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NOLS Wilderness Medicine > Ch. 1 - Patient Assessment System > Flashcards

Ch. 1 - Patient Assessment System Flashcards

1
Q

What is the initial assessment (AKA Primary Survey)?

A

Designed to find and treat life threatening issues first. Provides order in chaotic first minutes of realizing the emergency.
Special focus on circulation, breathing, MOI (identify/manage spinal injury), and exposing wounds.

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2
Q

What are the steps for Scene Size-Up?

A
  1. Identify Hazards- to patient, self, and other rescuers
  2. Determine MOI
  3. Form General Impression of Severity
  4. Determine # of Patients
  5. Don PPE
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3
Q

How do you establish responsiveness?

A

As you approach introduce yourself and ask if you can help. Get informed or implied consent.
If no response, raise your voice and try a painful stimulus.
Ask responsive patient to wear a mask, or drape one on unresponsive patient.
If there is a possible spinal injury, or if you are uncertain of MOI protect the spine by limiting head movement.

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4
Q

The Initial Assessment uses the ABCDE acronym, what does the A stand for?

A

A= Airway, check airway for obstruction, or potential obstruction (like gum).
If unresponsive, use the Head-Tilt-Chin-Lift method or the Jaw Thrust. If you can see/hear/feel air coming out of the mouth airway is open. If they are able to make sounds it is at least partially open, if pale or greyish blue color in mucus membranes or if breathing is absent or heavily labored, there may be a foreign body airway obstruction.

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5
Q

The Initial Assessment uses the ABCDE acronym, what does the B stand for?

A

B= Breathing- If patient is awake, ask them to take a deep breath, if it is painful or labored, expose chest and check for life-threatening injury.
If unresponsive, watch abdomen rise and fall, listen for breathing through upper airway. If not breathing, give two even breaths using a barrier device and check for pulse.

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6
Q

The Initial Assessment uses the ABCDE acronym, what does the C stand for?

A

C=Circulation- Check for pulse. If unresponsive check carotid artery (neck) for a minimum of 10 sec.
If responsive, can take radial pulse.
Pulse could be hard to find if people are cold or in shock, if having trouble can also check femoral artery.

Sweep for any signs of bleeding. For external bleed, control with direct pressure.

If no signs of life, start CPR!
If there is a pulse, but no breathing, start rescue breathing with a barrier device!

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7
Q

The Initial Assessment uses the ABCDE acronym, what does the D stand for?

A

D=Decision on Disability- If there is no MOI suggesting spinal injury, release the head at this point. It is a decision on whether to maintain spinal stabilization. If there is MOI suggesting spinal injury, or if you are unsure, maintain stabilization of the spine.

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8
Q

The Initial Assessment uses the ABCDE acronym, what does the E stand for?

A

E=Expose - Without moving the patient, check for any major injuries that could be hidden under clothing. Unzip zipper, open cuffs, etc. Make sure to put back clothing to keep patient warm.

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9
Q

ABC, CAB, or MARCH acronyms.

A 
ABC = Best for most patients (hypoxia/avalanche or submersion victim. 
CAB = Order taught by CPR, best for cardiac arrest where early chest compressions are key. 
MARCH = Used in tactical contexts where bleeding control is most important. Major hemorrhage, Airway, Repertory, Circulation, Hypothermia (or shock).
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10
Q

What is the Secondary Assessment (AKA Focused Exam or History )?

A

Immediate threats to life have been addressed, take a deep breath. Now move into the Head-to-Toe exam, measure vitals, and establish medical history.
It can be invasive, so be thoughtful, introduce yourself more fully, use preferred name/pronouns, if possible give them the choice of someone with same sex/gender conducting exam.
Maintain ABC’s, Look/Listen/Feel/Smell.
Delegate tasks to rescuers, have someone recording info.

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11
Q

The Secondary Assessment (or Focused Exam) includes the Head-to-Toe exam. What are you looking for when addressing the HEAD?

A

Head:

  1. Ears and Nose for fluid and mouth for injury affecting airway
  2. Check face for symmetry, look at cheek bones.
  3. Feel the skull for depressions, tenderness, irregularity, and check hair for bleeding.
  4. Check for eye injury, or abnormality. Look at pupils and ask about any vision disturbances.
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12
Q

What are you looking for when addressing the NECK in the Head-To-Toe?

