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EMS 101 > Chapter 13 - Patient Assessment > Flashcards

Chapter 13 - Patient Assessment Flashcards

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1
Q

Steps of Scene Size Up

A
  1. Take Necessary Standard Precautions
  2. Evaluate Scene Hazards to Ensure Scene Safety:
    • Personal Protection, PT Protection, Bystander
      Protection
  3. Determine MOI and NOI (Trauma or Medical)
  4. Establish # of PT’s
  5. Ascertain need for additional Resources
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2
Q

Scene Size Up (Step 1)

A

Take Necessary Standard Precautions

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3
Q

Scene Size Up (Step 2)

A

Evaluate Scene Hazards and Ensure Scene Safety

  • Personal Protection
  • Protection of PT
  • Protection of Bystanders
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4
Q

Scene Size Up (Step 3)

A

Determine MOI and NOI

  • Trauma PT
  • Medical PT
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5
Q

Scene Size Up (Step 4)

A

Establish # of PTs

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6
Q

Scene Size Up (Step 5)

A

Ascertain Need for Additional Resources

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7
Q

Primary Assessment

A

Conducted on every PT regardless of MOI or NOI

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8
Q

Main Purpose of Primary Assessment

A

ID and manage immediately life-threatening conditions to the: Airway, Breathing, Oxygenation, Circulation (ABOC) (Done in 60 seconds)

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9
Q

7 Components of Primary Assessment

A
  1. Form General Impression of Pt
  2. Assess Level of Consciousness (Mental Status AVPU)
  3. Assess Airway
  4. Assess Breathing
  5. Assess Oxygenation
  6. Assess Circulation
  7. Establish # of PTs
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10
Q

Forming General Impression

A
  • Establish age/sex
  • Trauma or Medical
  • Chief Complaint
  • ID/Manage immediate life threats
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11
Q

Self-Restriction

A

Form of Spine Motion Restriction (SMR) in which the PT is instructed to bring head/neck in line with umbilicus (naval) and not move it

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12
Q

2 Categories of PT

A
  • Injured (Trauma)

- ill (Medical)

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13
Q

2 Types of Trauma

A
  • Penetrating Trauma

- Blunt Trauma

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14
Q

Chief Complaint

A
  • Why did you call EMS TODAY?

- Pain, Abnormal Function, Change in Normal Function, EMS Observation

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15
Q

5 Immediate Life Threats During General Impression

A
  1. Compromised Airway
  2. Open Chest Wound
  3. Paradoxical Movement of Chest Segment
  4. Major Bleeding (Steady Flow/Spurting)
  5. Unresponsive with no breathing or no normal breathing
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16
Q

Cardiac Arrest

A
  • Unresponsive PT with no breathing or agonal breathing and no pulse
  • CAB (Compressions, Airway, Breathing)
  • Check Carotid for 10 seconds (Brachial - Infant)
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17
Q

AVPU

A

Assessing level of PT responsiveness

  • Alert
  • Responds to Verbal stim
  • Responds to Painful stim
  • Unresonsive
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18
Q

Alert

A
  • Eyes Open

- Can speak upon approach

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19
Q

Respond to Verbal Stimulus

A
  • PT opens eyes and responds or tries to respond ONLY when you speak to them
  • If NO Verbal response, check for command repsonse:
    - “Squeeze my finger, wiggle toes”
  • PT Considered AMS (Altered Mental Status)
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20
Q

Responds to Painful Stimulus

A

Central (Core): TESAS

  • Trap Pinch (1-2in of Trap Muscle, not skin)
  • Supraorbital Pressure (Upward Pressure under upper ridge of eye socket)
  • Sternal Rub (Hard downward pressure on sternum with knuckles - Least Ideal)
  • Earlobe Pinch
  • Armpit Pinch

Peripheral (Not Reliable):

  • Nail Bed Pressure (Least Ideal)
  • Pinch Web Between Thumb and Index
  • Pinch Finger, Toe, Foot
  • PT Considered AMS (Altered Mental Status)
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21
Q

Flexion Posturing

A
  • Decorticate Posturing
  • Non-purposeful movement in reaction to Painful Stim
  • Arches back, flexes arms INWARD toward chest
  • Upper Brain Stem Compression
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22
Q

Extension Posturing

A
  • Decerebrate Posturing
  • Non-purposeful movement in reaction to Painful Stim
  • Arches back, extends arms straight out parallel to body
  • Lower Brain Stem Compression
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23
Q

