROBLEM
  11. PLAN
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16
Q

Cough reflex (unconscious/sedated patient)

CN’s and how to assess

A

CN X [Vagus]

can be stimulated by a suction catheter down and endotracheal tube

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17
Q

Gag reflex (unconscious/sedated patient)

CN’s and how to assess

A

CN IX [Glossopharyngeal] and X [Vagus]

Some sources recommend shaking the endotracheal tube, whereas others recommend inserting a tongue depressor or suction catheter into the posterior pharynx.

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18
Q

corneal reflex (unconscious/sedated patient)

CN’s and how to assess

A

CN V [Trigeminal] and CN VII [Facial]

the provider lightly touches a wisp of cotton on the patient’s cornea. This foreign body sensation should cause the patient to reflexively blink.

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19
Q

DeBakey classification of aortic dissection

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A

The DeBakey classification, is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management

  1. type I: involves ascending and descending aorta (Stanford A)
  2. type II: involves ascending aorta only (Stanford A)
  3. type III: involves descending aorta only, commencing after the origin of the left subclavian artery (Stanford B)
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20
Q

Stanford classification of aortic dissection

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management
  2. divides dissections by the most proximal involvement

Stanford type “A” aortic dissection:

  1. Affects ascending aorta
  2. Accounts for 60% of aortic dissections
  3. Initially managed surgically

Stanford type “B” aortic dissection

  1. Affects descending aorta
  2. “B begins beyond brachiocephalic vessels”
  3. Accounts for 40% of aortic dissections
  4. Initially managed medically
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21
Q

TIMI Risk Score for STEMI

A
  1. Estimates mortality in patients with STEMI
  2. The TIMI Risk Score for STEMI may help a cardiology, medical and/or intensive care team with weighing risk/benefit of medications (like anticoagulation) and invasive procedures by knowing a patient’s baseline risk
  3. This score was developed based on thrombolytic outcomes, which likely have worse outcomes when compared to PCI.
  4. Should be used in patients with diagnosed STEMI, NOT to evaluate patients with chest pain
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22
Q

New York Heart Association (NYHA) Functional Classification for Heart Failure

defne, discuss

A

Who → Patients with signs and symptoms of heart failure.

What → Stratifies severity of heart failure by symptoms.

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23
Q

Canadian Cardiovascular Society (CCS) Angina Grade

A
  1. Classifies severity of angina
  2. developed to standardize the definition of terms used in CAD and CABG studies, analogous to the NYHA classification for heart failure
  3. not intended to prognosticate outcomes
  4. Higher grade indicates higher severity of angina

Grade
I: Angina with strenuous/rapid/prolonged exertion at work or recreation only; no angina with ordinary physical activity, e.g. walking, climbing stairs
II: Ordinary activity slightly limited: angina with walking/climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold/wind, under emotional stress, during few hours after awakening, walking >2 blocks on level ground, or climbing >1 flight of stairs at normal pace and normal conditions
III: Marked limitation of ordinary physical activity: angina with walking 1-2 blocks on level ground or climbing 1 flight of stairs at normal pace and normal conditions
IV: Inability to carry on any physical activity without discomfort; anginal syndrome may be present at rest

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24
Q

Forrester Class (Cardiogenic Shock Forrester Classification Table)

This is the CASH MONEY rubric outlining the different states of cardiogenic shock

listen TF up cause you gotta know this shit

💵💵💵💵 MONEY SLIDE 💵💵💵💵
🔥🔥🔥MEGA PEARL🔥🔥🔥

A

Cardiogenic Shock Forrester Classification Table and Mortality

    • Warm & Dry (Forrester Class I) 😀
      ~3% mortality
    • Warm & Wet (Forrester Class II) 😥
      ~9% mortality
    • Cold & Dry (Forrester Class Ill) 😨
      ~23% mortality
    • Cold & Wet (Forrester Class IV) 😰
      ~51% mortality
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25
Q

Hunt and Hess score

A

SAH Scale

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26
Q

Fisher Grading Scale for Subarachnoid Hemorrhage (SAH)

A
  1. Rates risk of arterial vasospasm in SAH based on amount and distribution of blood on CT. entirely radiographic and typically determined at presentation
  2. This scale only applies to aneurysmal subarachnoid hemorrhage (aSAH). does NOT apply to SAH due to trauma/AVM/or other causes
  3. Angiographic vasospasm occurs in at least 50% of patients with aSAH and often results in delayed cerebral ischemia (DCI), which occurs in up to 46% of all patients with aSAH
  4. Because vasospasm typically occurs between 4 and 14 days (“vasospasm window”) after the onset of aSAH, the Fisher scale may allow timely preventative treatment for vasospasm and DCI to be initiated
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27
Q

