Ch 05-1: Assessment / Scenario Flashcards
Order of Assessment
Scene Survey Primary Survey Oxygen Administration Rapid Body Survey Transport Decision Secondary Survey Ongoing Survey
Scene Survey
PPE SPERM Bystander Info General Impression C-Spine
PPE
Protect yourself first.
I arrive on scene and put on my personal protective equipment:
Gloves Goggles Face Shield Gown Reflective Clothing
SPERM
Understand what is going on to make your work more efficient and safe.
Safety:
Are there any obvious hazards in the scene?
Do I have clear access to the patient?
Patient:
How many patients are there?
What is the general behaviour of people on scene?
Environment: What is the weather? Where is the scene located? Is it lit? Is it Cold/Hot
Resources: ALS / BLS Fire Police Hazmat Poison Control
Mechanism of Injury:
Are there any obvious clues to the mechanism of injury?
Bystander Information
Gain more information about what happened from others who may know.
Send your partner to ask bystanders if they know anything related to the incident.
General Impression
May alert you to a serious problem that requires additional resources or a minor problem that can easily be cared for.
Are their eyes tracking Difficulty breathing Deadly bleeds Obvious fractures or dislocations C-spine precaution necessary Age / Gender
C – Spine
C-spine is proper alignment of the head and neck to minimize the risk of damage to the spinal cord, causing paralyzation.
Rule:
I will take c-spine precaution
Rule – Out:
I will rule out possible trauma to the head and spine
Primary Survey
Check for conditions that are immediately life threatening
Introduction/ Gain Consent C-Spine LOC ABCD Initial Transport Decision
Introduction / Consent
Gain valuable rapport with patient by introducing yourself as an emergency responder.
Hi, my name is ______, I am a trained EMR, may I help you?
C - Spine
Delegate Spinal Precautions or state that you don’t have to.
Level of Consciousness - AVPU
Can range from being fully alert to unconscious and is an indicator of a potentially serious problem.
Alert / Oriented x 4
Verbal
Pain
Unresponsive
Alert / Oriented x 4
Ask:
What is your name?
Do you know where we are?
Do you know what time it is?
Do you know what happened?
Verbal
If they did not respond to questions, yell loudly:
“Hey! Are you ok?”
Pain
If they do not respond to verbal stimulus, apply a painful stimulus to rouse a response.
Adults can be pinched at the collar bones
Infants can have the bottoms of their feet tapped
Unresponsive
If the patient does not respond to verbal or painful stimulus they are deemed unresponsive.
Glasgow Coma Scale
Eye Opening - 4
Best Verbal Response - 5
Best Motor Response - 6
Glasgow Coma Scale - Eye Opening
4 - Spontaneous
3 - Verbal
2 - Pain
1 - No Response, eyes do not open
Glasgow Coma Scale - Verbal Response
5 - Oriented and converses 4 - Disoriented and converses 3 - Inappropriate words 2 - Incomprehensible sounds 1 - Makes no sound
Glasgow Coma Scale - Motor Response
6 - Obeys Command 5 - Localizes Pain 4 - Withdraws from pain 3 - Decorticate Posture (flexes inward) 2 - Decerebrate Posture (flexes outward) 1 - Makes no movement
Decorticate
When stimulus is applied, the body tenses and flexes inward. Signal of brain trauma.
Decerebrate
When stimulus is applies, the body tenses and flexes outward. Signal of brain trauma.
A B C D
Airway
Breathing
Circulation
Deadly Bleeds
Airway
Open the patients airway:
Head-tilt chin lift
Jaw Thrust
Be sure that the airway is clear and insert an OPA or NPA when appropriate.
Head-tilt Chin Lift
A way of opening a patients airway that simultaneously moves the tongue and epiglottis off of the airway. Performed on patients without risk of head or spinal trauma.
Jaw Thrust
A way of opening a patients airway when they are suspected of head or spinal trauma.
Oropharyngeal Airway (OPA)
A plastic device inserted into the mouth to keep the tongue off of the airway in order to maintain the airway.
Nasopharyngeal Airway (NPA)
A silicon tube that is lubed and inserted into the nostril to maintain an airway.
Breathing
Rate Rhythm Depth Effort Apply Oxygen Rescue Breathing
Respiratory Rate
The number of breaths taken within a set amount of time, typically 60 seconds.
Average Respiratory Rates
Adult: 12 - 20
Child: 16 - 24
Baby: 30 - 40
Infant: 40 - 60
Respiratory Rhythm
Is their breathing following a rhythm that is even, or does it switch frequently.
Respiratory Depth
The breaths that they take, are they full and deep or shallow?
Respiratory Effort
Are they using other muscles in the body to help them breathe? Are they having any difficulties taking their breaths?
Dispnea
Difficulty Breathing; Shortness of Breath
Agonal Respiration
Isolated or infrequent gasping in the absence of other breathing in an unconscious person.
How long do we check breathing?
Maximum 5 to 10 seconds.
(Number of breaths in 5 seconds) x (12) = Breaths per minute
(Number of breaths in 10 seconds) x 6 = Breaths per Minute
Oxygen Administration Methods
Nasal Cannula: 4-6 lpm
Non Rebreather Mask: 15 lpm
Bag Valve Mask: 15 lpm
Assisted Ventilations
Assist when respiratory rate is less than 8 per minute or greater than 30 per minute.
Hypoventilation
Reduced or deficient ventilation of the lungs
Repirations taken less than 8 per minute.
Assist ventilation at each breath and in the space between breaths.
5 second check = <1.5
Hyperventilation
a condition characterized by abnormally prolonged and rapid breathing.
