Chapter 12 – Patient Assessment

Question 1

Define scene size up and discuss its components

Answer 1

Scene size up: first aspect of patient assessment. Survey the scene upon arrival

1. Taking standard precautions
2. Evaluating scene safety
3. Determining the mechanism of injury or patient’s illness
4. Determining the total number of patients
5. Determine the need for additional resources

Question 2

Determine if the scene is safe to enter

Answer 2

Seen survey: an assessment of the entire scene to ensure safety of you, other rescuers, and bystanders. If the scene is unsafe, either wait until hazards have been minimized or make the scene safe

Question 3

Describe common hazards and potential hazards found at the scene of a trauma patient and at the scene of a medical patient

Answer 3

Placards on the railroad cars or vehicles, unusual odors, spilled solids or liquids, leaking containers, vapor clouds, weapons visible, loud yelling and fighting, look for hostile bystanders, unstable surfaces, down powerlines and bystanders in danger

Question 4

Differentiate between a trauma patient in a medical patient

Answer 4

Trauma patient: someone who’s experienced an injury from external force, look for the mechanisms of injury
Medical patient: one who is condition is caused by an illness

Question 5

Define mechanism of injury and give examples of common mechanisms of injury

Answer 5

Mechanism of injury: refers to the way in which an injury occurs, as well as the forces producing the injury. Examples: falling, assaults, automobile accidents, firearms, motorcycle crashes

Question 6

Differentiate between blunt trauma and penetrating trauma

Answer 6

Blunt trauma: any mechanism of injury that occurs without penetrating The body. For example, a fall or a sports injury.
Penetrating trauma: any mechanism of injury that causes a cut or piercing of the skin. For example, getting shot or stabbed

Question 7

Define nature of illness and give examples

Answer 7

Nature of illness: describes the medical condition that resulted in the patient’s call to 911. Examples include fever, difficulty breathing, chest pain, vomiting, or headaches

Question 8

Discuss the reason for identifying the total number of patients at the scene

Answer 8

The need for additional resources is based on the amount of patients found in any emergency. If there are too many patients, call back up

Question 9

Explain the reason for identifying the need for additional help or assistance

Answer 9

A variety of special protective equipment and gear may need to be available. Chemical or biological suits may be needed, or rescue equipment

Question 10

Discuss the examination techniques used during patient assessment

Answer 10

Look: use your site to assess the look of body parts and facial expression
Listen: use your hearing to find out why patient called, and her breathing status
Feel: use touch for assessing body temperature, paint spots, or soft, hard, or swollen spots
Smell: use your sense of smell to identify odors, for example the odor of breath

Question 11

List and describe the components of patient assessment and the purpose of each component

Answer 11

Primary survey: a quick assessment for immediate life-threatening situations (ABCDE)
Airway/level of responsiveness, cervical spine protection
Breathing
Circulation
Disability
Expose
Secondary survey: a physical exam meant to cover medical conditions that weren’t covered in the primary survey, vital signs, focused history, head to toe physical exam

Question 12

Summarize the reasons for forming a general impression of the patient

Answer 12

The purpose is to decide if the patients sick. If the patient looks sick, you must act fast because it could be life-threatening. If the patient appears unresponsive, immediately begin the primary survey

Question 13

Define chief complaint and give examples

Answer 13

Chief complaint: the reason EMS was called. For example, chest pain, or shortness of breath

Question 14

Discussed methods of assessing the airway in adult, child, and infant patients

Answer 14

A patient who can talk clearly or cry has a open airway, if no sound comes out at all, it is a complete obstruction, if there is coughing and wheezing it is a partial obstruction. If you don’t suspect trauma on an unconscious patient, use the head tilt chin lift maneuver. If you do suspect trauma then use the modified jaw thrust maneuver, don’t hyperextend the child’s neck

Question 15

Discussed methods of assessing altered mental status in adult, child, and infant patients

Answer 15

AVPU scale:
*Alert *responds to Verbal stimuli *responds to Painful stimuli *Unresponsive
Evaluate the patient’s mental status by asking person place time and event. So their name, where they are, the day date and time, and what happened. Assessing a child over three is the same as an adult, or young child will smile, interact with others, orients to sound, and follows objects with eyes

Question 16

State reasons for management of the cervical spine once the patient has been determined to be a trauma patient

