ch10 (patient assessment) Flashcards
what are the 5 parts of safety assessment?
- scene size-up
- primary assessment
- history taking
- secondary assessment
- reassessment
symptom
a subjective condition that the patient feels and tells you about (can be identified only by the patient)
sign
an objective condition that you can observe or measure (can be seen, heard, smelled or measured)
field impression
conclusion about the cause of the patient’s condition after considering the situation that will help you determine your priorities of care
scene-size up
quick assessment of the scene and the surroundings (MOI and NOI) before you enter and begin patient care
situational awareness
knowledge and understanding of one’s surroundings and the ability to recognize potential risks (to the patient or EMS team)
mechanism of injury (MOI)
the forces, or energy transmission, applied to the body that cause injury
nature of illness (NOI)
the general type of illness the patient is experiencing
chief complaint
the most serious thing the patient is concerned about and the reason EMS was called
personal protective equipment (PPE)
clothing or specialized equipment that protects the wearer
standard precautions
protective measures developed by the CDC when dealing with blood/bodily fluids and risks of communicable disease
incident command system
a system to manage disasters+mass casualty incidents in which responders report to the incident commander
triage
the process of sorting patients based on the severity of their condition
primary assessment
to identify and begin treatment of immediate or imminent life threats
general impression
rapid identification of potentially life-threatening problems (LOC and ABCs)
what is the general impression formed to do?
determine the priority of care
what is the first part of the primary assessment
the general assessment
what should you make a note of during the general impression?
- age, sex, race
- level of distress
- overall appearance
during the general impression how can you define your patient’s condition as?
- stable
- potentially unstable
- unstable (to direct further assessment and treatment)
what does the AVPU test?
the patient’s responsiveness
what does AVPU stand for?
Awake and alert
Verbal (responsive to verbal stimuli)
Pain (responsive to pain)
Unresponsive
orientation
tests a patient’s mental status by checking their memory and thinking ability
-ask person, place, time and event (MOI or NOI)
altered mental status
a change in the way a person thinks or behaves to or from a patient’s normal baseline
responsiveness
the way in which a patient responds to external stimuli including verbal stimuli (sound and touch)
in certain cases, ___________ takes priority over airway and breathing concerns
life-threatening bleeding
perfusion
circulation of blood throughout the body
spontaneous respirations
spontaneous breathing that occurs without assistance
patient’s should have an oxygen saturation greater than…
94%
what questions should you ask when you assess a patient’s breathing?
- is the PT breathing
- is the PT breathing adequately
- is the patient hypoxic?
shallow respirations
little movement of the chest wall
deep respirations
significant rise and fall of the chest
retractions
indentations about the clavicles and in the spaces between the ribs
accessory muscles
neck, chest, abdominal muscles
-secondary muscles of respiration
nasal flaring
widening of the nostrils (indicates an airway obstruction)
two-to-three word dyspnea
PT can only speak 2-3 words at a time without pausing to take a breath
tripod position
PT is sitting and leaning forward on outstretches arms with the head and chin thrust slightly forward
sniffing position
PT sitting upright with the head and chin thrust slightly forward and seems to be singing (common in pediatrics)
labored breathing
breathing that requires greater than normal effort (grunting, stride, accessory muscles)
circulation is evaluated by…
checking the patient’s mental status, pulse, and skin condition
pulse
pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries
palpate
to examine by touch
conjunctiva
lines the eyelids and covers the exposed surface both e eye
cyanosis
skin turns blue
jaundice
liver disease that results in PT’s skin turning yellow
sclera
white portion of the eye
diaphoretic
when the skin in bathed in sweat
capillary refill
evaluated in pediatric patients to asses the ability of the circulatory system to perfuse in the fingers/toes
how do you perform a capillary test?
- compress the fingertip until it turns white
- release the fingertip and count until it goes back to pink (should take no more than 2 seconds)
hypothermia
cold environment
frostbite
frozen tissue
vasoconstriction
narrowing of a blood vessel
rapid head-to-toe exam
-after primary assessment, used to find additional injuries
-should take less than 90 seconds
DCAP-BTLS
DCAP-BTLS
Deformities (misshapen body part)
Contusions (bruising)
Abrasions (loss or damage to the surface of the skin)
Punctures (penetration through the skin)
Burns
Tenderness (pain when an area is palpated)
Lacerations (deep cut in the skin)
Swelling
what are the steps to perform a rapid exam?
asses:
1. head
2. neck
3. chest
4. abdoment
5. pelvis
6. all extremities
7. back and buttocks
and pupils
crepitus
grating sensation caused by fractures bone ends rubbing together
Golden Hour
time from injury to definitive care, during which treatment must occur to increase the patient’s chance of survival
breakdown of the golden hour
20 mins: discovery of incident+activation of EMS
10 minutes: initial assessment, intervention, packaging
30 minutes: EMS transport and initial hospital stabilization
history taking
provides details about the patient’s chief complaint+an account of the patient’s signs and symptoms
OPQRST
Onset (what were you doing when the symptoms began?)
Provocation/palliation (Does anything make the symptoms better or worse? How are you most comfortable)
Quality (What does the symptom feel like? Is it sharp, dull, crushing, tearing?)
Region/radiation (Where do you feel the symptom? Does it move anywhere?)
Severity (On a scale of 0-10 how would you rate your symptom?)
Timing (How long have you had the symptom, when did it start?)
pertinent negatives
signs and symptoms the patient does not have
-helpful in identifying a patient’s problem and choosing an appropriate treatment
SAMPLE
Signs and symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake
Events leading up to the injury or illness
secondary assessment
a systematic physical examination
-can be a head-to-toe assessment or examine a certain area/system
auscultation
to listen with a stethoscope
focused assessment
based on the chief complaint, focused on the body part system
done on nonsignificant MOIs or responsive patients
stridor
harsh high-pitched respiratory sound
breath sounds
indication of air movement in the lungs, assessed with a stethoscope
what is the avg respiratory rate for adults?
12 to 20 breaths/min
tidal volume
the amount of air moved into or out of the lungs during one breath
wheezing
high pitches whistling sound
crackles
wet crackling breath sounds (may indicate fluid in the lungs)
rhonchi
congested breath sounds, low pitched (may suggest mucus or fluid in the lungs)
what is the normal pulse rate for adults?
60 to 100 beats/min
tachycardia
above 100 beats/min in adults