PT Response to Low O2 Levels (Hypoxia) in Brain

A

PT will be agitated and anxious

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24
Q

PT Response to High CO2 Levels (Hypercapnia) in Brain

A

PT will be confused and sleepy

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25
Q

Unresponsive

A
  • Loss of gag/cough reflex
  • Airway compromise due to loss off control of tongue/epiglottis
  • Considered priority for emergency care/transpo
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26
Q

Opening the Airway

A
  • Head Tilt/Chin Lift (Medical - Non-Spinal)
  • Jaw Thrust (Trauma - Spinal)
  • Suction
  • Airway Adjunct (Naso/Oropharangeal)
  • Heimlich
  • Modified Lateral Position (Recovery or Coma Position)
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27
Q

Snoring

A
  • Sonorous
  • Airway blockage from tongue/epiglottis
  • Head Tilt/Chin Lift or Jaw Thrust
  • If no improvement, Oro or Naso
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28
Q

Gurgling

A
  • Sound similar to air rushing through water on inhale/exhale
  • Liquid in airway
  • Suction
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29
Q

Crowing/Stridor

A
  • High pitched sounds on inspiration
  • Swelling/muscle spasms from airway infections, allergic reactions or upper airway burns (sore throat, horse)
  • Do NOT use Airway Adjunct
  • BVM with supplemental 02
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30
Q

Assessing Breathing

A
  • After opening airway
  • Look (Inadequate TV, RR, Bradypnea, Tachypnea)
  • Listen for Air Movement
  • Feel for escape of warm humified air
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31
Q

Additional Signs of Inadequate Breathing

A
  • Retractions (Sunken in tissues pulled inward on inhale):
    - Suprasternal Notch (Above Sternum)
    - Supraclavicular Spaces (Above Clavicle)
    - Intercostal Spaces (Between Ribs)
  • Use of neck muscles on inhale
  • Nasal Flaring
  • Excessive Abdominal Use
  • Tracheal Tugging
  • Pale/Cool/Clammy Skin (Cyanosis)
  • Sp02 <94%
  • Asymmetrical Chest Wall Movement
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32
Q

Apnea

A

Absence of Breathing

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33
Q

Dyspnea

A

Difficulty Breathing

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34
Q

Assessing Oxygenation

A

Look for signs of:

  • Hypoxia
  • Hypoxemia
  • Poor Perfusion
  • Heart Failure
  • Respiratory Distress
  • Complaints of Dyspnea
  • Applying Pulse Oximeter
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35
Q

Oxygen Therapy for Medical PT

A

Nasal Cannula at 2LPM and titrated up until Sp02 >94%

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36
Q

Oxygen Therapy for Trauma PT

A

Non-Rebreather Mask until Sp02 at or above 95%

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37
Q

4 Assessments of Circulation

A
  • Pulse
  • Possible Major Bleeding
  • Skin Color/Temp/Condition
  • Capillary Refill
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38
Q

3 Primary Assessments of Pulse

A
  1. Pulse Present or Not
  2. Approximate Heart Rate (Fast/Normal/Slow - Do NOT do precise)
  3. Regularity and Strength

(Elderly patients commonly have “irregularly irregular” heart rhythm - should still be noted)

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39
Q

Bradycardia

A 
HR < 60bpm
Indicates:
- Severe Hypoxia
- Head Injury
- Drug Overdose
- Heart Attack
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40
Q

Tachycardia

A 
HR > 100bpm
Indicates:
- Anxiety
- Blood Loss
- Shock 
- Abnormal Heart Rhythm
- Heart Attack
- Early Hypoxia
- Drug Overdose
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41
Q

Minimum Systolic BP for Pulse Palpation

A

60mmHg

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42
Q

If NO Carotid Pulse

A
  1. Chest Compressions
  2. +PPV with Supplemental O2
  3. Application of AED
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43
Q

Identify Major Bleeding: Arterial

A

Bright Red, Spurting

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44
Q

Identify Major Bleeding: Venous

A

Dark Red, Steady, Rapid

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45
Q

4 Assessments of Perfusion

A
  1. Skin Color
  2. Skin Temperature
  3. Skin Condition
  4. Capillary Refill
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46
Q