A

Neck:

  1. Make sure trachea is centered in the middle of the neck .
  2. Check cervical spine from the base of the skull to the tops of the shoulders, to identify pain, tenderness, muscle rigidity, and deformity.
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13
Q

What are you looking for when addressing the SHOULDERS in the Head-To-Toe?

A

Shoulders-
1. Examine shoulders and collar bones for signs of deformity, tenderness or pain. If possible, touch collar bones along their entire length.

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14
Q

What are you looking for when addressing the ARMS in the Head-To-Toe?

A

Arms:

  1. Feel from armpit to wrist, check Circulation, Sensation and Motion (CSM), especially in the hands, one hand at a time. CSM checks for nerve damage in extremity or spine, and injury to bloodvesles in the extremity.
  2. Ask for radial pulse.
  3. Ask about abnormal sensations (tingling, numbness, hot or cold, and assess sensitivity by touching their pinky or thumb. Have them squeeze your hand.
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15
Q

What are you looking for when addressing the CHEST in the Head-To-Toe?

A

Chest:

  1. Feel for deformity or tenderness.
  2. Push in from the sides and ask the patient to breath deeply while you compress their chest .
  3. Look for open chest wounds
  4. Observe rise and fall of chest for symmetry.
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16
Q

What are you looking for when addressing the ABDOMEN in the Head-To-Toe?

A

Abdomen:

  1. Feel for tenderness or muscle rigidity with light pressure.
  2. Look for distention, discoloration, bruising
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17
Q

What are you looking for when addressing the BACK in the Head-To-Toe?

A

Back: Feel each vertebra from the neck to the pelvis. If patient is on their back, logroll to press on spine and look at their back.
While performing the logroll, place sleeping bag/matt under them before laying them back down.

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18
Q

What are you looking for when addressing the PELVIS in the Head-To-Toe?

A

Pelvis:
1. Press in from the sides of the pelvis, avoid aggressive or rocking motions with an injured pelvis.
Genitals are NOT assessed unless they are complaining of injury. Patient could also self-assess.

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19
Q

What are you looking for when addressing the LEGS in the Head-To-Toe?

A

Legs:

  1. Check legs from the groin to the ankle.
  2. Check CSM in the feet, one foot at a time.
  3. Look for pedal pulse in the foot or posterior tibia pulse. If pulses in legs are hard to find, look to see if they are warm and normal color to indicate good circulation. You want to see pink nail-beds, skin, and feel warm feet.
  4. Ask about abnormal sensations and test for sensitivity by touching a small and a big toe.
  5. Ask them to push their foot against your hand pressure to check motion.
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20
Q

The Head-to-Toe also is the time we take vital signs, what information do we need to collect for vitals?

A
  1. Level of Responsiveness (LOR)
  2. Heart Rate
  3. Skin Signs
  4. Respiration
  5. Temperature
  6. Blood Pressure
  7. Pupils
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21
Q

During Head-to-Toe, Vitals are taken. What is the LOR?

A

LOR= Level of Responsiveness.

1. Goal is to assess brain function by checking if people are responding to inputs from the environment.

22
Q

As a general rule, how often should you measure and record the patients vital signs.

A

After the initial vitals, take them again every 15-20 mins, or more frequently if they are seriously injured or ill. Monitor for any deterioration in vitals.

23
Q

With regard to LOR, what does AVPU stand for?

A 
A= Awake 
V= NOT Awake, but responds to VERBAL stimulus. (Eyes flicker when you yell at them)
P= NOT Awake, but responds to PAIN
U= Unresponsive
24
Q

What does it mean to be “Awake and Oriented Times Four” (A+Ox4)

A 
A+Ox4 = Patient knows: Person, Place, Time, and Event
A+Ox3 = Person, Place, Time, but NOT Event. 
A+Ox2 = Person, and Place, but NOT Time or Event 
A+Ox1 = Patient knows who they are and nothing else
A+Ox0 = Disoriented. Patient could be awake, but not able to respond coherently.

