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EMT Class > Chapter 13: Patient Assessment > Flashcards

Chapter 13: Patient Assessment Flashcards

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1
Q

primary assessment

A

after scene is safe and controlled, conducted on every patient regardless of the MOI or NOI

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2
Q

the overall purposes of patient assessment served during primary assessment

A

1) determine whether the patient is injured or ill
2) identify and manage immediately life-threatening conditions
3) determine priorities for further assessment and care on the scene versus immediate transport

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3
Q

the main purpose of the primary assessment

A

identify and manage immediately life-threatening conditions to the airway, breathing, oxygenation, or circulation

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4
Q

components of primary assessment

A

1) form a general impression of the patient
2) assess the level of consciousness (mental status)
3) assess the airway
4) assess breathing
5) assess oxygenation
6) assess circulation
7) establish patient priorities

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5
Q

spine motion restriction (SMR)

A

performed if you suspect spinal cord or vertebral injury (patient has sever MOI) or if patient complains or neck/back pain, loss of motor/sensory functions, or abnormal sensations in extremities

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6
Q

self-restriction

A

patient instructed to bring head and neck in line with umbilicus and not move it

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7
Q

penetrating trauma

A

a force that pierces skin and body tissues, e.g. gunshots, knives, other sharp objects

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8
Q

blunt trauma

A

caused by a force that impacts or is applied to the body but is not sharp enough to penetrate, e.g. blows or crushing

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9
Q

chief complaint

A

the patient’s answer to “why did you call EMS today?” and if patient cannot answer, it may be the response of a family member/bystander or what you infer from observation if no one can answer

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10
Q

immediate life threats that require immediate managements

A

1) an airway compromised by blood, vomit, tongue, etc…
2) obvious open wounds to chest
3) paradoxical movement of chest (moves in on inhalation and out on exhalation)
4) major bleeding
5) unresponsive with no breathing or no normal breathing (agonal or gasping breaths)

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11
Q

performing manual SMR

A

1) place one hand on either side of patient’s head
2) gently bring head into a position in which the nose is aligned with the patients naval
3) position the head neutrally so the head is not extended or flexed

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12
Q

performing self-restriction

A

1) instruct patient to bring his head and neck in line with his navel
2) instruct the patient to bring his legs and feet also in line with his body and to keep his toes in line with his nose and naval
3) instruct the patient not to move his head or neck by extending, flexing, or making any lateral movements until further instructed, a cervical collar is often put in place as a reminder

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13
Q

AVPU mnemonic

A

Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive

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14
Q

trapezius pinch

A

painful stimulus, pinch the trapezius muscle that extends from along the base of the neck to the shoulder, grasp 1-2 inches of the muscle and squeeze

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15
Q

supraorbital pressure

A

slide fingers under the upper ridge of the eye socket and apply upward pressure

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16
Q

sternal rub

A

apply hard downward pressure to center of sternum with knuckles

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17
Q

earlobe pinch

A

pinch the soft tissue portion of the earlobe

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18
Q

armpit pinch

A

pinch the skin and underlying tissue along the margin of the armpit

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19
Q

nail bed pressure

A

apply point pressure to the cuticle area of the nail bed

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20
Q

other peripheral painful stimuli

A

1) pinch the web between thumb and index finger
2) pinch the finger, toe, hand, or foot

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21
Q

flexion posturing

A

aka decorticate posturing, a non-purposeful movement, patient arches back and flexes arms inward towards chest, sign of serious head injury

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22
Q

extension posturing

A

aka decerebrate posturing, a non-purposeful movement, patient arches back and extends arm straight out parallel to the body, sign of serious head injury

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23
Q

occluded airway

A

closed or blocked airway, immediate life-threatening condition

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24
Q

patent airway

A

open airway

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25
Q

assess breathing to:

A

1) determine whether breathing is inadequate or adequate
2) determine need for early oxygen therapy if breathing is adequate
3) provide positive pressure ventilation with supplemental oxygen for inadequate breathing

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26
Q

inadequate tidal volume

A

poor movement (rise) of chest wall (shallow respiration)

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27
Q

abnormal respiratory rate

A

breathing that is either too fast or too slow

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28
Q

bradypnea

A

a respiratory rate that is too slow, causes inadequate minute ventilation leading to hypoxia. can be caused by hypoxia, drug overdose (depressant drugs), head injury, stroke, hypothermia, toxic inhalation

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29
Q

tachypnea

A

respiratory rate that is too fast, can lead to hypoxia. can be caused by hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, other medical conditions

