Chapter 8 - Patient Assessment

Question 0

Elements of Assessment Process (5)

Answer 0

1. Scene size-up
2. Primary assessment
3. History taking
4. Secondary assessment
5. Reassessment

Question 1

How a traumatic injury occurred.

Answer 1

Mechanism of Injury (MOI)

Question 2

Force of injury occurs over a broad area.

Answer 2

Blunt trauma
Skin usually not broken.
Tissues and organs below area of impact may be damaged.

Question 3

Force of injury occurs at a small point of contact.

Answer 3

Penetrating trauma
Object pierces skin and creates open wound.
High potential for infection.
Severity of injury depends on characteristics of penetrating object, amount of force, part of the body affected.

Question 4

General type of illness a patient is experiencing.

Answer 4

Nature of illness (NOI)
Chief complaint.
Look for clues.
Talk with patient and others at scene.

Question 5

When you observe more than one patient at a scene…..

Answer 5

Utilize Incident Command System
Call for additional units.
Perform triage.

Question 6

Sorting patients on the severity of each patient’s condition.

Answer 6

Triage

Question 7

Identify and initiate treatment of immediate or potential life threats.

Answer 7

Primary Assessment
Form a general impression.
Assess level of consciousness.
Assess the airway; identify and treat life threats.
Assess breathing; identify and treat life threats.
Assess circulation; identify and treat life threats
Perform rapid scan.
Determine priority of care and transport.

Question 8

Key signs to identify a patient’s condition.

Answer 8

Vital signs
Level of consciousness.
Airway, breathing, and circulation (ABCs)

Question 9

Causes of altered level of consciousness in a conscious patient.

Answer 9

Altered LOC caused by:
Altered organ perfusion
Medications
Drugs
Alcohol
Poison

Question 10

How to assess responsiveness (consciousness)?

Answer 10

AVPU
Patient is Alert
Patient responds to Verbal commands
Patient responds to Painful stimuli
Patient is Unresponsive

Question 11

How to evaluate mental status in a responsive patient?

Answer 11

Person - patient remembers own name.
Place - patient is able to identify current location.
Time - patient knows current year, month, and approximate day.
Event - patient can describe event (MOI or NOI)

Question 12

What is Glasgow Coma Scale?

Answer 12

Eye opening (spontaneous 4; speech 3; pain 2; none 1)
Verbal response (oriented 5; confused 4; inappropriate 3; incomprehensible 2; none 1)
Motor response (obeys 6; localizes pain 5; withdraws to pain 4; abnormal flexion 3; abnormal extension 2; none 1)
13-15 mild dysfunction
9-12 moderate dysfunction
8 or less Severe dysfunction

Question 13

A useful guide in assessing pupils.

Answer 13

PEARRL
P - pupils
E - equal
A - and
R- round
R - regular in size
L - react to light

Question 14

Signs of airway obstruction in an unconscious patient?

Answer 14

Obvious trauma, blood or other obstruction.
Noisy breathing; snoring, bubbling, gurgling, crowing.
Extremely shallow breathing.

If any apply, open the airway with appropriate head tilt-chin lift or jaw-thrust maneuver, suction as necessary.

Question 15

Breathing without assistance?

Answer 15

Spontaneous respirations
Includes inspiration and expiration. 1 to 3 timing ratio.
Watch chest move, feel breath on exhalation, listen to breath sounds.

Question 16

What information do you need to assess breathing. (4)

Answer 16

Respiratory rate
Rhythm, regular or irregular
Quality/characteristics of breathing
Depth of breathing

Question 17

Normal respiration rates? (3)

Answer 17

Adults and adolescents - 12 to 20
Children (6 to 12 years) - 15 to 30
Infants - 25 to 50

Question 18

Auscultation

Answer 18

Hear breath sounds better from back.
Auscultate apices (upper), bases (lower), midclavicular and midaxillary (over major airways).
Lift clothing and place stethoscope firmly.

Question 19

Breath sounds? (5)

Answer 19

Normal - clear and quiet
Wheezing - high pitched whistling sound; lower obstruction.
Rales - moist crackling sound; cardiac failure.
Rhonchi - congested sound, most prominent on expiration; mucus in the lungs.
Stridor - brassy, crowing sound; neck or upper airway.

Question 20

Presence of indentations above the clavicle and in spaces between the ribs?

Answer 20

Retractions or use of accessory muscles is a sign of inadequate breathing.
Also nasal flaring.
Two- to three-word dyspnea.
Tripod position and labored breathing.

Question 21

Secondary muscles of respiration?

Answer 21

Accessory muscles
Neck muscles (sternocleidomastoids)
Chest pectoralis muscles
Abdominal muscles

Question 22

Test to evaluate distal circulatory system function?

Answer 22

Capillary refill
Squeeze blood from an area (nail bed or skin), evaluate rate of return of color.
2 seconds is normal.

Question 23

A noninvasive method that can provide information on a patient’s ventilation status, circulation, and metabolism.

Answer 23

Capnography
Measures amount of expired carbon dioxide.
Normal range 35 - 45 mm Hg (5% - 6% CO2)
Secondary tool to determine accurate placement of endotracheal intubation or effectiveness of ongoing CPR.
2% or greater indicates adequate circulation.

Question 24

What is capnometry?

Answer 24

Use of a capnometer to determine end-tidal carbon dioxide.

A colorimetric device that uses colors to provide qualitative measurements.

Question 25

What is the membrane that lines the eyelids?

Answer 25

Conjunctiva

Question 26

A grinding sensation caused by fractured bone ends or joints rubbing together?

Answer 26

Crepitus

Question 27

Blue or grey skin color caused by reduced oxygen in blood?

Answer 27

Cyanosis

Question 28

DCAP-BTLS assessments?

Answer 28

Deformities
Contusions
Abrasions
Punctures/Penetrations

Burns
Tenderness
Lacerations
Swelling

Question 29

Physical assessment performed on patients who have sustained non-significant mechanisms of injury?

Answer 29

Focused assessment

Question 30

A systematic head to toe examination performed during second assessment?

Answer 30

Full-body scan

Question 31

Time from injury to definitive care?

Answer 31

Golden Period
60 minutes or less for discovery, activation of EMS, initial assessment/intervention/packaging (Platinum Ten Minutes), EMS transport/initial hospital stabilization.

Question 32

Involuntary muscle contractions (spasms) of abdominal wall?

Answer 32

Guarding
Effort to protect an inflamed abdomen.
Sign of peritonitis.

Question 33

Key terms in evaluating a patient’s pain?

Answer 33

OPQRST
Onset
Provocation/Palliation
Quality
Region
Severity
Timing of pain

Question 34

What is paradoxical motion?

Answer 34

Motion of chest wall section that is detached; in during inhalation and out during exhalation.

Question 35

Pertinent negatives?

Answer 35

Negative findings that warrant no care or intervention.

Question 36

Step within patient assessment to identify and initiate treatment of immediate and potential life threats?

Answer 36

Primary assessment

Question 37

The white portion of the eye?

Answer 37

Sclera

Tough outer coat.

Question 38

An indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.

Answer 38

Battle’s sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma. Battle’s sign consists of bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery.

Another common bruising sign of a skull injury is raccoon eyes, the purplish discoloration around the eyes following fracture of the frontal portion of the skull base.

Battle’s sign may be confused with a spreading hematoma from a fracture of the mandibular condyle, which is a less serious injury.

Question 39

Associated symptoms.

Answer 39

Patient complaints in addition to the chief complaint.

Question 40

Pertinent negatives

Answer 40

Signs or symptoms that you expect, but are denied by the patient.