When communicating their status, record patient’s initial state, stimulus you gave, and their response.

25
Q

During Head-to-Toe, Vitals are taken. How do we check HEART RATE, RHYTHM, and STRENGTH? What is normal heart rate?

A

Heart Rate: Normal Adult Heart Rate = 50-100 bpm (athletes may be below 50).
Check radial or carotid pulses by counting beats for 30 sec and multiply by 2.

Rhythm: Make sure the beats are even and not irregular

Strength: The pressure against your fingers when feeling pulse. Described as strong-weak.

EX. “The pulse is 110bpm, irregular, and weak”

26
Q

During Head-to-Toe, Vitals are taken. How do we check the condition of their SKIN?

A

SCTM= Skin Color, Temperature, and Moisture.

Check for:

  1. Pinkness - good blood profusion (nail beds, mucus membranes).
  2. Redness - in skin or membranes may indicate heat stroke, carbon monoxide, poisoning, fever, allergic reaction.
  3. Paleness - Blood has withdrawn from the skin, fright, shock ,fainting, or cooling of the skin.
  4. Cyanosis - Blue skin or membranes. May be reduced circulation, or blood oxygen levels. Or they are cold.
  5. Jaundice - Yellow skin, membranes, or eyes. Liver or gallbladder issue. Excess bile pigment in the blood.
  6. Temperature and Moisture - Slip warm hand under clothing to assess, because patients face and hands might be misleading in a cold environment.

EX. “The patients’ mucus membranes are pink, and their skin is cool and clammy”

27
Q

During Head-to-Toe, Vitals are taken. How do we check RESPITORY RATE, RHYTHM, and EFFORT? What is normal?

A

Same as Heart Rate, but count each rise of the chest over 30 sec and times by 2.
Normal= 12-20 bpm

28
Q

During Head-to-Toe, Vitals are taken. What problems should we be looking out for when assessing BREATHING RATE, RHYTHM, and EFFORT?

A
  1. Air Hunger
  2. Shallow, rapid, painful breaths= chest injury
  3. Irregular breathing may = brain disorder
  4. Noisy breathing = clear the airway obstruction
  5. Smell breath, Fruity/ Acetone breath = Diabetic Coma. Foul, fecal smelling breath = Bowel Obstruction

EX. “20 per minute, regular, labored, deep. There is a fruity odor.”
Describe - Rate, Rhythm, Effort, Depth, Noises, Odors.

29
Q

During Head-to-Toe, Vitals are taken. How do we measure BODY TEMPERATURE?

A

Not measured often in the field. Focus more on behavior, history, appearance and mental status.

30
Q

During Head-to-Toe, Vitals are taken. How do we assess PUPILS

A

Pupils - Size, Equality, Reactivity. They are clues to brain function. Indicate head/eye injury, stroke, drugs, or lack of oxygen to brain.
Both need to be round, and equal in size, contract and dilate symmetrically when responding to light.
When lacking oxygen, pupils will be slow to react.

31
Q

During the Head-to-Toe, Vitals are taken. How do we assess BLOOD PRESSURE?

A

If a patient has a strong radial or pedal pulse they have enough blood pressure. If there is a weak radial or pedal pulse that cannot be explained by limb injury, they they have low blood pressure. Look for additional signs of shock.

32
Q

When assessing the patient’s Medical History, we first ask about their Chief Complaint. What acronym is used to aid in investigating it?

A

OPQRST

Chief Complaint = issue that caused the person to solicit help.

33
Q

While investigating the Chief Complaint we use OPQRST. What does the O stand for?

A

ONSET- sudden or gradual?

34
Q

While investigating the Chief Complaint we use OPQRST. What does the P stand for?

A

PROVOKES/ PALLIATES- What provoked the injury/illness? Under what circumstances did the illness occur? What makes the problem worse or better?

35
Q

While investigating the Chief Complaint we use OPQRST. What does the Q stand for?

A

QUALITY - What adjectives describe the pain/discomfort? (sharp, dull, stabbing, aching, burning, cramping).

36
Q

While investigating the Chief Complaint we use OPQRST. What does the R stand for?

