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Emergency care 13th edition > Chap 14 > Flashcards

Chap 14 Flashcards

1
Q

3 basic Secondary assessment components

A 
Physical exam
Patient history- History of present and past illnesses 
   -OPQRST
   -SAMPLE
Vital signs
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2
Q

OPQRST

A 
O- Onset
P- Provocation
Q- Quality
R- Region, relief 
S- Severity
T- Time
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3
Q

SAMPLE

A 
S- Signs and symptoms
A- Allergies
M- Medications
P- Past pertinent history
L- Last oral intake
E- Events leading to the injury or illness
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4
Q

Reassessment

A

a procedure for detecting changes in a patients condition. It involves four steps: repeating the primary assessment, repeating and recording vital signs, repeating the physical exam and checking interventions

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5
Q

building rapport with patient

A
  • Get on same level with patient
  • demonstrating empathy for problems an condition
  • listen carefully
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6
Q

Open ended questions

A

a question requiring more than just a yes or no answer

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7
Q

Closed ended questions

A

a question requiring only a yes or no

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8
Q

Three techniques in physical exam

A

Observe
Auscultate
Palpate

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9
Q

Respiratory assessment- History

A
  • Dyspnea on exertion
    • Difficulty breathing after exerting himself

Weight gain
-Does patient have recent, rapid weight gain or that clothes fit more tightly? This may indicate fluid build up (heart failure)

Orthopnea
-Difficulty breathing laying down? This occurs in several respiratory conditions, including heart failure

Does the patient sleep on pillows? Has the patient required more pillows recently?

Does the patient have a cough? Has the cough been productive? What does the patient cough up?

Has respiratory conditions recently? (Flu, bronchitis, cold

Does the patient have a chronic illness that affects the respiratory system? (Asthma, emphysema (COPD)

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10
Q

Respiratory exam

A

Mental status
-due to hypoxia to brain

Level of respiratory distress

Observe chest wall motion

Auscultate lung sounds

Use pulse oximeter

Observe edema

  • Lungs, feet
  • Bedridden patients have edema in abdomen and flanks

Fever
-Infectious process such as pneumonia

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11
Q

Cardiovascular history

A

History of existing cardiac conditions and medications

Determine if signs and symptoms match previous episode

Obtain description of chest pain

Determine specific characteristics of the pain

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12
Q

Cardiovascular exam

A

Look for signs that the condition may be severe

  • Skin color, temperature and condition
  • mental status altered due to poor perfusion to brain

Obtain a pulse

Obtain blood pressure

Note the pulse pressure

Jugular vein distension (JVD)
- Heart failure or obstruction within chest

Palpate the chest
-Trauma

Observe posture and breathing

  • Guarding chest?
  • Shallow breathing indicate chest trauma
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13
Q

Two main elements to the nervous system exam

A

Mental status
-Decreased oxygen, low perfusion, stroke, tumors, dementia
Signs of dysfunction
-Facial asymmetry, slurred speech, weakness or inability to move extremities

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14
Q

Neurological history

A

Patients mental status
-AO x4

Patients normal state of mental functioning
-patients might not have normal functioning to begin with (dementia, Alzheimer’s

History of neurological conditions

  • Prior strokes, transient ischemic attacks
  • Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) or Guillain-Barre syndrome

Patients Speech

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15
Q

Neurological exam

A

Perform a stroke scale
-Cincinnati Prehospital Stroke Scale (CPSS)

Check peripheral sensation and movement

Gently palpate the spine for tenderness or deformity

Check extremity strength

Check the patients pupils for PEARL

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16
Q

Endocrine History

A

Obtain history of endocrine conditions
-Diabetes mellitus or thyroid disease

Determine medications taking, last taken and is doses have changed

Determine if patient has eaten

Has patient exerted himself at unusual levels

Patient currently sick

Has patient recently taken his blood glucose

Does patient have insulin pump

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17
Q

Endocrine Exam

A

Evaluate patients mental status

Observe skin
-Cool, moist skin may occur in hypoglycemia

Obtain glucose level
-Normal 70-100

Look for insulin pump

Unusual fruity breath mean hyperglycemic

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18
Q

Gastrointestinal History

A

Oral intake

Pain

History of gastrointestinal issues

Vomiting
-dark blood, red blood or coffee ground looking

Bowel movements
-Dark, tarry, or bright red blood

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19
Q

Gastrointestinal Exam

A

Observe the patients position

Assess the abdomen

Inspect gastrointestinal system

Inspect vomitus or feces

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20
Q

Immune History

A

Allergies and typical reactions

Exposed to something he is allergic to

Feel tightness in the chest or throat, difficulty breathing, or swelling around the face, mouth or tongue

Patient have medications for allergic reactions

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21
Q

Immune system exam

A

Inspect point of contact with the allergen

Inspect the patients skin for hives

Inspect the face, lips, and mouth for swelling

Listen to the lungs to assure adequate breathing

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22
Q

Musculoskeletal History

A

Prior injuries

Taking blood-thinning medications or medications that might delay clotting

History to determine if medical problem (loss of consciousness) caused the traumatic injury

23
Q

Musculoskeletal Exam

A

Inspect and palpate for DCAP-BTLS
-Deformities, contusions, abrasions, punctures, burn, tenderness, lacerations, swelling

Compare sides of the body and note asymmetry

Be alert for crepitations

24
Q

Rapid physical exam

A

Head- Jugular vein distention, medical devices

Neck

Chest presence and equality of breath sounds

abdomen- Distention, firmness, and rigidity

Pelvis- Incontinences of the urine and feces

Extremities- Pulse, motor function, sensation, oxygen saturation, medical devices

25
Q

Questioning bystanders at scene

A

What’s the patients name?

