Chapter 9 Flashcards
1
Q
Patient assessment divided into 5 main parts::
- …
- … assessment
- … taking
- … assessment
- …
A
scene size-up primary history secondary reassessment
2
Q
a … is a subjective condition the patient feels and tells you about
a … is an objective condition you can observe/measure about the patient
A
symptom; sign
3
Q
the treatment EMTs provide patients is based on …, not an …
A
symptoms; exact diagnosis
4
Q
(scene size-up) the scene size-up refers to your evaluation of the … in which you will be operating. … is necessary throughout the entire call to ensure safely.
A
conditions; situational awareness
5
Q
(scene size-up) … is paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose.
A
situational awareness
6
Q
(scene size-up) dispatch provides basic information about the request for assistance. Scene size-up combines info and observations to help ensure … and …:
an understanding of the situation and conditions prior to responding
the dispatcher’s info
an observation of the scene
A
safe; effective operations
7
Q
(scene size-up) if a scene is not safe for you and your team to enter the scene and approach and manage the patient, do what you can to make it safe or call for additional resources: …. … workers … technicians … personnel
A
firefighters
utility
hazardous materials
law enforcement
8
Q
(scene size-up) typically the way you enter an area is also the way you will leave, with a stretcher, a patient, patient care equipment, and personnel belongings. consider …
A
difficult terrain
9
Q
(scene size-up) consider … and issues related to scene safety if you must approach a patient on a working roadway. wear, at minimum a high-visibility Class 2 or 3 safety vest approved by the American National Standards Institute.
Other traffic-incident management techniques may be appropriate:
…
… (cones, flares, signs)
strategic … of emergency vehicles
A
traffic safety; personnel; traffic markers; positioning
10
Q
(scene size-up) consider … conditions at the scene:
your patient may be outdoors, indoors, or in a public place
be aware of the … and the …
A
environmental; weather; physical terrain
11
Q
(scene size-up) working in unfavorable conditions and on unstable surfaces is a large part of prehospital care. A good rule to use when faced with a wide variety of possibilities is that any actions you may take to protect yourself should also be …
A
considered for the patient
12
Q
(scene size-up) if appropriate, help protect … from becoming patients as well
A
bystanders
13
Q
(scene size-up) some forms of hazards: … … (sharp metal, broken glass, slip-and-fall hazards) … (hazardous materials) … … .. … …
A
environmental physical chemical electrical water fire explosions physical violence
14
Q
(scene size-up) be aware of scenes that have the potential for violence:
… patients
… family members
… bystanders
…
… crowds
an emergency scene is a dynamically changing environment –> it is up to you to either make the scene safe if you have the training and equipment to safely do so, or call for additional resources and move to a safe location
A
violent; distraught; angry; gangs; unruly
15
Q
(scene size-up) virtually all calls for assistance to which you may respond can be categorized as medical conditions, traumatic injuries, or ….
A medical problem can lead to a …
you will need to be able to identify the general classification and underlying issue(s) of the emergency to which you respond.
A
both; traumatic injury
16
Q
(scene size-up) traumatic injuries are the result of … applied to the outside of the body, usually from an object striking the body/ the body striking an object.
Classified according to the … or … of force, how … it was applied, and … it was applied to the body.
This is described as the …
A
physical forces; type; amount; long; where; mechanism of injury
17
Q
(scene size-up) certain parts of the body are more easily injured than others. Fragile and easily injured areas include the .., …, and …
An understanding of anatomy and physiology will help EMTs to identify times when a mechanism of injury may lead to injury to parts of the body not directly impacted.
A
brain; spinal cord; eyes
18
Q
(scene size-up) with blunt trauma, the force of the injury occurs over a …, and the skin is sometimes not …. However, the tissues and organs underneath the area of impact may be …
A
broad area; broken; damaged
19
Q
(scene size-up) with penetrating trauma, the force of the injury occurs at a … between the skin and the object. it is an … with high potential for …
A
specific point of contact; open wound; infection
20
Q
(scene size-up) for medical patients, determine the …
There are similarities between the MOI and the NOI –> Both require you to search for clues regarding … the incident occurred. To quickly determine the NOI, talk with the patient, family, or bystanders. Use your senses to check the scene for clues as to the possible problem.
A
nature of illness; how;
21
Q
(scene size-up) be aware of scenes with … who are exhibiting similar signs or symptoms. Could indicate an … for you and your partner
A
multiple patients; unsafe scene
22
Q
(scene size-up) considering the MOI or NOI early can be of value in preparing to …. During your prehospital assessment, you may be tempted to categorize your patient immediately as a trauma/medical patient. Remember, the fundamentals of a good patient assessment are the same despite the unique aspects of trauma and medical care.
A
care for your patient
23
Q
(scene size-up) standard precautions and PPE need to be considered and adapted to the prehospital task at hand. PPE includes … or specialized equipment that provides protection to the wearer. The type of PPE used will depend on the specific job duties required during a patient care interaction
A
clothing
24
Q
(scene size-up) ... are protective measures that have traditionally been recommended by the CDC for use in dealing with: ... .. ... other potential exposure risks of ...
