Chapter 12 – Patient Assessment Flashcards
Define scene size up and discuss its components
Scene size up: first aspect of patient assessment. Survey the scene upon arrival
- Taking standard precautions
- Evaluating scene safety
- Determining the mechanism of injury or patient’s illness
- Determining the total number of patients
- Determine the need for additional resources
Determine if the scene is safe to enter
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
Describe common hazards and potential hazards found at the scene of a trauma patient and at the scene of a medical patient
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
Differentiate between a trauma patient in a medical patient
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
Define mechanism of injury and give examples of common mechanisms of injury
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
Differentiate between blunt trauma and penetrating trauma
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
Define nature of illness and give examples
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
Discuss the reason for identifying the total number of patients at the scene
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
Explain the reason for identifying the need for additional help or assistance
A variety of special protective equipment and gear may need to be available. Chemical or biological suits may be needed, or rescue equipment
Discuss the examination techniques used during patient assessment
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
List and describe the components of patient assessment and the purpose of each component
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
Summarize the reasons for forming a general impression of the patient
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
Define chief complaint and give examples
Chief complaint: the reason EMS was called. For example, chest pain, or shortness of breath
Discussed methods of assessing the airway in adult, child, and infant patients
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
Discussed methods of assessing altered mental status in adult, child, and infant patients
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
State reasons for management of the cervical spine once the patient has been determined to be a trauma patient
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
Describe message for if a patient is breathing
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
State what care should be provided to adult, child, and infant patients with adequate breathing
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
State what care should be provided to adult, child, and infant patients with in adequate breathing
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
Discussed the need for assessing the patient for external bleeding
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
Differentiate between central and peripheral pulses
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
Differentiate obtaining a post in adult, child, and infant patients
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
Describe normal and abnormal findings when assessing skin color
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
Differentiate between hot, cool, and cold skin temperatures
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
Describe normal and abnormal findings when assessing skin moisture
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
Describe normal and abnormal findings when assessing capillary refill in the infant or child patient
Normal capillary refill: less than two seconds. Delayed: refill time of three to five seconds. Markedly delayed: refill time of more than five seconds
Explain the reason for prioritizing a patient for care and transport
If the patient is in critical condition, they need to be transported immediately
Discuss the purpose and components of the secondary survey
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
State the areas of the body that are evaluated during the secondary survey
Physical examination, which is head to toe
Recite examples of and explain why patients should receive a rapid trauma assessment
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
Discuss the reason for performing a focused history and physical exam
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
Distinguish between the secondary survey that is performed on a trauma patient and the one performed on a medical patient
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
Identify the components of vital signs
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
Explain baseline vital signs and describe trending of vital signs
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
Describe the methods of obtaining a breathing rate
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
Identify the attributes that should be obtained when assessing breathing
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
Differentiate Shallow, labored, and noisy breathing
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
Describe the methods of obtaining a pulse rate
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
Differentiate between strong, weak, regular, and irregular pulses
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
Describe the methods of assessing blood pressure
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
Define systolic pressure
Systolic pressure is the pressure in an artery when the heart is pumping blood
Define diastolic pressure
Diastolic pressure is the pressure in an artery when the heart is at rest
Describe the methods of assessing the pupils
Briefly shine a light, and assess size, equality, and reactivity
Identify normal and abnormal pupil size
Normally, both pupils will constrict even if light enters one.
Differentiate dilated and constricted pupils size
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
Differentiate between reactive and non-reactive pupils and equal and unequal pupils
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
Explain what additional care should be provided wow you are performing the secondary survey
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
Discuss the purpose of patient reassessment
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
Describe the components of patient reassessment
Repeating the primary survey, reassessing and documenting vital signs, repeating the focused assessment, reevaluating the emergency care provided
Discuss the reasons for repeating the primary survey as part of reassessment
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
Differentiate between pale, blue, red and yellow skin colors
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
Describe normal and abnormal findings when assessing skin temperature
Normal skin temperature is warm, use the back of your fingers to judge body temperature.