Normal Skin Color

A

Pink

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47
Q

4 Areas to Observe Skin Color

A
  1. Mucous Membrane of Mouth (Including Lips)
  2. Mucous Membranes Lining Eyelid
  3. Under the Tongue
  4. Nail Bed (Least Desirable - Temp/Smoking Can Alter)
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48
Q

Skin in Cold Temp

A
  1. Vessels constrict
  2. Blood shunted to core to preserve heat
  3. Skin becomes pale/cool
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49
Q

Skin in Hot Temp

A
  1. Vessels dilate
  2. Blood flow to skin increases
  3. Skin becomes flushed/warm
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50
Q

Pale or Mottled Skin Color

A
  • Decrease in Perfusion
  • Onset of Shock (Hypoperfusion)
  • Blood loss internally/externally
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51
Q

Cyanotic Skin Color

A
  • Blue/Gray

- Late sign of poor perfusion

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52
Q

Red Skin Color

A
  • Anaphylactic or Vasogenic Shock
  • Poison
  • Drug OD
  • Alcohol
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53
Q

Yellow Skin Color

A
  • Liver disfunction; Jaundice
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54
Q

Hot Skin Temperature

A
  • Hot environment

- Elevated Body Core Temp

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55
Q

Cool Skin Temperature

A
  • Decreased perfusion from shock
  • Fright
  • Anxiety
  • Drug OD
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56
Q

Cold Skin Temp

A
  • Frostbite; Hypothermia
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57
Q

Cool and Clammy Skin Temp

A
  • Moist
  • Most commonly a sign of Shock
  • Blood Loss
  • Fright
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58
Q

2 Types of Skin Condition

A
  • Dry

- Moist

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59
Q

Dry Skin Condition

A
  • Dehydrated

- Severe Heat Exposure

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60
Q

Moist Skin Condition

A
  • Heart Attack
  • Hypoglycemia
  • Shock
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61
Q

Capillary Refill

A
  • Checks Peripheral Perfusion
  • More reliable in kids than adults
  • Best assessed at room temp
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62
Q

Assessing Capillary Refill in Adults

A
  • Depress Nailbed
  • Fleshy part of palm along ulnar margin
  • Forehead
  • Cheeks
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63
Q

Assessing Capillary Refill in Children

A
  • Depress Forearm

- Over the Kneecap

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64
Q

Capillary Refill Times

A
  • Infant/Children/Adult Male: 2 Seconds
  • Adult Women: 3 Seconds
  • Elderly: 4 Seconds
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65
Q

Establishing Patient Priority at End of Primary Assessment

A

Decide if PT is:
1. Unstable and a priority for a rapid secondary assessment and immediate transportation

  1. Stable and secondary assessment and treatment can be conducted on-scene prior to transport
66
Q

3 Components of the Secondary Assessment

A
  • Conducted after Scene Size-Up and Primary Assessment
    1. Conduct Physical Exam
    2. Take Vital Signs
    3. Obtain a History
67
Q

Purpose of Secondary Assessment

A
  • Identify any additional injuries or conditions that may be life threatening
68
Q

Order of Secondary Assessment Components in Trauma PT with Significant MOI or AMS

A
  1. Rapid Secondary Assessment
  2. Vital Signs
  3. History
69
Q

Order of Secondary Assessment Components in Trauma PT Without Significant MOI, No Multiple Injuries, NO AMS

A
  1. Modified Secondary Assessment
  2. Vital Signs
  3. History
70
Q

Order of Secondary Assessment Components in PT Responsive, Alert, Oriented

A
  1. History
  2. Modified Secondary Assessment
  3. Vital Signs
71
Q

Information Assessed in Trauma PT

A
  • Physical exam conducted to ID evidence of injury
72
Q

Information Assessed in Medical PT

A
  • Physical exam conducted to determine severity of condition
73
Q

8 Common Signs of Trauma, What to Palpate For

ABCDLPST

A
  1. Abrasions
  2. Burns
  3. Contusions
  4. Deformities
  5. Lacerations
  6. Punctures
  7. Swelling
  8. Tenderness
74
Q

Cerebrospinal Fluid (CSF)

A
  • Clear fluid that surrounds/cushions the brain and spinal cord
  • May leak our of nose/ears as a result of skull fracture
75
Q

Battle Sign

A
  • Ecchymosis

- Black/Blue discoloration to mastoid area behind ear

76
Q

Secondary Assessment of Eyes

A
  • Do not force eyelids open or apply pressure
  • Remove RGPs if PT is unresponsive
  • Consensual Pupil Reflex
77
Q