TILE pelvic fracture staging

A
  1. The Tile classification of pelvic fractures is the precursor of the more contemporary Young and Burgess classification of pelvic ring fractures.
  2. TILE takes into account stability, force direction, and pathoanatomy.
  3. The integrity of the posterior arch determines the grade, with the posterior arch referring to all of the pelvis posterior to the acetabulum.
  4. Stability is defined as the ‘ability of the pelvis to withstand physiologic force without deformation’ by the original author
  5. Tile “A” = Stable (posterior arch intact)
  6. Tile “B” = Partially stable (incomplete disruption of the posterior arch)
  7. Tile “C” = Unstable (complete disruption of the posterior arch)
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28
Q

American Spinal Cord Injury Association (ASIA) Impairment Scale

💵💵💵💵 MONEY SLIDE 💵💵💵💵

MUST KNOW SCORE

A
  1. The American Spinal Injury Association (ASIA) impairment scale or AIS describes a person’s functional impairment as a result of a SCI.
  2. This scale indicates how much sensation a person feels after light touch and a pin prick at multiple points on the body and tests key motions on both sides of the body.

Grade A = Complete. Complete lack of motor and sensory function below the level of injury
Grade B = Sensory Incomplete. Some sensation below the level of the injury
Grade C = Motor Incomplete. Some muscle movement is spared below the level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity
Grade D = Motor Incomplete. Most (more than 50 percent) of the muscles that are spared below the level of injury are strong enough to move against gravity
Grade E = Normal. SCI whereby all neurologic function has returned. Full recovery

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29
Q

Global Initiative for Obstructive Lung Disease (GOLD) Criteria for COPD

A
  1. Assesses different stages of COPD and provides treatment recommendations
  2. The GOLD Criteria are used clinically to determine the severity of expiratory airflow obstruction for patients with COPD.
  3. Should not be used to diagnose COPD, but rather to categorize clinical severity to inform prognosis and to guide therapeutic interventions
  4. Predicts risk of future COPD exacerbations and mortality
  5. Can serve as a framework to discuss disease management and risk reduction for patients with COPD.
30
Q

Gustilo-Anderson Classification of Compound Fracture

A

the most widely accepted classification system of open (or compound) fractures.

The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications.

Soft tissue injury is graded on a combination of:

  1. amount of energy dissipated
  2. extent of soft-tissue injury
  3. degree of contamination
31
Q

pure sensory cranial nerves

A

CN I (olfactory)

CN II (optic)

CN VIII (vestibulocochlear)

32
Q

pure motor cranial nerves

A 
CN III (oculomotor)
CN IV (trochlear)
CN VI (abducens)
CN XI (accessory nerve)
CN XII (hypoglossal nerve)
33
Q

mixed sensory and motor nerves

A 
CN V (trigeminal)
CN VII (facial)
CN IX (glossopharyngeal)
CN X (vagus nerve)
34
Q

contains special sensory neurons concerned with smell.

A

CN I (olfactory)

35
Q

contains special sensory neurons dedicated to vision

A

CN II (optic)

36
Q

provides motor function for all eye muscles except those supplied by cranial nerves IV and VI

A

CN III (oculomotor)

37
Q

provides motor function to the superior oblique muscle of the eye

A

CN IV (trochlear)

38
Q

principal sensory supply to the head (face, teeth, si­nuses, etc.); it also provides motor function to the muscles of mastication.

A

CN V (trigeminal)

39
Q

provides motor function to the lateral rectus muscle of the eye.

A

CN VI (abducens)

40
Q

provides motor innervation to the muscles of facial expression, lacrimal gland, submaxillary gland, sublingual gland, as well as sensory supply to the anterior two-thirds of the tongue.

A

CN VII (facial)

41
Q

provides sen­sory innervation for hearing and equilibrium.

A

CN VIII (vestibulocochlear)

42
Q

provides motor innervation to the pharyngeal mus­culature and sensory function to the posterior one-third of the tongue and pharynx.

A

CN IX (glossopharyngeal)

43
Q

provides motor innervation to the heart, lungs, and gastrointes­tinal tract. It also provides sensory innervation to the heart, respiratory tract, gastrointes­tinal tract, and external ear.

A

CN X (vagus nerve)

44
Q

provides motor function to the sternocleidomastoid and trapezius muscles.

A

CN XI (accessory nerve)

45
Q

pure motor nerve that innervates the muscles of the tongue.