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30
Q

retraction

A

sunken-in appearance, tissues pulled in on inhalation

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31
Q

tracheal tugging

A

pendulum motions of the trachea in the anterior neck during inhalatoin

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32
Q

apnea

A

absence of breathing, no chest wall movement and no sensation/sound of air moving in and out of nose/mouth

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33
Q

dyspnea

A

difficulty breathing

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34
Q

when to administer oxygen treatment

A

SpO2 reading below 94%, signs of hypoxia, hypoxemia, poor perfusion, heart failure, respiratory distress

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35
Q

circulation assessment

A

check the:
1) pulse (presence, absence, approx. HR, regularity and strength)
2) possible major bleeding
3) skin color (mucous membranes), temperature, condition
4) capillary refill

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36
Q

major bleeding

A

bright red, spurting bleeding (arterial) OR dark red, steady, rapid bleeding (venous)

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37
Q

abnormal skin

A

1) pale/mottled
2) cyanotic
3) red
4) yellow

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38
Q

pale/mottled skin

A

decrease in perfusion, onset of shock (hypoperfusion), suspect blood loss or other shock cause

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39
Q

cyanotic skin

A

blue-grey skin, indicate reduced oxygenation from chest injuries, blood loss, conditions that disrupt gas exchange in lungs, late sign of poor perfusion

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40
Q

red skin

A

increase in the amount of blood circulating in blood vessels in skin, can indicate anaphylactic or vasogenic shock, poisonings, overdose, diabetic.other medical conditions, alcohol, local inflammation, cold exposure, heat emergency

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41
Q

yellow skin

A

jaundice, indicates liver dysfunction

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42
Q

hot skin

A

from a hot environment or a very elevated body core temperature

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43
Q

cool skin

A

decreased perfusion as seen in shock, exposure to cold temperatures, fright, anxiety, drug overdose, medical conditions that may interfere with body’s ability to regulate temperature

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44
Q

cold skin

A

frostbite, significant cold exposure, immersion in cold water, severe hypothermia

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45
Q

cool and clammy skin

A

cool and moist, from blood loss, fright, nervousness, anxiety, pain, other medical conditions, THE MOST common sign of shock (hypoperfusion)

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46
Q

dry skin

A

dehydrated or suffering from severe heat exposure or from some medical emergencies

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47
Q

moist skin

A

sweating (in a hot environment), exercise or exertion, fever…from heart attack, hypoglycemia, shock, many other conditions

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48
Q

secondary assessment

A

to identify any additional injuries or conditions that may be life threatening
1) conduct a physical exam
2) take vital signs
3) obtain a history
NOT necessarily in this order

49
Q

cerebrospinal fluid (CSF)

A

clear fluid that surrounds and cushions the spinal cord, CSF leakage usually indicates a skull fracture

50
Q

consensual reflex

A

when both pupils react simultaneously and equally to light being shined in either eye

51
Q

fixed and dilated pupil

A

pupil that is large and not responding to light

52
Q

visual acuity

A

clarity of vision

53
Q

conjugate movement

A

eyes should move together

54
Q

nystagmus

A

jerky eye movements

55
Q

fixed gaze

A

singular eye that is fixed

56
Q

dysconjugate gaze

A

eyes do not move together

57
Q

sclera

A

white portion of eye

58
Q

icterus

A

yellow sclera, possible liver damage/failure

59
Q

hematoma

A

collection of blood

60
Q

subcutaneous emphysema

A

air under the skin, evidence of trauma to the airway

61
Q

tension pneumothorax

A

air trapped in the chest cavity because of chest or lung injury

62
Q

pericardial tamponade

A

blood filling the sac around the heart

63
Q

productive cough

A

mucus produced with cough

64
Q

peritonitis

A

inflammation or irritation of the abdomen lining

65
Q

priapism

A

a persistent erection of the penis, sign of a possible spine injury

66
Q

paraplegia

A

paralysis involving both legs only

67
Q

quadriplegia

A

paralysis involving both arms and both legs

68
Q

hemiplegia

A

paralysis of an arm and leg on one side of the body

69
Q

vital signs that need to be assessed during the secondary assessment and reassessed throughout the entire call

A

breathing (rate and tidal volume), pulse (location, rate, strength, regularity), skin (temperature, color, condition), capillary refill, blood pressure (systolic and diastolic), pupils (equality, size, rate of reactivity), SpO2

70
Q

SAMPLE history

A

S: Signs and Symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last oral intake
E: Events prior to the incident