A

RADIATE/REGION- Where is the pain? Does it spread? What causes it to move?
(Pain from Spleen may be felt in the left shoulder).

37
Q

While investigating the Chief Complaint we use OPQRST. What does the S stand for?

A

SEVERITY - Describe the effect the pain is having on the patient’s affect. “The patient is distracted and moaning from pain”
Can ask on scale of 1-10

38
Q

While investigating the Chief Complaint we use OPQRST. What does the T stand for?

A

TIME/TREND - When did the pain start, how often does it occur? How long does it last? Is it getting better or worse?

39
Q

After investigating the Chief Complaint with OPQRST, we must complete the Medical History section by asking for additional relevant background information. What acronym is used as a memory aid to complete this second half of the Medical History.

A

SAMPLE

40
Q

The acronym SAMPLE is used to aid in investigation of the patients’ general medical history. What does the S stand for?

A

SYMPTOMS - In addition to chief complaint, what other symptoms are present?
(Nausea, Dizziness, Headache, Pain, etc.)
Symptoms are things the patient perceives and must tell you about.
A SIGN is something you can observe when touching or exposing and injury.

41
Q

The acronym SAMPLE is used to aid in investigation of the patients’ general medical history. What do the A and M stand for?

A

ALLERGIES & MEDICATIONS -
Ask if allergic to medications or has environment related allergies (food, insects, pollen, etc.).
If they mention an allergy confirm if they were exposed and their typical reaction.
Ask if they are currently taking medications (non-prescription, prescription, and herbal, alcohol, drugs).
Determine if they are supposed to be taking medication, but are not. Or if they have missed a dose.

42
Q

The acronym SAMPLE is used to aid in investigation of the patients’ general medical history. What does the P stand for?

A

PAST PERTNENT MEDICAL HISTORY - Don’t be unnecessarily invasive. Start with more general questions like, “have you ever been in a hospital?”
Move to more specific body systems. “Have you had any previous heart problems?”
Look for Medical Alert Tags!

43
Q

The acronym SAMPLE is used to aid in investigation of the patients’ general medical history. What does the L stand for?

A

LAST INS AND OUTS-

When they last ate and drank? When they last went to the bathroom?

44
Q

The acronym SAMPLE is used to aid in investigation of the patients’ general medical history. What does the E stand for?

A

EVENTS - Recent events are unusual circumstances that have occurred within the past few days that may be relevant. Symptoms of Mountain Sickness, or changes in diet due to stomach upset.

45
Q

After competing the primary and secondary surveys the next step is to make the ASSESSMENT and the PLAN. What do these include?

A

ASSESSMENT = Review information, create a “problems list.” Make a list of possible explanations of the signs and symptoms and rule out causes. If it can’t be ruled out the problem stays on the list!

PLAN = Prioritize the problem list and develop a treatment plan for each. Review and repeat exams, and make a decision about evacuation.

Anticipated problems such as weather status or patients’ worsening condition.

EX. If mild hypothermia is on the problem list, the plan will be to remove any wet clothing, dry the patient and insulate with a hypo-wrap.

46
Q

What is a SOAP note?

A

The SOAP note is a standardized way of organizing information for better communication among EMS providers. We need to have a record of all relevant information.

47
Q

We use the SOAP note to document and organize vital information found during the surveys. What does the S stand for?

A

SUBJECTIVE SUMMARY - (Who, what, where). The patient or bystander tells you the subjective story/summary of the event. Including patient age, sex, mechanism of injury, chief complaint and OPQRST findings.

48
Q

We use the SOAP note to document and organize vital information found during the surveys. What does the O stand for?

A

OBJECTIVE INFO - (head-to-toe, vitals, history). Information that is measurable and observable. All vital signs, as well as results (or findings) from SAMPLE history and patient exam.

49
Q

We use the SOAP note to document and organize vital information found during the surveys. What does the A stand for?

A

ASSESSMENT - Categorizes persistent concerns into a problem list.

50
Q

We use the SOAP note to document and organize vital information found during the surveys. What does the P stand for?

A

PLAN - List of interventions corresponding to each item on the problems list. You can also sketch how you plan to evacuate the patient if necessary.

NOLS Wilderness Medicine (9 decks)

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