Fixed and Dilated Pupils

A
  • Sign of cardiac arrest
78
Q

Conjugate Movement

A
  • Eyes moving together and smoothly
79
Q

Fixed Gaze

A
  • Indicated cranial nerve palsy
80
Q

Dysconjugate Gaze

A
  • Eyes do not move together

- Injury to orbit, ocular muscles, nerves, intoxication

81
Q

Icterus

A
  • Yellow color of sclerae
82
Q

Nystagmus

A
  • Jerky eye movements
83
Q

Jugular Vein Distension (JVD)

A
  • 2/3 of jugular vein filled/engorged from base of neck to jaw
  • Could be a sign of:
  • Tension Pneumothorax
  • Pericardial Tamponade
  • Congestive Heart Failure
84
Q

Hematoma

A
  • Collection of blood in neck causing swelling that could compress the airway in neck
85
Q

Subcutaneous Emphysema

A
  • Air under skin

- In neck, can be from trauma to airway or respiratory tract

86
Q

Tension Pneumothorax

A
  • Air trapped in chest cavity due to injury of chest/lung
87
Q

Pericardial Tanponade

A
  • Blood filling sac around the heart
88
Q

Shifted/Deviated Trachea

A
  • Late sign of tension pneumothorax
89
Q

Tracheal Tugging

A
  • Movement to one side during inhalation

- Airway obstruction in bronchi

90
Q

Assessing Chest

A
  • Retractions of muscles between ribs pulling in on inhale
  • Chest rise/fall with symmetry
  • Paradoxical Movement
  • Auscultation for sounds
91
Q

Paradoxical Movement

A
  • Segments of chest moving in on inhale, out on exhale, opposite of the rest of the chest
  • Sign of flail segment
92
Q

Flail Segment

A
  • 2+ broken ribs in 2+ areas
  • Stabilize segment, do not impede chest movement
  • Immediate 02
93
Q

Wheezing

A
  • Occurs on exhale
  • Narrowing of airways at bronchiole level
  • Diffuse: All lung fields, asthma, anaphylaxis, emphysema
  • Isolated: Localized lung infection, obstruction
94
Q

Crackles (Rales)

A
  • Fluid collection in lungs
95
Q

Stridor

A
  • Partial obstruction of upper airway at larynx

- Foreign body or swelling

96
Q

Peritonitis

A
  • Inflammation or irritation of abdominal lining
  • Abdomen remains rigid during palpation
  • Detected with Markle Test
97
Q

Markle Test (Heel Drop Test)

A
  • If PT can stand, go on balls of feet and drop down onto heels
  • Watch for face grimace
  • Pain in abdomen implies rebound tenderness
  • Peritonitis or appendicitis
98
Q

Heel Jar Test

A
  • For PT who cannot stand
  • Make fist and strike bottom of heel
  • Abdominal pain indicates rebound tenderness
99
Q

Assessment of Pelvis

A
  • Injuries considered critical
  • If no pain or patient unresponsive, each hand on interior lateral wings and compress inward and downward
  • Place hand on symphysis pubis and gentle pressure backward
100
Q

Priapism

A
  • Persistent erection as a result of injury to spinal cord
101
Q

Assessment of Lower Extremities in Medical PT

A
  • Look for excessive swelling around ankles (peripheral edema)
  • Check for pain in calf by testing dorsiflexion and plantar flexion
102
Q

3 Checks for Lower Extremity Assesment

A
  1. Pulse
  2. Motor Function
  3. Sensation
103
Q

Lower Extremity Pulse Check

A
  • Dorsalis Pedis pulse on the top surface of foot
  • Posterior Tibial pulse behind medial malleolus (inner ankle bone)
  • Absent in PT with severe blood loss/shock
104
Q

Lower Extremity Motor Function Check

A
  • Have PT move toes

- Have PT use feet to push hands down and pull hands up

105
Q

Lower Extremity Sensation Check

A
  • Touching one of PTs toes and asking to ID which toe

- Pinch foot for pain response

106
Q

3 Checks for Upper Extremity Assessment

A
  1. Distal Pulses
  2. Motor Function
  3. Sensation
107
Q

Upper Extremity Pulse Check

A
  • Check radial pulse

- May not be felts with blood loss

108
Q

Upper Extremity Motor Function Check

A
  • Have PT move fingers
  • Have PT grip EMT fingers and squeeze together
  • Have PT close eyes, hold arms out front for 10 seconds, watch for unequal lifting or drifting
109
Q

