Chapter 4, Initial Assessment Flashcards
What is the initial assessment A-J mnemonic?
A = Alertness and Airway (with cervical spinal motion restriction ad indicated)
B = Breathing and ventilation
C = Circulation and Control of hemorrhage
D = Disability (neurologic status)
E = Exposure and Environmental control
F = Full set of vital signs and Family presence
G = Get adjuncts and Give comfort using the mnemonic LMNOP
H = History and Head to toe
I = Inspect posterior surfaces
J = Just keep reevaluating
What tenant must be kept in mind when preparing to receive a trauma patient?
Safe practice, safe care.
Safe practice: Consider the protection of the team.
Safe care: The patient gets to the right hospital in the right amount of time for the right care.
What is the main goal of the general impression and primary survey?
Immediately identify all life-threatening conditions within the first few minutes of arrival.
What is the recommended method to clear the cervical spine?
Noncontrast multidetector computed tomography (MDCT)
What are two ways to maintain spinal motion restriction?
Manual stabilization
Correctly sized, semi-rigid cervical collar
What does the mnemonic AVPU stand for?
A = Alert and oriented
V = Responds to Verbal stimuli
P = Responds only to Painful stimuli
U = Unresponsive (check pulse)
How do you open the airway in patient who is unable to open their mouth, responds only to pain, or is unresponsive?
Jaw-thrust maneuver
How do you assess proper definitive airway placement?
Assess presence of exhaled CO2 (CO2 detector)
Observe for adequate rise and fall of the chest
Auscultate for presence of gurgling over the epigastrium and presence of bilateral breath sounds
How do you determine adequate ventilation?
ETCO2 35-45 mmHg (>50 mmHg signifies depressed ventilation)
SpO2 94-98%
How do you assist ventilation with a bag-mask device?
1 breath every 6 seconds (10 breaths per minute)
O2 source at 10-15 L/min
What patient population is appropriate to use advanced airways with cuffed tubes?
All ages.
At what GCS score should an advanced airway be placed?
GCS of 8 or less.
What major assessment parameters produce important information regarding a patient’s circulatory status within seconds of arrival?
LOC
Skin color
Pulse
What assessment can help perform an emergent abdominal or pelvic exam?
Focused assessment with sonography for trauma (FAST)
How should IV access be obtained in a trauma scenario?
Cannulate two veins with large-caliber intravenous catheters.
Blood must be administered with what fluid?
0.9% sodium chloride
What are common sites for internal hemorrhage in the trauma patient?
Chest
Abdomen
Pelvis
Long bones
Damage control resuscitation (DCR) involves which two strategies?
Hypotensive resuscitation
Hemostatic resuscitation
What is the gold standard to evaluate neurologic status?
GCS
3 (unconsciousness) - 15 (alert, converses normally, obeys commands)
What interventions help evaluate neurologic status in addition to the GCS?
Computed tomography
ABGs
Glucose, alcohol level, toxicology screening
What should be assumed with any changes in level of consciousness?
CNS injury
When clothing is removed during the primary assessment where should clothing be stored that might be needed for evidence?
Paper bag and label appropriately
Is an assessment of the patient’s posterior required during the primary assessment?
It may be deferred until after the head-to-toe assessment and imaging if needed to evaluate spinal and pelvic stability.
How should family members be viewed during a trauma resuscitation?
As an extension of the patient.
What does LMNOP stand for under G: Get adjuncts and Give comfort?
L: Laboratory studies
M: Monitor
N: Nasogastric or orogastric tube consideration
O: Oxygenation and ventilation assessment
P: Pain
What lactic acid level is associated with poor outcomes?
2-4 mmol/L
What additional lab should be considered for those who have suffered burn trauma?
Carboxyhemoglobin
What two points are considered during Reevaluation?
Portable radiographs
The need for patient transfer
What portable radiographs should be considered during Reevaluation?
Anterior-posterior chest
Pelvis (may be deferred for definitive imaging)
Confirmation of ET, chest, gastric tubes
What mnemonic highlights important aspects of a patient’s history?
S: Symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last meal, output, menstrual period
E: Events/Environmental factors r/t the illness/injury
What mnemonic helps in the assessment of soft-tissue injuries?
L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis
What are two ways to screen for CSF when performing the head-to-toe assessment during the secondary survey?
Halo sign
Test for glucose
Why is monitoring urinary output important?
Urinary output reflects end-organ perfusion and is considered a sensitive indicator of the patient’s volume status.
What is a prerequisite for inspecting posterior surfaces for a patient with pelvic or spinal trauma?
Complete imaging (may not apply if patient is hemodynamically unstable or has a compromised airway)
What should be avoided when rolling a patient to inspect posterior surfaces?
Rolling the patient onto the side of an injured extremity.
The major components of the reevaluation can be recalled using what mnemonic?
V: Vital signs
I: Injuries sustained and Interventions performed
P: Primary survey
P: Level of pain
