CH 12 Primary Assessment

Question 1

Primary Assessment

Answer 1

The first element in a patient assessment; steps taken for the purpose of discovering and dealing with any kind life-threatening problems. The six parts of primary assessment are: (1) forming a general impression, (2) assessing mental status, (3) assessing patients airway, (4) assessing breathing, (5) assessing circulation, and (6) determining the priority of the patient for treatment and transport to the hospital

Question 2

Interventions

Answer 2

Actions taken to correct or manage a patient’s problems

Question 3

General Impression

Answer 3

Impression of the patient’s condition that is formed on first approaching the patient, based on the patient’s environment, chief complaint, and appearance

Question 4

Spinal Motion Restriction

Answer 4

A procedure for limiting movement of the head, neck, and spine when spinal injury is possible or likely

Question 5

Manual Stabilization

Answer 5

Using one’s hands to prevent movement of a patient’s head and neck until a cervical collar can be applied

Question 6

Chief Complaint

Answer 6

In emergency medicine the reason EMS was called, usually in the patients own words

Question 7

Mental Status

Answer 7

Level of responsiveness

Question 8

AVPU

Answer 8

A memory aid for classifying a patient’s level of responsiveness or mental status. The letters stand for Alert, Verbal Response, Painful Response, Unresponsive

Question 9

ABC’s

Answer 9

Airway Breathing Circulation

Question 10

Priority

Answer 10

The decision regarding the need for immediate transport of the patient versus further assessment and care at the scene

Question 11

High Priority Conditions

Answer 11

Poor General Impression Unresponsive Responsive, but not following commands Difficulty breathing Shock Complicated childbirth Chest pain consistent with cardiac problems Uncontrolled bleeding Severe pain anywhere

Question 12

Primary Assessment - Responsive

Answer 12

General Impression : Form general impression of patients condition Mental Status : AVPU - Alert Airway - Open Breathing - Look for rise and fall of chest, and listen and feel for rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions). Assess O2 saturation Circulation - Pulse; bleeding; skin color, temperature, condition

Question 13

Primary Assessment - Responsive Interventions Priority

Answer 13

Breathing interventions: Administer O2 based on the patient’s O2 saturation reading, complaint, and level of distress. If breathing becomes inadequate, provide positive pressure ventilations and high-concentration O2 Circulation Intervention: Control bleeding. Treat for shock. If Cardiac arrest occurs perform CPR Priority - A responsive patient’s depends on on chief complaint, status of ABC’s and other factors

Question 14

Primary Assessment - Unresponsive

Answer 14

General Impression: Form general impression of patient’s condition Mental Status: AVPU - Responsive to only verbal or painful stimulus, or unresponsive Airway is compromised Breathing : Look for rise and fall of chest and listen feel for rate and depth of breathing (use of accessory muscles, retractions). Assess oxygen saturation Circulation : Pulse; bleeding, skin color, temperature, condition

Question 15

Primary Assessment - Unresponsive Interventions Mental Airway Breathing Circulation Priority

Answer 15

MENTAL INTERVENTION : Recognize that hypoxia or shock may be a cause of altered mental status/ Administer O2, as appropriate, during your treatment in breathing intervention AIRWAY INTERVENTION : Open airway with head-tilt, chin lift maneuver; consider oropharyngeal or nasopharyngeal airway; suction as needed. For foreign body obstruction, use abdominal thrusts or other blockage-clearing technique BREATHING INTERVENTION : Administer O2 based on the patient’s O2 saturation reading complaint and level of distress. Position patient on side. If breathing is inadequate, provide positive pressure ventilations with O2. If respiratory arrest develops, perform rescue breathing CIRCULATION INTERVENTION : Control breathing. Treat for shock. If cardiac arrest occurs perform CPR PRIORITY : An unresponsive patient is automatically a high priority for immediate transport