Upper Extremity Sensation Check

A
  • Squeeze one finger and have PT ID which finger

- Pinch if PT is unresponsive

110
Q

Secondary Assessment Body System Check: Respiratory (Pulmonary) System

A
  • Chest shape/symmetry
  • Accessory muscle use (retractions)
  • Auscultation (normal/abnormal breathing)
111
Q

Secondary Assessment Body System Check: Cardiovascular System

A
  • Central/Peripheral Pulse (Rate/Rhythm/Strength/Location)

- Blood Pressure (Systolic/Diastolic/Pulse Pressure)

112
Q

Secondary Assessment Body System Check: Neurological System

A
  • Mental Status (AVPU)
  • Posture and Motor Activity
  • Facial Expression
  • Speech/Language
  • Mood
  • Memory/Attention
113
Q

Secondary Assessment Body System Check: Musculoskeletal System

A
  • Pelvic Region (Symmetry and Tenderness)
  • Lower Extremities
  • Upper Extremities
  • Peripheral Vascular System
  • Perfusion
  • Posterior Body
114
Q

OPQRST

A
  • Further evaluates Chief Complaint
115
Q

SAMPLE

A
  • Obtaining PT History
116
Q

2 Types of Physical Exams for Trauma PT

A
  • Rapid Secondary Assessment (Rapid Head-to-Toe)

- Modified Secondary Assessment (Focused on injury site)

117
Q

When to Use Rapid Secondary Assessent

A
  • Significant MOI
  • Multiple Injuries
  • AMS
  • Critical Findings in Primary Assessment
118
Q

When to Use Modified Secondary Assessment

A
  • Isolated Injury
  • No Significant MOI
  • Alert
  • No Critical Findings in Primary Assessment
119
Q

First Step in Secondary Assessment in Trauma PT

A
  • Re-evaluate MOI
120
Q

Significant MOIs (Producing Trauma)

A
  • Ejection
  • Crash that causes death in same vehicle
  • Fall >20ft
  • Vehicle Rollover
  • High-Speed Collision
  • Intrusion >12in into passenger side
  • Intrusion >18in anywhere
  • Pedestrian Bike Hit by Vehicle
  • Motorcycle >20mph
  • Blunt/Penetrating trauma resulting in AMS
  • Penetrating injuries to head, neck, torso, extremities above knee/elbow
  • Explosion
  • Seat-Belt Injuries
  • Collisions with no seatbelts
  • Impact causing deformity to steering wheel
  • Collision resulting in prolonged extrication
121
Q

Significant MOI in Children/Infants

A
  • Fall >10ft or 2-3x child’s height
  • Bike collision with vehicle
  • Pedestrian in vehicle at medium speed
  • Any collision where child was unrestrained
122
Q

Order of Operations if Significant MOI

A
  1. Continue In-Line Stabilization
  2. Consider ALS Request
  3. Reconsider Transportation Decision
  4. Reassess Mental Status (Where you are/date/time/full name)
  5. Rapid Secondary Assessment
  6. Vitals
  7. History
  8. Transport
  9. Reassessment
123
Q

Order of Operations if No Significant MOI

A
  1. Modified Secondary Assessment
  2. Vitals
  3. History
  4. Transport
  5. Reassessment
124
Q

Unstable Trauma PT Critical Findings: Altered/Deteriorating Mental Status (Possibility)

A
  • Hypoxia/High CO2 Levels
  • Injury to head/chest/spinal cord
  • Blood Loss
  • Inadequate airway/breathing
125
Q

Unstable Trauma PT Critical Findings: Altered/Deteriorating Mental Status (Care)

A
  • Establish airway
  • +PPV @ 10-12/min if RR or TV inadequate
  • Administer O2
126
Q

Glasgow Coma Scale

A
  • Ranks PTs consciousness (3-15)
  • Eye Opening (4); Verbal Response (5); Motor Response (6)
  • 8 or Less indicates severe brain alteration to brain function
  • 13 or less indication for limited on scene time (10min or less) ad rapid transportation
127
Q

Glasgow Coma Scale: Eye Opening

A

Spontaneous - 4
Verbal Command - 3
Pain - 2
No Response - 1

128
Q

Glasgow Coma Scale: Verbal Response

A 
Oriented/Converses - 5
Disoriented/Converses - 4
Inappropriate Words - 3
Incomprehensible Sounds - 2
No Response - 1
129
Q

