CH. 5 Assessment Flashcards
When should reassessment be done?
-LOR changes
-Patient is moved/position change
-Bandage change
what is included in the scene assessment
HEMPEG
Hazards, Environment, MOI/chief complaint, persons/PPE, Equipment, General impression
what do you do as soon as you respond to an emergency
assess the scene. Make sure it is safe for you/ bystanders
What do you look for before you approach the patient
look for hazards /anything threatening around the patent or bystanders
what do you do as you approach the patient
look for any life threatening injuries already visible/ MOI
Key to knowing MOI (4)
-understand the sport (each has its own level of risk)
-knowing what to look for
-optimal view point (be able to have the best & quickest access to the athletes)
-what the athletes/bystanders say
what does the ‘general impression’ include? (5)
-patients chief complaint
-if patient is injured or ill
-the patient approximate age
-position of the patient
-the equipment that could be blocking your assessment
define primary assessment
a rapid systematic check of the patient to identify conditions that pose immediate threat to the patients life
why is the order of primary assessment important?
it is ordered to identify the highest priority conditions first
what is included in the primary assessment?
-chief complaint
-LOR
-SMR
-ABC
-O2
-Rapid body check
-transport decision
-patient positioning
What are the different ranges of LOR and its acronym
AVPU
Alert- eyes are open and patient can verblize. (Spontaneous responds to you coming over/eyes are open)
Verbal- Patient responds to a verbal command (can you open your eyes)
Pain- patient responds to a painful stimulis (pinch tricep)
Unresponsive- Patient does not respond to any signals/commands.
define spinal motion restriction (SMR)
the reduction or limitation of spinal movement. Will reduce the additional injury to a patient
When should you consider an SMR injury? (7)
- unresponsive and did not see MOI
- fall from a height greater than 1 meter of 5 stairs (taller than the persons standing height)
- any motor vehicle accident or ejection or fall as speed (snowboard/skateboard)
- injury in which their helmet is broken
- Involving severe blunt force to the head or trunk (hockey check into the boards)
- any injury that penerates the head or trunk (gun shot)
- any diving mishap/going head first into something (axial load)
what can you do if a patients position prevents you from checking ABC?
roll them onto their back keeping their neck , head and spine in as a straight line as possible
Why wouldn’t jaw thrust work in opening the airway? (2)
- obstructed airway
- swelling
how do you check the airway?
- visually inspect
- jaw thrust
how long do you check ABC’s for?
10 seconds
criteria for dyspnea (3)
- inadequate rise and fall of chest
- increase effort on respirations
- very slow or very fast respiration rates
define agonal respiration
-Are an inadequate pattern of breathing sometimes associated with cardiac arrest
-irregular & sporadic. Can present as snorting, gurgling, laboured breathing
What do you do if you do not feel a pulse
start CPR, request for AED
Goals for ABC’s (3)
- check mouth
- secure airway
- check breathing & circulation for 10 seconds
what does the pulse ox do?
measures the pulsating blood vessels (arterial)
when can oxygenation be a concern? (4)
- abnormal vital signs
- neurological/resp. or cardiovascular complaints
- all patients under the effect of respiratory depressants
- multi-system trauma patients
define SpO2
Oxygen saturation level
what does the capacity of SpO2 depend on? (2)
- amount of hemoglobin in the blood
- partial pressure oxygen
How can the SpO2 binding be affected? (4)
- blood PH
- temperature
- presence of carbon monoxide
- anemia (hemoglobin disorder)
What should you also take into consideration besides the SpO2 levels?