A

CN XII (hypoglossal nerve)

46
Q

gag reflex CN’s

A

glossopharyngeal (IX) and vagus (X) nerves

47
Q

Neurons that receive information from our sensory organs (e.g. eye, skin) and transmit this input to the central nervous system

A

afferent neurons

48
Q

Neurons that send impulses from the central nervous system to your limbs and organs

A

efferent neurons

49
Q

cough reflex CN

A

vagus (X) nerve

50
Q

cough reflex CN

A

vagus (X) nerve

51
Q

corneal reflex CN’s

A

CN V (trigeminal) and CN VII (facial)

52
Q

cranial nerves originating from the cerebrum

A

olfactory nerve (CN I) and optic nerve (CN II)

53
Q

cranial nerves originating from the brainstem

A

CN III - XII (3-12)

54
Q

Corneal reflex cranial nerves

A

CN V (trigeminal) & VII (facial)

55
Q

gag and cough cranial nerves

A

CN IX (glossopharyngeal)

CN X (vagus nerve)

56
Q

CVS Assessment

A 
□ HR \_\_\_\_\_\_\_ (supported?)
□ Rhythm \_\_\_\_\_\_\_\_\_
□ SBP\_\_\_\_\_\_ □ DBP\_\_\_\_\_\_\_□ MAP \_\_\_\_\_\_\_\_ (supported?)
□ CVP \_\_\_\_\_\_
□ Peripheral Pulses
□ Cap Refill
□ Perfusion (limb temperature/mottling)
□ Heart sounds
□ Temp (core) \_\_\_\_\_\_
□ Peripheral lines
□ Central lines
□ Arterial lines
□ 12 Lead \_\_\_\_\_\_\_\_\_
□ Echo Findings
□ Other diagnostic tests
57
Q

Respiratory Assessment

A 
□ RR \_\_\_\_\_\_\_
□ SpO2 \_\_\_\_\_\_\_
□ Breath Sounds
□ Other Physical findings
□ ETT Size \_\_\_\_\_
□ ETT Depth \_\_\_\_\_
□ ETT cuff pressure \_\_\_\_\_
□ Chest Tubes (# of tubes/location/size/secured/drainage)
□ CXR \_\_\_\_\_\_\_\_\_
□ Ultrasound \_\_\_\_\_\_\_\_\_
□ Other diagnostic tests

Vent Settings
Mode Rate Vt Ti FiO2 Pressure Peep Plat

ABG’s
Time pH CO2 O2 HCO3 AG Base Excess

58
Q

GI/GU Assessment

A

□ GI Physical Exam (Inspect, Palpate, Percuss, Auscultate)
□ Peritoneal Signs
□ OG/NG (Size/Location/Confirmed/Drainage)
□ Feeds (Formula/Route/Rate/Residuals)
□ LBM
□ Abdominal Imaging (AXR/CT/US)
□ Drains (# of drains/type/location/secured/draining)
□ Pregnant? (GTPAL)
□ Foley (type/size/secured/draining)
□ Urine Output (draining/volume/colour/diuretics?)
□ Bladder Pressure
□ IAP

59
Q

CCP Infectious Disease Assessment

A
  1. Confirmed or suspected infections
  2. Organism
  3. Location
  4. Antibiotic/antiviral/antifungal Rx
  5. Temperature and trends (current or recent fever)
  6. WBC Count
  7. Bands
  8. Cultures drawn before ABX?
  9. Pending cultures?
  10. Patient history of drug-resistant microbes?
60
Q

6 reasons to do a physical assessment

A
  1. Confirm pathophysiology
  2. Confirm Dx
  3. Refute Dx
  4. Norm setting (compare/contrast normal to abnormal)
  5. Therapeutic for patient
  6. Inventory and secure lines and tubes
61
Q

CCP MSK/Derm Assessment

A
  1. C-Spine
  2. Physical Exam (inspect, palpate, percuss, auscultate)
  3. Long bones
  4. Pelvis
  5. Fractures (splinted/padded/distal perfusion)
  6. Skin (Temp/colour/texture/mottling/edema)
  7. Skin Lesions (Type/shape/colour/distribution)
  8. Surgical incisions (open/closed/colour/temp/drainage)
  9. Pain (Analgesia?)
  10. Imaging (XR/CT/MRI/US)
  11. Bleeding (Adequately controlled/Coagulation status)
  12. Tourniquets (# placed/location/time applied/ensure patent)
62
Q

What are the three highest yield data points for shock state differentiation?