Question 16

TRAUMA PATIENT Primary Assessment - Responsive

Answer 16

General Impression : Form general impression of patient’s condition. Evaluate MOI Mental Status: Alert Airway : Open Breathing : Look for rise and fall of chest, listen and feel for rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions) Circulation : Pulse; Bleeding; Skin Color; temperature; condition

Question 17

TRAUMA PATIENT Primary Assessment - Responsive INTERVENTIONS General Impression Breathing Circulation PRIORITY

Answer 17

GENERAL IMPRESSION INTERVENTION : Manual stabilization of head and neck if you suspect spinal injury BREATHING INTERVENTION : Patients with minor or isolated injuries usually do not require O2. Administer O2 based on the patients saturation reading, compliant, and level of distress. If respiratory failure develops, provide positive pressure ventilations and high-concentration O2 CIRCULATION INTERVENTION : Control bleeding. Treat for shock. If cardiac arrest occurs, perform CPR PRIORITY : A responsive patient’s depends on chief complaint, status of ABCs and other factors

Question 18

TRAUMA PATIENT Primary Assessment - Unresponsive

Answer 18

General Impression : Form general impression of patients condition. Evaluate MOI Mental Status : AVPU - Responsive only to Verbal or Painful stimuli, or unresponsive Airway : Compromised Breathing: Look for rise and fall of chest and listen and feel for rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions) Expose and palpate the chest for signs of trauma that will affect breathing Circulation : Pulse; bleeding; skin color; temperature; condition

Question 19

TRAUMA PATIENT Patient Assessment - Unresponsive INTERVENTIONS General Impression Mental Status Airway Breathing Circulation PRIORITY

Answer 19

GENERAL IMPRESSION INTERVENTION : Manual stabilization of head and neck if you suspect spinal injury MENTAL STATUS INTERVENTION : O2 administration. For patients with shock, hypoxia, or severe injuries, you will administer high-concentration O2 AIRWAY INTERVENTION : Open airway with jaw-thrust maneuver; consider oropharyngeal or nasopharyngeal airway. Suction as needed. For foreign-body obstruction, use abdominal thrusts or other blockage-clearing technique BREATHING INTERVENTION : Administer O2 based on patient’s O2 saturation reading, complaint, and level of distress. If breathing becomes inadequate, provide positive pressure ventilation with O2. If respiratory arrest develops, perform rescue breathing CIRCULATION INTERVENTION : Control bleeding. Treat for shock, if cardiac arrest develops, perform CPR PRIORITY: An unresponsive patient is automatically a HIGH priority for IMMEDIATE transport

Question 20

You have a 41 y/o M patient, who has sustained a large laceration to his leg after falling from a tree that he was trimming. You identify a massive hemorrhage, and apply a tourniquet. The bleeding is now controlled. What is the next step that you would take? Considering that your primary assessment is going to always involve ABCs, but does not have to always be a straight down the line. In this case, the C was done first, because you had to handle the Circulation portion first.

Answer 20

Assess the patients airway would be the next step you would take. You may always want to conduct Airway, Breathing and Circulation. In this scenario, you handled Circulation, so as the scenario is happening - you are doing CAB

Question 21

You arrive on the scene of a MVA. You find a 40 y/o Male who was riding a motorcycle and crashed. Your first general impression identified that your patient is unconscious, has blood spurting out of his leg, and has gurgling respirations. What should you do FIRST

Answer 21

Apply direct pressure to the bleeding wound While your patient is presenting with gurgling respirations, his hemorrhage is at his Femoral artery, he will bleed out from this in potentially 2-3 minutes. This must be addressed FIRST

Question 22

When you decided to use a number system to assign an assisted breathing condition 1-4, with 1being the most severe and 4 being the least; how would that look?

Answer 22

1 - Respiratory arrest with a pulse - requires rescue breathing 2 - Patient is not alert and breathing is inadequate (with an insufficient minute volume because of decreased rate or depth, or both) 3 - Patient has some level of alertness and the patients breathing is inadequate 4 - Patients breathing is inadequate but there are signs suggesting respiratory distress or hypoxia