signs and symptoms (SOB/ashen pale skin) and chief complaint
ranges:
-normal
-mild hypoxia
-moderate hypoxia
-severe hypoxia
normal: 95-100%
mild: 91-94%
moderate: 86-90%
severe: <85%
pulse ox limitations (14)
-hypoperfusion/shock
-hypotension
-decreased circulation in extremities
-cardiac arrest
excessive motion while trying to get a reading
-nail polish
-carbon monoxide poisioning
-hypothermia
-sickle cell anemia
-smoking cigs
-edema
-delay in response
-ambient light (hard to read)
-false positives
O2 device and LPM flow rate and when to use
-nasal cannula
-standard mask
-non re breather
-BVM
-1-4 LPM (mild hypoxia)
-6-10 LPM (mild hypoxia)
-10+ LPM (moderate/severe hypoxia and breathing)
- 15+ LPM (moderate/severe hypoxia, breathing & not breathing)
what do you check during RBS: Head/neck
-Skin check
-Blood fluids from eyes, ear and mouth
-Bruising under eyes/behind ears
-C spine palpation
what do you check during RBS: Chest
-Paradoxyl breathing at collarbone & ribs
what do you check during RBS: Abdomen/pelvis
-Lift shirt and check for bruising/internal bleeding
-Compress & gap pelvis for fracture
what do you check during RBS: lower extremeties
- Shear femur
-Wet check lower leg
-PMS check at foot
what do you check during RBS: upper extremeties (4)
-wet check of arms
-PMS
-check pulse ox
- Medical ALERT Bracelett/tattoo check
what do you check during RBS: back
-wet check & spine palpate
Focus of Rapid body survey (6)
- head and spine
- major external hemorrhage
- major wounds (puntures/abdominal eviscerations)
- significant fractures (femur & pelvis)
- injuries causing breathing issues (paradoxical breathing)
- neurological issues (PMS)
What is a rapid transport category? (RTC)
patient considered to have life threatening conditions
examples of immediate transport emergencies (17)
-severe/multi system trauma
-internal/external hemorrhage
-decreased LOR/unresponsive
-chest pain (not from a broken rib
-extensive burns
-unstable pelvis injury
-amputation
-severe hypothermia
-decompression illness
-instability/absence of ABC
-neurological defects
-ongoing siezures
-burns with signs of inhalation
-abdominal distension/tenderness
-fractured femur
-childbirth complications
-electrocution
should you move the patient if interventions are found during the primary assessment?
no, if interventions are found (fractured pevis/femur) leave the patient as is
what do you check during reassessment
ABC’s
What are the 3 steps in secondary assessment
- Interview
- Check vitals
- Head to toe examination
what is included in the interview during secondary assessment (2)
- SAMPLE
-S/S- whats bothering them
-Allergies- do they have allergies, have they been in contact with them recently
-Medications- what medications are you currently taking/have there been any changes
-Past medical history- what medical conditions do you have
-Last oral intake- when & what did you eat/drink last
-Events prior- what happened to cause the problem - OPQRST
-Onset- did it suddenly develop over days, hours ect?
-Provocation- what makes it worse
-Quality- What does the pain feel like? Is it a sharp pain, dull/achey?
-Region- Where does it hurt? Does it radiate
-Severity- what is your pain out of 1-10
-Time- when did the pain start
when do you use OPQRST?
when the patient has pain
If the patient is unresponsive what can you do for the interview part of secondary assessment
ask by standers or people that know them & refer to their medical history forms if you have them
Goal of getting vital signs
gather more detailed physiological information about the patient by taking clinical measurements
when should vital signs be reassessed in a stable & unstable patient?
stable 15 mins
unstable 5 mins
what characterizes stable criteria (4)
- pertinent findings
- normal vital signs
- no findings in primary assessment
- LOR is alert
What does vitals include during secondary assessment?
-PEARL (pupils)
-LOR glascow comma scale
-Respiration
-Heart rate
-Blood pressure
-Skin check
-SpO2
what is the glagow comma scale
-standardized system used to asses patients with neurological damage using a numerical score.
Glasgow comma scale: eye opening responses
-spontaneous
-to voice
-to pain
-no response
glasgow comma scale: best verbal response
-orientated & converese
-disorientated converes (right context wrong answer)
-inappropriate words
-incomprehendable sounds
-no response
glasgow comma scale: best motor response
-obeys command
painful response:
-localizes pain (pushes away stimulus)
-withdrawal
-abnormal flexion
-abnormal extension
-no response
what quality & quantity are we looking for when look, listening and feeling for respirations during vitals (3)
- rate
- rhythm
- volume
how does a healthy person breathe (3) and what is normal respiration rates in an adult?
quiet, effortless and regular.