Glasgow Coma Scale: Motor Response

A 
Obeys Verbal Commands - 6
Localizes Pain - 5
Withdraws From Pain (Flexion) - 4
Abnormal Flexion in Response to Pain (Decorticate Rigidity) - 3
Extension in Response to Pain 
(Decerebrate Rigidity) - 2
No Response - 1
130
Q

Brain Herniation

A
  • Significant amount of swelling/bleeding to or around the brain creating pressure in skull that pushes brain down toward stem
131
Q

Head - Unstable Critical Findings (Possibility/Care):

  • Trauma to Head/Face with AMS
  • Unequal/Fixed Pupils
  • CSF Leaking from Ears/Nose/Mouth
A

Possibility:
- Head Injury

Care:

  • Establish Airway
  • +PPV if inadequate RR/TV
  • Administer O2
132
Q

Head - Unstable Critical Findings (Possibility/Care):

- Blood/Secretions/Vomitus/Teeth

A

Possibility:
- Airway Obstruction

Care:

  • Suction mouth/nose
  • If necessary, logroll PT to side to clear out blockage
133
Q

Anisocoria

A
  • Unequal Pupils (6-10% of Population)
134
Q

Neck - Unstable Critical Findings (Possibility/Care):

  • JVD with PT at 45 degree angle
  • Engorged Jugular Veins
A

Possibility:

  • Injury to heart (pericardial tamponade)
  • Injury to lungs (tension pneumothorax)
  • Poor heart function

Care:

  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
135
Q

Neck - Unstable Critical Findings (Possibility/Care):

- Tracheal Deviation

A

Possibility:
- Lung injury with excessive buildup of pressure in pleural space (tension pneumothorax)

Care:

  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
136
Q

Neck - Unstable Critical Findings (Possibility/Care):

- Tracheal Tugging

A

Possibility:
- Blockage of airway at bronchi level

Care:

  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV
  • Administer O2
137
Q

Chest - Unstable Critical Findings (Possibility/Care):

- Open Wound to Chest

A

Possibility:
- Sucking chest wound (air sucked into pleural space, causing lung to collapse - pneumothorax)

Care:

  • Occlude wound with gloved hand until nonporous/occlusive dressing taped on 3 sides
  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
138
Q

Chest - Unstable Critical Findings (Possibility/Care):

- Paradoxical Movement of Chest

A

Possibility:

  • Flail Segment (2+ ribs fractured @ 2+ locations)
  • Lung Bruise (pulmonary contusion) from injury
  • Severe Hypoxia can result from either

Care:

  • Consider CPAP if breathing is adequate
  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
139
Q

Chest - Unstable Critical Findings (Possibility/Care):

- Absent/Severely Limited Breath Sounds

A

Possibility:
- Lung injury with excessive pressure buildup in pleural space (tension pneumothorax)

Care:

  • +PPV with supplement O2
  • Look for deviated trachea or JVD or air in chest cavity
  • ALS intercept
  • Lift dressings momentarily during exhale to allow trapped air out
140
Q

Chest - Unstable Critical Findings (Possibility/Care):

- Poor Chest Wall Movement With Inhale

A

Possibility:

  • Lung injury with pressure buildup in pleural space (tension pneumothorax)
  • Collapse of one or both lungs (pneumothorax)
  • Severe chest pain from injury
  • Head/spinal injury
  • Injury to diaphragm

Care:

  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
141
Q

Abdomen - Unstable Critical Findings (Possibility/Care):

  • Severe Abdominal Pain
  • Tenderness Upon Palpation
  • Discoloration in Flank Areas
  • Abdominal Rigidity
  • Distended Abdomen
A

Possibility:

  • Bleeding within abdominal cavity
  • Obstruction of gastrointestinal tract
  • Irritation of abdominal lining (peritonitis)

Care:

  • Rapid Transport
  • Establish airway
  • +PPV
142
Q

Abdomen - Unstable Critical Findings (Possibility/Care):

- Protruding Organs

A

Possibilities:
- Abdominal evisceration

Care:

  • Do not replace organs
  • Rinse with sterile water or saline
  • Wet sterile dressing covered with large occlusive dressing
  • Rapid Transport
  • Establish airway
  • Administer O2
  • +PPV
143
Q

Pelvis - Unstable Critical Findings (Possibility/Care):

