Chapter 10: Patient Assesment

Question 1

What are wheezing lung sounds?

Answer 1

Wheezes sound high-pitched and musical. They are due to air moving through narrowed airways. They are located throughout the entire lung. An example of them are asthma exacerbations.

Question 2

What is Rhonchi lung sounds?

Answer 2

Rhonchi sounds like low-pitches rumbling or gurgling. It is due to narrowed airways. It is found in trachea and bronchi. An example of it is chronic bronchitis.

Question 3

What are crackles lung sounds?

Answer 3

Crackles sound like fine hair moving through fingers or course Velcro. They are due to collapsed small airways and alveoli “popping open.” They are found in the lower lobes. An example of them is in pulmonary edema.

Question 4

What are Pleural Friction Rub lung sounds?

Answer 4

Pleural friction rub sounds like dry rubbing or squeaking. It is due to inflamed Pleuta. It is found on the anterior lateral of the lung. An example of it is autoimmune disorders.

Question 5

What are the vital signs and what are we checking in each?

Answer 5

Blood pressure:
Eyes: Pupils are round and responsive to light
Respirations: Unlabored, rhythmic, normal body movement, rate within the appropriate range.
Pulse: Strong, regular, rate within the appropriate range
Skin: Color, temperature, condition

Question 6

What is SAMPLE?

Answer 6

Signs (what I see)/ Symptoms (what patient tells me)
Allergies
Medication
Pertinent medical history
Last oral intake
Events leading to injury/illnes

Question 7

What is OPQRSTi?

Answer 7

Onset (when did this start?)
Provocation (does anything make it better or worse?)
Quality (What does it feel like?)
Radiation (Where does it hurt?)
Severity (On a scale of one to ten how would you rate your pain?)
Time (What happens over time?) (Consistency/improvement)
interventions (Have you taken anything for this?)

Question 8

What does moist, pale, cool skin indicate?

Answer 8

Pale/cyanotic, cool, damp (clammy) : Inadequate braking

Question 9

What does skin tell us?

Answer 9

Perfusion: skin color, temperature, moisture, and capillary refill
Blood circulation: Determines color

Question 10

What are the pulse rate ranges for Neonates to Late adults?

Answer 10

Neonate (0-1mo): 100-180bpm
Infant (1mo-1yr): 100-160bpm
Toddler (1-3yrs): 90-150bpm
Preschooler (3-6yrs): 80-140bpm
School age (6-12yrs): 70-120bpm
Adolescent (12-18yrs): 60-100bpm
Early Adult (19-40yrs): 60-100bpm
Middle Adult (41-60yrs): 60-100bpm
Late Adult (61+yrs): 60-100bpm

Question 11

What are the Respiration rate ranges for Neonates to Late Adults?

Answer 11

Neonate (0-1mo): 30-60bpm
Infant (1mo-1yr): 25-50bpm
Toddler (1-3yrs): 20-30bpm
Preschooler (3-6yrs): 20-25bpm
School age (6-12yrs): 15-20bpm
Adolescent (12-18yrs): 12-20bpm
Early Adult (19-40yrs): 12-20bpm
Middle Adult (41-60yrs): 12-20bpm
Late Adult (61+yrs): 12-20bpm

Question 12

What are the systolic BP ranges for Neonates to Late Adults?

Answer 12

Neonate (0-1mo): 50-70mmHg
Infant (1mo-1yr): 70-95mmHg
Toddler (1-3yrs): 80-100mmHg
Preschooler (3-6yrs): 80-100mmHg
School age (6-12yrs): 80-110mmHg
Adolescent (12-18yrs): 90-110mmHg
Early Adult (19-40yrs): 90-130mmHg
Middle Adult (41-60yrs): 90-130mmHg
Late Adult (61+yrs): 90-130mmHg

Question 13

What part of the patient assessment is: Oxygen was administered via NRB@12 Ipm?

Answer 13

Treatment

Question 14

What part of the patient assessment is: The dyspnea woke him up from sleep?