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A

1) Skin (Distributive vs ALL)
2) JVP (Hypovolemic/distributive vs cardiogenic/obstructive)
3) U/S (Cardiogenic vs obstructive)

63
Q

Key questions to ask when presented with a patient in shock

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Is the patient in shock?
  2. What type of shock is it?
  3. How do I reverse this kind of shock?
64
Q

Populations that hide shock well

A
  1. Obstetrics (changes to HR, circulating volume)
  2. Pediatrics (compensate compensate crash)
  3. Rate controlled (mask the tachycardia)
  4. Geriatric (baseline HTN, relative hypovolemia)
65
Q

CCP Endocrine Assessment

A
  1. Glucose
  2. Insulin
  3. Glucagon
  4. Episodes of hyper or hypoglycemia
  5. Cortisol
  6. Aldosterone
  7. T4 (thyroxine), T3 (triiodothyronine)
  8. PTH (parathyroid hormone)
66
Q

CCP Neurological Assessment

A 
□ AVPU \_\_\_\_\_\_\_\_\_
□ RASS\_\_\_\_\_\_\_\_
□ GCS \_\_\_\_\_\_\_\_\_ (Sedation/Paralysis?)
□ CAM-ICU
□ Pupils (CN II/III, Midbrain)
□ Cough (CN X, Medulla)
□ Cornea (CN V/VII Pons)
□ Gag (CN IX/X, Medulla)
□ Respiratory effort (Medulla)
□ Cranial Nerves
□ Motor/Sensory Response x4 (Spinal pathways)
□ Dermatomes
□ Reflexes (Biceps C5-6; Triceps C6-8; Brachioradialis C5-7;
Patellar L2-4; Achilles tendon S1-2; plantar; oculocephalic)
□ Special tests (CT/MRI/ONSD)
67
Q

Killip Classification definition

A
  1. Quantifies severity of heart failure in ACS and predicts 30-day mortality
  2. Use in patients with confirmed acute coronary syndrome
  3. Predicts mortality in ACS and is validated for both STEMI and NSTEMI.
68
Q

GRACE ACS Risk and Mortality Calculator definition

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Estimates admission-6 month mortality for patients with acute coronary syndrome
  2. Used in Patients with known STEMI or unstable angina/NSTEMI, to determine mortality risk
  3. prospectively studied scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality
  4. Many guidelines recommend more aggressive medical management for patients with a high mortality (or even early invasive management for these patients). Knowing a patient’s risk early may help with management and prognostication/goals of care discussions with patient and family.
  5. A patient with some nonspecific features of their workup (history, EKG, troponin) can be more objectively risk stratified for their chest pain, quantify their risk, and potentially lead to shorter hospital stays, fewer inappropriate interventions, and more appropriate interventions.
69
Q

TIMI Risk Score for UA/NSTEMI definition

A
  1. Estimates mortality for patients with unstable angina and non-ST elevation MI (NSTEMI)
  2. Can be used to help risk stratify patients with presumed ischemic chest pain. However, it was originally derived in patients with confirmed unstable angina or non-ST elevation myocardial infarction.
70
Q

New York Heart Association (NYHA) Functional Classification for Heart Failure definition

A
  1. Stratifies severity of heart failure by symptoms.
  2. Use on Patients with signs and symptoms of heart failure.
  3. The New York Heart Association (NYHA) Functional Classification[1] provides a simple way of classifying the extent of heart failure.
  4. It places patients in one of four categories based on how much they are limited during physical activity; the limitations/symptoms are in regard to normal breathing and varying degrees in shortness of breath and/or angina.
71
Q

what is the best way to characterize and trend shock? aka what shit are you looking for to establish trends and goals in terms of how the patient’s shock is being managed?

this is straight outta Critical Care Essentials 5th Ed (OG textbook)

💵💵💵💵 MONEY SLIDE 💵💵💵💵
🔥🔥🔥MEGA PEARL🔥🔥🔥

A
  1. Mental status
  2. Skin perfusion
  3. Urine output
  4. Lactate
  5. Acid-Base balance
72
Q

TIMI Risk Score for UA/NSTEMI

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Estimates mortality for patients with unstable angina and non-ST elevation MI
  2. Can be used to help risk stratify patients with presumed ischemic chest pain. originally derived in patients with confirmed UA/NSTEMI
  3. One of the earliest chest pain decision rules that was widely implemented
  4. Newer chest pain risk scores such as HEART Score have been shown to better stratify risk than the TIMI Score
  5. UA/NSTEMI can sometimes be missed. Traditionally, the TIMI Risk Score for UA/NSTEMI can correlate the risk of adverse outcome in chest pain patients

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