12-20x minute
S/S of abnormal breathing (4)
-gasping for air
-noisy (whistling, gurgling, snoring)
-excessivley fast/slow
-painful
what are we concerned about when taking pulse (3)
rate, rhythm, quality
normal bpm for an adult and what type of quality of pulse
60-100bpm
regular and strong
S/S of abnormal pulse (3)
-irregular pulse
-weak/hard to find pulse
-excessivley fast/slow pulse
define blood pressure
the force exerted by the blood against the blood vessel walls as it travels through the body
2 phases of blood pressure
- contracting (systolic/working phase)
- Refiling (dyastolic/resting pahse)
Define systolic & dyastolic BP
Systolic- pumping force of blood vs artery walls
Diastolic- resting force of blood vs artery walls when heart is refilling
Secondary assessment: skin check, what are you looking for & what does it tell you?
Looking for: Temp, colour and condition
If the skin is cool, pale/flushed and moist the blood is being pulled away from the skin and somewhere else. Could indicate a bleed.
Skin characteristics:
1. pale/ashen/grey, clammy & Moist
2. flushed, red
3. hot
4. cool
5. cold
- shock
- heat illness (exhaustion), anaphaylaxis, hypertension, emotional distress
- heat stroke, fever
- shock
- prolonged cold exposure
secondary assessment: Pupils
-what are we looking for
-what does it tell us
-Looking for pupils to be equal & reactive to light
-Indicate a serious head injury or illness if not equal & reactive to light
Vital changes due to exercise:
-respirations
-BP
-skin colour
-skin temp
-skin moisture
-pulse rate
-faster & deeper
-systolic elevated, diastolic regular
-flushed if warm & moist, grey/whiteish if cold
-cool with sweat or hypothermia, hot/flushed or heat stroke
-sweating, could be significant
-faster & deeper
Secondary assessment: head to toe
-what for
-steps (9) & areas to check
- To gather additional information about injuries or conditions that may require additional care
Steps:
1. Ask for consent
2. indicate what you will be doing/looking for
3. check head
4. neck
5. thorax/back
6. abdomen
7. pelvis
8. assess PMS on all distal limbs
9. Check for medical alert bracelet
Secondary assessment what are you looking for: Head & neck
Head:
-fluids in ear, nose, eyes
-bruising around eyes/ears
Neck:
-tracheal deviation
-jugular vien distention
-cervical spine palpation
Secondary assessment what are you looking for: thorax & back
-paradoxical breathing at clavicle and ribs
-palpate clavicle, sternum, shoulders & ribs for fractures
Secondary assessment what are you looking for: abdomen & pelvis
abdomen:
-expose and palpate 4 quadrants (above and below belly button)
- note discolouration/tenderness
Pelvis:
- observe for incontinence/blood
-compression & gapping
-femoral pulse
Secondary assessment what are you looking for: extremities (arms/legs)
arms:
-shear and PMS
Legs:
-shear and PMS
what do these stand for:
DCAP
BLS
TIC
Deformity, contusions, abrasions, penetrations
burns
lacerations
swelling
tenderness
instability
crepitus
When do you do a focused physical assessment? (6)
- you are satisfied with the MOI
- There is no more than one problem and the casualty is not in significant distress
- injury/illnes is obvious (alert on AVPU or 15/15 on glasgow)
-only one body system is affected
-no life saving interventions are needed
when and why document?
when:
-immediately after/as soon as possible
why:
-protect you from legal action
on going assessment (3)
-monitor the patient
-keep them calm/comfortable until transfer care arrives
-exams do not need to be repeated unless there is a changes in position/LOR. Vitals should still be taken
name 3 changing patient conditions
- scene assessment
- patient assessment
- transport decision treatment