  • Pain to Pelvis
  • Tenderness or Instability Upon Palpation of Iliac Crest or Symphysis Pubis
A

Possibilities:
- Pelvic Fracture

Care:

  • Rapid Transport
  • Administer O2
  • +PPV
  • Stabilize with splint or commercial device
144
Q

Extremities - Unstable Critical Findings (Possibility/Care):

- Open Wound with Spurting or Steady Flow Blood Loss

A

Possibilities:
- Lacerated artery or vein

Care:

  • Direct pressure to wound
  • Pressure dressing
  • TQ if needed
  • Rapid Transport
  • Administer O2
145
Q

Extremities - Unstable Critical Findings (Possibility/Care):

- Pain/Swelling/Discoloration/Deformity to Thigh

A

Possibility:
- Femur Fracture (life threatening)

Care:

  • Traction splint
  • Rapid transport
  • Administer O2
146
Q

Posterior - Unstable Critical Findings (Possibility/Care):

- Open Wound to Posterior Thorax

A

Possibility:

  • Sucking chest wound
  • Lung injury (pneumothorax)

Care:

  • Occlude wound with gloved hand until nonporous/occlusive dressing taped on 3 sides
  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
147
Q

Vitals - Unstable Critical Findings (Possibility/Care):

- Inadequate RR/TV

A

Possibility:

  • Lung injury with pressure buildup in pleural space (tension pneumothorax)
  • Collapse of one or both lungs (pneumothorax)
  • Severe chest pain from injury
  • Head/spinal cord injury
  • Injury to diaphragm

Care:

  • Rapid Transport
  • Consider ALS Intercept
  • Establish airway
  • +PPV (Aggressive may worsen lung injury)
  • Administer O2
148
Q

Vitals - Unstable Critical Findings (Possibility/Care):

  • Absent Carotid Pulse (Adult) Brachial (Infant)
  • No Movement/Breathing/Signs of Life
A

Possibility:
- Cardiac Arrest

Care:

  • CPR (beginning with compressions)
  • AED
  • ALS intercept
149
Q

Vitals - Unstable Critical Findings (Possibility/Care):

  • Cool/Clammy Skin
  • Weak Pulse
  • Tachycardia
  • Decrease in Systolic BP
  • Narrow Pulse Pressure
  • Delayed Capillary Refill
A

Possibility:
- Hypoperfusion (shock)

Care:

  • Stop any bleeding
  • Administer O2
  • Rapid transport
  • Splint fractures
150
Q

Vitals - Unstable Critical Findings (Possibility/Care):

- Unequal/Fixed Pupils

A

Possibility:
- Head Injury

Care:

  • Establish airway
  • +PPV
  • Administer O2
151
Q

Vitals - Unstable Critical Findings (Possibility/Care):

- Sp02<94%

A

Possibility:
- Hypoxia from injury, occluded airway or inadequate respiration

Care:

  • O2 if breathing adequate
  • +PPV if inadequate with supplemental 02
152
Q

Revised Glasgow Trauma Scale: Respiratory Rate

A 
10-29/min - 4
>29/min - 3
6-9/min - 2
1-5/min - 1
None - 0
153
Q

Revised Glasgow Trauma Scale: Systolic BP

A 
>89mmHg - 4
76-89 - 3
50-75 - 2
1-49 - 1
None - 0
154
Q

Reassesment

A
  • Conducted following the secondary assessment
  • Usually conducted in ambulance until transfer of care
  • Determine any changes to PT condition as a result of care
155
Q

3 Reasons for Reassessment

A
  1. Detect any change in PT condition
  2. ID any missed injuries/conditions
  3. Adjust emergency care as needed
156
Q

5 Steps of Reassessment

A
  1. Repeat Primary Assessment
  2. Reassess and Record Vitals
  3. Repeat Secondary Assessment for other complaints, injuries, or change in chief complaint
  4. Check Interventions
  5. Note Trends in PT condition
157
Q

-A-

A
  • No/Not/Without/Lack Of
158
Q

Dys

A
  • Difficult
159
Q

Icter

A
  • Jaundice
160
Q

-ic

A
  • Pertaining To
161
Q

-us

A
  • Condition Of
162
Q

5 General Techniques Used in Patient Assessment

A
  1. Inspect
  2. Palpate
  3. Auscultate
  4. Listen
  5. Smell

EMS 101 (2 decks)

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