Ch10: Patient Assessment Flashcards
A 29-year-old male with a head injury opens his eyes when you speak to him, is confused as to the time and date, and is able to move all of his extremities on command. His Glasgow Coma Scale (GCS) score is:
A. 13.
B. 10.
C. 12.
D. 14
A. 13
Which of the following would the EMT likely NOT perform on a responsive patient with a headache and no apparent life-threatening conditions?
A. Noninvasive blood pressure monitoring
B. Systemic head-to-toe examination
C. Assessment of O2 saturation
D. Focused secondary assessment
B. Systemic head-to-toe examination
The goal of the systematic head-to-toe exam that is performed during the secondary assessment is to:
A. locate injuries not found in the primary assessment.
B. definitively rule out significant internal injuries.
C. assess only the parts of the body that are injured.
D. detect and treat all non-life-threatening injuries.
A. locate injuries not found in the primary assessment.
The systematic head-to-toe assessment should be performed on:
A. responsive medical patients and patients without a significant MOI.
B. stable patients who are able to tell you exactly what happened.
C. patients with a significant MOI and unresponsive medical patients.
D. all patients with traumatic injuries who will require EMS transport.
C. patients with a significant MOI and unresponsive medical patients.
A blood pressure cuff that is too small for a patient’s arm will give a:
A. falsely low systolic and diastolic reading.
B. falsely high systolic and diastolic reading.
C. falsely low systolic but high diastolic reading.
D. falsely high systolic but low diastolic reading.
B. falsely high systolic and diastolic reading.
A patient’s short-term memory is MOST likely intact if they correctly answer questions regarding:
A. day and event
B. person and place
C. time and place
D. event and person
A. day and event
5 Stages of Patient Assessment
- Scene size up
- Primary assessment
- History taking
- Secondary assessment
- Reassessment
5 Stages of Scene Size-Up
- Ensure scene safety
- Determine MOI and NOI
- Take standard precautions
- Determine no. of patients
- Consider add’l resources
2 Types of Trauma
- Blunt: force applied over a large area, sometimes skin isn’t broken
- Penetrating: piercing skin, open wounds
How do energy transfers apply to MOI?
Blunt trauma or force to one area of the body can transfer and cause injury in other places because of energy transfers.
E.g. trauma on foot can transfer up to pelvis and spinal cord
Triage
Sorting patients based on severity of condition
Incident command system
system to manage disasters & mass-casualty events
7 Stages of Primary Assessment
- Form general impression (by talking to patient, noting any observations/bleeding)
- Assess LOC
- Airway
- Breathing
- Circulation (ABCs)
- Identify & treat life-threatening conditions
- Determine priority of patient care
What are not included in primary assessments?
In-depth physical examination, vital signs
How to assess LOC? (2 steps)
1) AVPU scale
Awake & alert
Verbal stimuli
Pain stimuli - pinching tissue in sternum, lower jaw, trapezius (muscle above collarbone)
Unresponsive
2) PPTE (for orientation)
Person
Place
Time
Event
–> all yes = “awake and fully oriented”
–> deviation from normal mental status = “altered mental status”
When do patients need spinal immobilization?
Blunt/Penetrating Trauma with any of:
- tenderness on neck or spine palpation
- reported neck/back pain
- paralysis or neurologic complaint
Blunt trauma with any of:
- intoxication
- altered mental status
- difficulty in communicating
OR distracting injury
(may distract from any neck/back pain)
What happens if airway is obstructed
blocks air movement
not enough perfusion
How do you tell if a responsive patient has unobstructed airways?
If they can talk and cry.
How do you tell if a responsive patient has an obstructed airway?
If they cannot talk or cry.
How do you tell if an unresponsive patient has an obstructed airway?
trauma –> jaw thrust movement
noisy breathing
shallow respirations
Conditions that cause sudden death
respiratory arrest
respiratory failure
airway obstruction
cardiac arrest
shock
severe bleeding
What’s the diff between respiratory arrest and failure
arrest: complete cessation of BREATHING
failure: ventilation failure; inadequate O2 getting into blood
How do you document a patient breathing on his/her own in a PCR?
spontaneous breathing
What are examples of positive pressure ventilation as breathing support?
endotracheal tube, oxygen mask
Signs of inadequate breathing
shallow respirations; little chest movement, poor chest excursion
tripod or sniffing (infants) position
use of accessory muscles (abdomen, neck)
two to three-word dyspnea
Difference between respiratory distress, arrest, and failure
distress: difficulty breathing
arrest: complete cessation of BREATHING
failure: ventilation failure; inadequate O2 getting into blood
signs of respiratory distress
increased breathing rate (tachypnea)
increased HR (tachycardia)
use of accessory muscles
seesaw breathing, nasal flaring, head bobbing
stridor, wheezing
anxiety
signs of respiratory failure
increased breathing rate (tachypnea)
low O2 sats
bradycardia
gasping for air with gurgling or snoring sounds
lethargy
diminished of muscle tone
inadequate chest rise
3 Steps of Assessing Circulation
1) mental status 🗣️
2) pulse
3) skin condition
Where to find pulse in infant?
brachial artery (inside of upper arm)
Where to find the pulse of an unresponsive child/adult (1+ years)?
carotid artery
Where to find the pulse of a responsive child/adult (1+ years)?
radial artery (wrist)
What do you do if there is a pulse but no breathing?
provide ventilations
- for adult: 10-12 breaths per min
- for infants/children: 12-20 breaths per min
What do you do if there is no pulse?
start CPR, apply AED
What does pale, ashen, grey or white skin indicate?
poor circulation
or abnormally cold skin
What does cyanosis indicate?
poor perfusion (cells not getting O2)
What does flushed & red skin condition tell us?
High bp
What does jaundice tell us?
liver disease