71
Q

secondary assessment order for a trauma patient

A
  1. physical exam
  2. vital signs
    .3. history
72
Q

rapid secondary assessment

A

a rapid head-to-toe exam, followed by prompt transport or on-scene emergency care

73
Q

modified secondary assessment

A

an exam focused on a specific injury site, followed by on-scene emergency care

74
Q

when to do a rapid secondary assessment followed by rapid emergency care and transport

A

if the mechanism of injury is significant enough to cause critical injuries, if multiple injuries exist, if the patient has an altered mental status, or if any other critical finding identified in the primary assessment makes the patient unstable,

75
Q

when to do a rapid secondary assessment followed by rapid emergency care and transport

A

if the mechanism of injury is significant enough to cause critical injuries, if multiple injuries exist, if the patient has an altered mental status, or if any other critical finding identified in the primary assessment makes the patient unstable

76
Q

when to do a rapid secondary assessment followed by on-scene emergency care

A

the mechanism of injury is not significant enough to produce critical injuries but you suspect the patient could be suffering from multiple or serious injuries anywhere on the body, or if the patient has altered mental status

77
Q

when to do a modified secondary assessment followed by appropriate on-scene emergency care

A

if the patient is suffering from an isolated injury that is not critical, the mechanism of injury is minor, there is no evidence of multiple injuries, and the patient is alert and oriented

78
Q

significant mechanisms of injury

A
  • ejection (partial or complete) of the patient from a vehicle in an automobile crash
  • a crash that causes death to a person in the same passenger compartment in which the patient is found
  • a fall of greater than 20 feet
  • rollover of the vehicle the patient was in
  • a vehicle collision that has occurred at a high speed
  • an intrusion of greater than 12 inches into the passenger compartment or greater than 18 inches at any site on the vehicle
  • a pedestrian/bicyclist struck by a vehicle
  • a motorcycle crash greater than 20mph with separation of rider from motorcycle
  • blunt or penetrating trauma that results in an altered mental status from confusion to unresponsiveness
  • penetrating injuries to the head, neck, torso, or extremities above the knee or elbow
  • blast injuries from an explosion
  • seat-belt injuries
  • collisions in which seat belts are not worn, even if air bags have been deployed
  • impact causing deformity to the steering wheel
  • collision that results in prolonged extrication
79
Q

special considerations for infants and children for MOIs

A
  • a fall of greater than 10 feet or 2-3 times the height of the child
  • a bicycle collision with a motor vehicle
  • a pedestrian or occupant in a vehicle collision at a medium speed
  • any vehicle collision where the infant or child was unrestrained
  • all other adult significant MOIs
80
Q

secondary assessment: trauma patient with significant MOI, multiple injuries, or altered mental status

A

1) continue in-line stabilization
2) consider ALS request
3) reconsider transport decision
4) reassess mental status
5) perform rapid secondary assessment
6) assess vital
7) obtain history
8) transport
9) perform reassessment

81
Q

secondary assessment: trauma with NO significant MOI, NO multiple injuries, and NO altered mental status

A

1) perform modified secondary assessment
2) assess vitals
3) obtain history
4) transport
5) perform reassessment

82
Q

AVPU

A

A: alert
V: responds to verbal stimulus
P: responds to painful stimulus
U: unresponsive

83
Q

Glascow Coma Scale

A

GCS, to rank the patients level of conciousness between 3-15. A score of 8 or less means that there is a severe alteration in brain function. A score of 13 or less means that there needs to be limited (less than 10 minutes) of on-scene time and rapid transport

84
Q

brain herniation

A

significant swelling and/or bleeding to or around the brain creates excessive pressure within the skull and causes the brain to be compressed and pushed downward toward the brain stem, when the brain is pushed out of the foramen magnum (the opening where the spinal cord exits the brain) or the fibrous tentorium (divides the upper and lower brain).