What happened?

Did you see anything else?

Did the patient complain of anything before this happened?

Does the patient have any known illnesses or problems?

Is the patient taking any medication?

26
Q

General combination of factors to determine how serious patient is

A

Location of the injury

Mental status

Airway

Vital signs

MOI

age or the presence of preexisting conditions

27
Q

different terms to describe a seriously injured patient

A

Serious, critical, high priority

28
Q

Steps for not seriously injured patient

A
  1. Determine chief complaint and illicit information about how the patient was injured
  2. Perform the physical exam based on the chief complaint or MOI
  3. Assess baseline vital signs
  4. Obtain a past medical history
29
Q

Steps for a more seriously injured patient

A
  1. Determine the chief complaint, and rapidly elicit information about how the patient was injured
  2. Continue manual stabilization of the head and neck
  3. Consider requesting Advanced life support
  4. Perform rapid trauma assessment
  5. Assess baseline vital signs
  6. Obtain a past medical history
30
Q

HPI

A

History of present illness

  • nature of force
  • Direction and strength of force
  • Equipment used to protect the patient
  • Actions taken to prevent or minimized injury
  • Areas of pain and injuries resulting from the incident
31
Q

Cervical collars

A

STIFNECK SELECT
WIZLOC
Philadelphia Cervical Collar
NEC-LOC

32
Q

Rapid trauma assessment

A

a rapid assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury

33
Q

Field triage: significant MOI

A

Falls

  • Adults greater than 20ft
  • Children <15 yrs fall >10 or 2 to 3 times height of child

High-risk auto crash

  • Intrusion: >12 inches to the occupant site or > 18 inches to any site
  • Ejection (partial or complete) from car
  • Death in the same passenger compartment
  • Vehicle telemetry data consistent with the high risk of injury

Auto versus pedestrian/ bicyclist thrown, run over, or with significant (>20mph) impact

Motorcycle crash >20mph

34
Q

CSF

A

cerebrospinal fluid

35
Q

Battle signs

A

a late sign of head injury

  • bruise behind the ears
  • Blood in anterior chamber of eye
  • blood or clear water-like fluid in ear and nose
  • Unequal pupils
  • Discoloration of soft tissue under eyes
36
Q

tension pneumothorax

A

air trapped in chest

37
Q

Cardiac tamponade

A

Blood filling the sac around the heart

38
Q

Flat neck veins in a patient laying down

A

Might be a sign of blood loss

39
Q

Paradoxical motion

A

Movement of a part of the chest in the opposite direction to the rest of the chest during respiration
-Usually occurs when ribs have broken at both ends and are free floating

40
Q

Subcutaneous emphysema

A

Crackling or crunching sensation under the skin from air that has escaped from normal passageways

41
Q

Distention

A

a condition of being stretched, inflated, or larger than normal

42
Q

Palpating abdomen

A

Palpate painful abdomen last

Make sure hands are warm

Depress surface about 1 inch

Firmness of the abdomen can be sign of injury to the organs or internal bleeding

Pulsating mass might be a enlarged aorta

43
Q

Priapism

A

Persistent erection of penis resulting from spinal cord injury or certain medical problems

44
Q

general principles of an exam

A

Tell patient what you are going to do

Expose any injured area before examining it

Try to maintain eye contact

Apply your spinal protocols

You may stop or alter the assessment process to provide care that is necessary

During the rapid trauma assessment, apply cervical collar if spine injury is suspected

45
Q

Detailed physical exam

A

assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect sign and symptoms of injury

Differs from rapid trauma assessment only in that it also includes examination of the face, ears, eyes, nose, and mouth during the examination of the head

46
Q

Reassessment

A

Repeating primary assessment

  • Reassess mental status
  • Maintain an open airway
  • Monitor breathing for rate and quality
  • Reassess the pulse for rate and quality
  • Monitor skin color and temperature
  • Reestablish patient priorities

Repeat pertinent parts of history and physical exam

  • see if chief complaint changed
  • See if pain changed

Check interventions

Observe trends

47
Q

Diagnosis

A

description or label for a patients condition that assists a clinician in further evaluation and treatment

48
Q

differential diagnosis

A

a list of potential diagnoses compiled early in the assessment of the patient

49
Q

Heuristics and their biases- Representativeness

A

-When you encounter a patients with a certain group of signs and symptoms that resemble a particular condition

50
Q

Heuristics and their biases- Availability

A

-urge to think of things because they are more easily recalled, often because of a recent exposure

51
Q

Heuristics and their biases- Overconfidence

A

Thinking you know more than you really do

52
Q

Heuristics and their biases- Confirmation bias

A

Primarily looks for evidence that supports the diagnosis he already has in mind

53
Q

Heuristics and their biases- Illusory correlation

A

Humans are able to draw conclusions about how the world works because they are able to see how one thing causes another

Emergency care 13th edition (32 decks)

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