Answer 16

Stabilization of the spy needs to be done to reduce the risk of injury to the spinal cord. In-line stabilization is a technique to minimize movement of the neck and head

Question 17

Describe message for if a patient is breathing

Answer 17

If a patient is responsive, watch and listen to her as she breathes. Look for the rise and fall in the chest. Watch abdomen for children, and chest for adults. Feel for air movement under nose or chest

Question 18

State what care should be provided to adult, child, and infant patients with adequate breathing

Answer 18

If breathing is adequate and patient is responsive, allow patient to assume comfortable position while getting oxygen as needed. Patient is unresponsive, maintain an open airway, provide 02 and watch patient carefully

Question 19

State what care should be provided to adult, child, and infant patients with in adequate breathing

Answer 19

If patient’s breathing is in adequate and they are unresponsive, begin positive pressure ventilation using a pocket mask, mouth to mouth, or bag mask. Watch patients chance to ensure air is correctly traveling

Question 20

Discussed the need for assessing the patient for external bleeding

Answer 20

You must stop heavy bleeding because it will cause shock and ultimately death. Keep pressure on wounds and apply a tourniquet it if pressure doesn’t work

Question 21

Differentiate between central and peripheral pulses

Answer 21

Central pulse: a pulse found close to the trunk of the body. For example, the cartoon and femoral pulses
peripheral pulse: located further from the trunk. Examples include the radial or bronchial pulse

Question 22

Differentiate obtaining a post in adult, child, and infant patients

Answer 22

When checking a responsive child one and up or adult, check the radial pulse in the wrist. Use carotid artery in neck for unresponsive adult or child one and up. For an infant, feel for a brachial pulse for 5 to 10 seconds

Question 23

Describe normal and abnormal findings when assessing skin color

Answer 23

In Caucasians, normal skin color is pale pink. Pale skin occurs when blood vessels narrow causing perfusion. Assess skin color by looking at areas not exposed to the sun like palms or feet

Question 24

Differentiate between hot, cool, and cold skin temperatures

Answer 24

Normal skin temperature is warm, use the back of your fingers. Cold skin can be blue and clammy. Hot skin can be dry and flushed and red

Question 25

Describe normal and abnormal findings when assessing skin moisture

Answer 25

Warm and moist can come from anxiety, or exercise. Clammy skin which is cool and moist, can be caused by shark, localized warmth can be caused by an infection or burn, localized coolest can be caused by poor blood flow to a limb

Question 26

Describe normal and abnormal findings when assessing capillary refill in the infant or child patient

Answer 26

Normal capillary refill: less than two seconds. Delayed: refill time of three to five seconds. Markedly delayed: refill time of more than five seconds

Question 27

Explain the reason for prioritizing a patient for care and transport

Answer 27

If the patient is in critical condition, they need to be transported immediately

Question 28

Discuss the purpose and components of the secondary survey

Answer 28

The secondary survey is performed to locate and begin management of the signs and symptoms of an injury, this is performed after you assess all life-threatening emergencies

Question 29

State the areas of the body that are evaluated during the secondary survey

Answer 29

Physical examination, which is head to toe

Question 30

Recite examples of and explain why patients should receive a rapid trauma assessment

Answer 30

A rapid trauma assessment is a quick secondary survey of a trauma patient with a rapid mechanism of injury. A significant mechanism of injury is likely to cause serious injuries, like a car crash

Question 31

Discuss the reason for performing a focused history and physical exam

Answer 31

Focused physical exam: used to describe an assessment of a specific body areas that are affected by the injury. This can narrow down a head to toe examination to a specific body part

Question 32

Distinguish between the secondary survey that is performed on a trauma patient and the one performed on a medical patient

Answer 32

The procedure for the secondary survey is the same on both, however the physical findings are different. For example a swollen ankle in a trauma patient is probably a break or sprain, while in a medical patient it could be from heart failure

Question 33

Identify the components of vital signs

Answer 33

Vital signs: assessments of breathing, pulse, skin temperature, pupils and blood pressure. Vital signs are measured two: detect changes a normal body function, recognize life-threatening situations, determine a patient’s response to treatment