A respiratory rate greater than 30 per minute.
Assist ventilations at every second breath taken.
5 second check = >2.5
10 second check = >5
Respiratory Arrest
When the patient has stopped breathing
Circulation
The continuous movement of blood through the heart and blood vessels
Circulation Components
Pulse Rate Rhythm Quality Skin Color and Condition CPR
Where do we check for a pulse?
Adults:
Radial Pulse
Carotid Pulse
Babies: Bracheal
How long do we check for a pulse?
Maximum 5 - 10 seconds
If a pulse is not found at the carotid, begin CPR
Cardiopulmonary Resuscitation
CPR; Technique that combines rescue breathing and chest compressions for a patient whose breathing and heart have stopped.
Severe Bleeding
Bleeding that spurts from a wound or cannot be controlled. Also known as a ‘deadly bleed’
Transport Decision
The moment after brief assessment of patient where you choose to get them advanced help or can treat the patient at the scene.
Load and Go
Stay and Play
Load and Go Emergencies
Serious trauma Instability/absence of ABC's Decreased LOC Ongoing Seizures Chest Pain Burns with inhalation injury Extensive burns Abdominal distention and tenderness Unstable pelvic injury Fractured Femur Amputation Pregnancy related conditions Conditions related to environment (Hypothermia, animal bites, lighting strike)
Rapid Body Survey
A hands on physical check of the patient to locate life threatening injuries and conditions to be stabilized on scene.
Non life threatening conditions are treating in the ambulance.
DCAP BLS TIC
Acronym for rapid body survey.
Look For: Deformities Contusions Abrasions Penetrations Burns Lacerations Swelling
Feel For:
Tenderness
Instability
Crepitus
Contusion
Bruise
Battle Signs
Bruising around the back of the ears, sign of a skull fracture.
Raccoon Eyes
Blood from skull fracture seeps into the soft tissue around the eyes.
Crepitus
Term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.
Fractured bone ends grating
Jugular Vein Distention
When pressure in the veins causes the jugular to be pronounced from under the skin surface.
Tracheal Deviation
When pressure within the thoracic cavity alters the position of the trachea.
Paradoxical Movement
When a part or parts of the chest do not rise and fall with the breathing rhythm. Commonly move the opposite of breathing.
Sucking Chest Wound
Penetration of the thoracic cavity causing air movement through the wound to produce a sucking sound.
CMS
Acronym
Circulation
Motor Function
Sensation
Edema
Abnormal accumulation of fluid beneath the skin or in cavities of the body.
S A M P L E
Acronym;
Signs and Symptoms Allergies Medications Past Medical History Last Oral Intake Events Prior
O P Q R S T
Acronym;
Onset - Sudden/Gradual Provoke - What makes it worse Quality - What does pain feel like Radiate/Region - Where is it Severity - How bad is it Time - When did it start
Name the Vitals
Blood Pressure Blood Glucose Level Blood Oximetry Body Temperature Breathing Rate Pulse Pupils equal and reactive to light Level of Consciousness Skin Color and Condition
Blood Pressure
The force exerted by the blood against the blood vessel walls as it travels through the body.
Auscultate
To listen
Apeces
The upper part of the lungs. Auscultate with a stethescope at the mid clavicular level.
Baces
The bottom part of the lungs. Auscultate with a stethescope at the mid auxilliary level.
Systolic Blood Pressure
The pressure of blood in the arteries and blood vessels during a heart contraction.
Diastolic Blood Pressure
Pressure of the arteries and blood vessels at rest.
Glucose
The sugar the body uses as fuel
Healthy Blood Glucose Level (BGL)
4 - 8 mmol/L
“Four to Eight, Feeling Great!”
Hypoglycemia
A medical emergency that involves an abnormally diminished content of glucose in the blood.
BGL < 4 mmol/L
Hyperglycemia
A condition in which an excessive amount of glucose circulates in the blood plasma.
BGL > 8 mmol/L
Glucometer
Device used to measure levels of glucose in the body. Requires a droplet of blood on special test strips.
Pulse / Blood Oximetry
The percentage of oxygen saturation in the blood; SPO2.
The reading appears as a percentage of hemoglobin saturated with oxygen. (O2)
What O2 percentage cannot sustain life?
80 and under
SPO2 readings for adults who are smokers and non smokers
Non Smokers: 95 - 100
Smokers: 94 - 96
Hypoxia
Low oxygen levels in the blood
Mild Hypoxia Level
91 - 94 %
Moderate Hypoxia Level
86 - 90 %
Severe Hypoxia
85 %
Cyanosis
Blueness of the skin and mucous membranes, as from improperly oxygenated blood.
6 Rights - Medication
Patient Medication Route Dose Time Documentation
4 C’s and E
Color Concentration Clarity Condition Expiry Date
C H A T
Chief Complaint
History
Assessment
Estimated Time of Arrival
Average Vitals - Newborn: < 28 days
Pulse: 120-160
Respirations: 40-60
Blood Pressure: 80/40
Average Vitals - Baby: 1 - 12 months
Pulse: 100-120
Respirations: 30-40
Blood Pressure: 80/40
Average Vitals - Child: 1 - 8 Years
Pulse: 80-120
Respirations: 16-24
Blood Pressure: 90/50
Average Vitals - Adult: > 8 years
Pulse: 60-100
Respirations: 12-20
Blood Pressure: 120-80
H A I N E S Recovery Position
High Arm In Endangered Spine
A position unconscious patients are put into to maintain and open airway and allow blood and vomit drainage.