Answer 14

OPQRST history

Question 15

What part of the patient assessment is: The patient’s color improved enroute to the hospital?

Answer 15

Reassessment

Question 16

What part of the patient assessment is: He takes vitamin pills regularly?

Answer 16

SAMPLE history

Question 17

What part of the patient assessment is: “I can’t breathe.”

Answer 17

Chief Complaint

Question 18

What part of the patient assessment is: He has no known allergies?

Answer 18

SAMPLE history

Question 19

What part of the patient assessment is: The dyspnea was somewhat relieved by getting up and walking around?

Answer 19

OPQRST history

Question 20

What part of the patient assessment is: The pulse was 120, full, and regular; respirations were 30 and labored; BP was 190/120.

Answer 20

Secondary Assessment

Question 21

What part of the patient assessment is: He has no history of respiratory or heart disease?

Answer 21

SAMPLE history

Question 22

What part of the patient assessment is: The lungs were full of loud, bubbling rales.

Answer 22

Secondary Assessment

Question 23

What part of the patient assessment is: He denies chest pain?

Answer 23

Secondary Assessment

Question 24

What part of the patient assessment is: He is a 57 year-old male, sitting and appears in extreme distress?

Answer 24

General Impression

Question 25

What part of the patient assessment is: There is no edema in his feet?

Answer 25

Secondary Assessment

Question 26

What part of the patient assessment is: He was hospitalized a year ago for a bowel obstruction?

Answer 26

SAMPLE history

Question 27

What part of the patient assessment is: The skin is cold, clammy and cyanotic.

Answer 27

Secondary Assessment

Question 28

What part of the patient assessment is: His airway is open, clear and self-maintained because he is talking to me?

Answer 28

Primary Assessment

Question 29

What can moist, pale, cool skin indicate?

Answer 29

Inadequate flow of blood to the skin (via breathing or perfusion), early shock.

Question 30

What can hot dry skin indicate?

Answer 30

Hyperthermia

Question 31

What can hot moist skin indicate?

Answer 31

shock

Question 32

What are the steps of patient assessment?

Answer 32

Scene size up, primary assessment, secondary assessment, intervention, and reassessment

Question 33

Tell me about scene size up.

Answer 33

It begins with dispatch. Use gathered information to prepare the necessary BSI/PPE and gear (most important that we are safe). When you get there, is the scene safe, is this a NOI (nature of illness) or MOI (method of injury). Consider the number of patients. Do I need more resources.

Question 34

Tell me about the primary assessment.

Answer 34

This is when you assess immediate life threats (airway obstruction, respiratory failure, respiratory arrest, shock, severe bleeding, cardiac arrest) and you consider where you want to take the patient. General impression (age, sex, position, level of distress, appearance). LOC: AVPU scale (Alert-aware of presence, Verbal, Painful, Unresponsive). Orientation: Person (name), place (where are you), Time (what day), Event (what happened).
Chief complaint: What they “say”
Life Threats: A- open, clear, maintained (suction?)
B- adequate- rate, effort, depth: look, listen, feel: (Inspect, Palpitate, Auscultate, Seal/Stabilize, Oxygen: I PASS Gass) positive pressure if less than 8 or more than 24 (oxygen saturation should be b/w 94% and 99%)
C- Pulse: present, quality, rhythm, bleeding (ask about signs of internal) Skin: CTC & profusion
D- decision, Load & GO/ Stay&Play
E- Inform additional EMS of decision

Question 35

Tell me about the secondary assessment.

Answer 35

History intake: SAMPLE, OPQRSTi,
Differential “Diagnosis”: Consider all possibilities, then narrow to probabilities
Challenges include: Silence, crying, anxiety, anger, language
Take Vitals
Focused Medical Assessment: Physical exam of system based on chief complain

Question 36

Tell me about reassessment:

Answer 36

Check vitals: Unstable: every 5 min, Stable: Every 15 min
Check ABCs, consider effects of interventions