Question 34

Explain baseline vital signs and describe trending of vital signs

Answer 34

Baseline vital signs: in initial set of vital sign measurements. Trends are changes. It’s important to watch trends in vital signs because you can see if the heart rate is increasing or decreasing or steady

Question 35

Describe the methods of obtaining a breathing rate

Answer 35

Place the patients arms across chest and hold wrist, count number of respirations for 30 seconds and multiply it by two. If breathing is irregular or if it’s an infant, count for one whole minute

Question 36

Identify the attributes that should be obtained when assessing breathing

Answer 36

Many things can affect your respiratory rate. Exercise, stress, pain, anxiety, and use of stimulants can increase respiratory rate. Use of narcotics or sedatives can decrease it

Question 37

Differentiate Shallow, labored, and noisy breathing

Answer 37

Shallow breathing is when it’s difficult to see the chest or abdomen moving during breathing because a small volume of air is exchanged. Labored breathing is an increase of effort to breathe, while noisy breathing could be high pitched breathing or snoring

Question 38

Describe the methods of obtaining a pulse rate

Answer 38

To feel for a pulse, use the pads of your index and middle fingers by placing them on an artery gently, feeling for a pulse
Count the number of beats for 30 seconds and multiply it by two, if pulse is irregular then count for one minute

Question 39

Differentiate between strong, weak, regular, and irregular pulses

Answer 39

A strong pulse is easily felt, with equal pressure in each beat. It weak pulse is hard to feel, a thready pulse is a weak and fast pulse

Question 40

Describe the methods of assessing blood pressure

Answer 40

Blood pressure is assessed by using a blood pressure cuff and stethoscope. You put the cover on the persons arm and inflate it, cutting off circulation, then slowly deflate it while measuring pulse with stethoscope. blood pressure is written as a fraction, with the systolic number first

Question 41

Define systolic pressure

Answer 41

Systolic pressure is the pressure in an artery when the heart is pumping blood

Question 42

Define diastolic pressure

Answer 42

Diastolic pressure is the pressure in an artery when the heart is at rest

Question 43

Describe the methods of assessing the pupils

Answer 43

Briefly shine a light, and assess size, equality, and reactivity

Question 44

Identify normal and abnormal pupil size

Answer 44

Normally, both pupils will constrict even if light enters one.

Question 45

Differentiate dilated and constricted pupils size

Answer 45

Dilated pupils can be caused by trauma, fight, poison, Eye medication, glaucoma, and feta means, caffeine cocaine or meth
Constricted can because by eyedrops, head injury, shrooms or nerve agents

Question 46

Differentiate between reactive and non-reactive pupils and equal and unequal pupils

Answer 46

Reactive pupils will react to light shined in one eye, they will constrict. Non-reactive pupils will not. Unequal pupils is when one pupil constricts and one doesn’t, and can be due to a head injury or stroke

Question 47

Explain what additional care should be provided wow you are performing the secondary survey

Answer 47

Start by feeling skull for deformities or swelling, then look for face symmetry, then exam and I sockets and nasal bones and zygotic bones. Work your way down

Question 48

Discuss the purpose of patient reassessment

Answer 48

A patient reassessment is a reevaluation of a patient. Reassessment allows for: identify any missed injury, observe subtle changes or trends in a patient, alter emergency care, assess the effectiveness of the care provided

Question 49

Describe the components of patient reassessment

Answer 49

Repeating the primary survey, reassessing and documenting vital signs, repeating the focused assessment, reevaluating the emergency care provided

Question 50

Discuss the reasons for repeating the primary survey as part of reassessment

Answer 50

You want to repeat the primary survey in order to catch life-threatening injuries that may have been missed. Reassess patients airway in order to ensure breathing is still happening, reassess breathing rate and quality

Question 51

Differentiate between pale, blue, red and yellow skin colors

Answer 51

Cyanosis: blue gray color of skin, suggests low level of oxygen which creates poor perfusion
Mottling: skin discoloration blue and white, usually seen in shock patients with cardiac arrest or hypothermia
Joundiced : yellow skin is seen in patients with liver or gallbladder problems
Redskin suggests alcohol abuse, allergic reaction’s, late stages of Carbon monoxide poisoning, heat exposure or high blood pressure

Question 52

Describe normal and abnormal findings when assessing skin temperature

Answer 52

Normal skin temperature is warm, use the back of your fingers to judge body temperature.