85
Q

aspiration

A

the patient breaths a substance into the lungs

86
Q

aniscoria

A

unequal pupils (normally)

87
Q

subcutaneous emphysema

A

air trapped under the lower layer of the skin, good indicator of significant neck or chest injury

88
Q

tension pneumothorax

A

trachea shifted to one side due to air in the chest cavity, the result of severe lung or chest injury (trachea deviates away from the injured side), when a lung is completely collapsed from air trapped in pleural space

89
Q

tracheal tugging

A

pendulum motion of the trachea, indicates airway obstruction

90
Q

paradoxical movement

A

a section of the chest sinks inward on inhalation while the rest of the chest moves outward

91
Q

flail segment

A

two or more adjacent ribs fractured in two or more places, alters negative chest pressure, life threatening injury (reduces breathing and oxygenation adequacy), CPAP can be good here

92
Q

tenderness

A

a pain response elicited upon palpation

93
Q

markle test/heel jar test

A

strike bottom of heel sharply with fist while patient is supine, tests for rebound tenderness and possible internal injury to abdominal organs

94
Q

DCAP-BTLS

A

for rapid secondary assessment (trauma)
D: Deformities
C: Contusions
A: Abrasions
B: Burns
T: Tenderness
L: Lacerations
S: Swelling

95
Q

PMS

A

for rapid secondary assessment of the extremities
P: Pulses (distal pulses)
M: Motor function
S: Sensation

96
Q

breathing assessment: rapid secondary assessment (trauma patient)

A

rate, tidal volume, quality of breathing (normal, shallow, labored, deep, noisy)

97
Q

pulse assessment: rapid secondary assessment (trauma patient)

A

radial pulse (adult and child patient), brachial pulse (infant less than 1 year), if radial not present, assess carotid

98
Q

skin assessment: rapid secondary assessment (trauma patient)

A

pale or cyanotic nail beds, pale skin, pale oral mucosa, pale conjunctiva, feel skin w/ back of hand for temperature and condition, capillary refill

99
Q

pupil assessment: rapid secondary assessment (trauma patient)

A

size and reactivity

100
Q

blood pressure assessment: rapid secondary assessment (trauma patient)

A

via auscultation, determine systolic and diastolic, narrow pulse pressure and hypotension = signs of serious blood loss and shock

101
Q

pulse oximeter assessment: rapid secondary assessment (trauma patient)

A

apply to determine oxygen level, any reading less than 94% is suspicious

102
Q

revised trauma score

A

includes Glasgow Coma Scale, has 3 major components (respiratory rate, systolic blood pressure, GCS score)

103
Q

secondary assessment: medical patient who is responsive, alert, and oriented

A

1) assess complaints plus signs and symptoms (OPQRST)
2) obtain history
3) perform a modified secondary assessment
4) assess vital signs
5) make transport decision
6) reassessment

104
Q

secondary assessment: medical patient who is unresponsive, not responsive to verbal or painful stimuli, not alert or oriented

A

1) perform a rapid secondary assessment
2) assess vital signs
3) position patient
4) obtain history
5) transport
6) reassessment

105
Q

orthopnea

A

inability to breathe/shortness of breath while lying flat

106
Q

crackles/rales

A

fine crackling noises on inhalation similar to hair being rubbed together close to your ear, indication of fluid in/around alveoli and terminal end of bronchioles

107
Q

wheezing

A

a musical sound on inhalation and exhalation, indicates higher resistance in bronchioles with restricted airflow, usually from bronchiole constriction or swelling/inflammation

108
Q

peritonitis

A

irritation of the abdomen lining (peritoneum)

109
Q

peripheral edema

A

swelling around the hands, feet, ankles

110
Q

recovery/coma position

A

left lateral recumbent position (modified), avoids the potential for aspiration

111
Q

reassessment

A

conducted following the secondary assessment, reassess vital signs every 5 minutes for unstable patient or every 15 minutes in the stable patient

112
Q

three basic reasons to perform a reassessment

A
  • to detect any change in the patient’s condition
  • to identify any missed injuries or conditions, especially those that are life-threatening
  • to adjust the emergency care as needed
113
Q

breathing assessment for an unresponsive medical patient

A

tachypnea, abnormal respiratory patterns

113
Q

pulse assessment for an unresponsive medical patient

A

radial pulse, then carotid pulse if radial pulse is not present, determine rate and quality

114
Q

pupil assessment for an unresponsive medical patient

A

document size, equality, reactivity to light

115
Q

skin assessment for an unresponsive medical patient

A

assess temperature, color, condition (pale cool and clammy may indicate vasoconstriction)

115
Q

blood pressure assessment for an unresponsive medical patient

A

get both systolic and diastolic, pay attention to pulse pressure

115
Q

pulse oximeter

A

determine SpO2 on room air

116
Q

general steps of reassessment

A

1) repeat primary assessment
2) reassess and record vital signs
3) repeat secondary assessment for other complaints, injuries, or a change in the chief complaint
4) check interventions
5) note trends in the patient’s condition

EMT Class (37 decks)

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