A
standard precautions; objects; blood; body fluids; communicable disease
25
(scene size-up) the concept of standard precautions assumes that all blood, body fluids (except sweat), nonintact skin, and mucous membranes may pose a substantial risk of ...--> this includes blood and other potentially infectious materials that are ... because some diseases can live outside the body for days.
infection; dried
26
(scene size-up) when you step out of the EMS vehicle and before actual patient contact, standard precautions must have been taken or initiated. At a minimum, ... must be in place before any patient contact. Also consider ... and a ...--> if the patient's condition warrants a higher level of PPE, providers should regroup and upgrade the protection
gloves; glasses; mask
27
(scene size-up) during scene size-up it is important to accurately identify the ... of patients. --> critical in determining your need for additional resources
total number
28
(scene size-up) when there are multiple patients, you should use the ... system, identify the number of patients, and then begin ...
incident command; triage
29
(scene size-up) the incident command system is a flexible system implemented to manage a variety of ...
triage is the process of ... patients based on the ... of each patient's condition
emergency scenes; sorting; severity
30
(scene size-up) some situations may require: more ... and ... resources
ambulances; specialized
31
(scene size-up) specialized resources include:
... (ALS)
... support
.... may handle hazardous materials management, technical rescue services including complex extrication from motor vehicle crashes, wilderness search and rescue, high-angle rope rescue, or water rescue.
... personnel---> may be needed to assist with traffic/scene control, should be first to enter crime scenes and hostile environments
advanced life support; air medical; fire departments; law enforcement
32
(scene size-up) to determine if you require additional resources, ask yourself:
does the scene pose a ... to you, your patient, or others
how ... patients are there?
do we have the .. to respond to their conditions?
threat; many; resources
33
(primary assessment) patient assessment begins when you greet your patient. The single, all-important goal of the primary assessment is to ... and begin ... of immediate or imminent ...
identify; treatment; life threats
34
(primary assessment) you must physically examine the patient and assess ... (LOC) and ..., ..., and ... (...s)
level of consciousness; airway; breathing; circulation; ABCs
35
(primary assessment) the initial ... is formed to determine the priority of care and is the first part of your primary assessment
general impression
36
```
(primary assessment) general impression includes making a note of the person's:
...
...
...
level of ...
overall ...
```
age; sex; race; distress; appearance
37
(primary assessment) as you approach, make sure the patient sees you coming. note the patient's ... and whether the patient is moving/still.
avoid .. over the patient, if possible
address the patient by ...
introduce yourself to the patient
ask about the ...
the patient's response can give insight into the ..., .., ... status, and overall ... status
life-threatening problems should be treated immediately
position; standing; name; chief complaint; LOC; air patency; respiratory; circulatory
38
(primary assessment) define whether your patient's condition is ..., stable but potentially ..., or ... to direct further assessment and treatment
stable; unstable; unstable
39
(primary assessment) The LCO can tell you a great deal about the patient's nuerologic and physiologic status.
determine which of the following categories best fits your patient:
...
conscious with an ...
conscious with an ...
unconscious; altered LOC; unaltered LOC
40
(primary assessment) assessment of an unconscious patient focuses first on .., ..., and ...
sustained unconsciousness should warn you that a critical .., ..., or ... problem/deficit might exit
airway; breathing; circulation; respiratory; circulatory; central nervous system
41
(primary assessment) conscious with an altered LOC may be due to ..., but can also be caused by medications, drugs, alcohol, or poisoning
inadequate perfusion
42
(primary assessment) to assess for responsiveness, use the mnemonic ..., and choose on description:
AVPU
43
(primary assessment) AVPU:
A: ... and ..--> the patient is aware of you and is responsive to the environment
V: responsive to .. stimuli --> the patient is not A, but the patient's eyes open to loud .. stimuli, and he or she is able to respond in some meaningful way when spoken to
P: responsive to ..--> the patient doesn't respond to your questions but moves/cries out in response to ... stimulus
U: ...--> the patient doesn't respond spontaneously or to a verbal/painful stimulus; no cough/gag reflex
awake and alert; verbal; verbal; pain; painful; unresponsive
44
(primary assessment) stimulus tests determine whether a patient who does not respond to verbal stimuli will respond to a .. stimulus: these tests include:'
... the patient's skin --> back of the upper arm, ... area
Applying upward pressure along the ridge of the ... along the underside of the eyebrow--> a patient who moans/withdraws is responding to the stimulus
painful; pinching; trapezius; orbital rim
45
(primary assessment) ... tests mental status by checking a patient's memory and thinking ability:
evaluates a patient's ability to remember:'
...--Remembers his or her name
...- identifies the current location
...-the current year, month, and approximate date
...-describes what happened
orientation; person; place; time; event
46
(primary assessment) orientation evaluates ... memory, ... memory, and ... memory
if the patient knows the four facts, the patient is said to be "alert and fully oriented," "alert and oriented to person, place, time and event," or "alert and oriented x 4"
long-term; intermediate-term; short-term
47
(primary assessment) any deviation from alert and oriented to person, place, time, and event, or from a patient's normal baseline, is considered an ...
altered mental status
48
```
(primary assessment) conditions that cause sudden death:
...
... failure
... arrest
...
...
...
```
airway obstruction; respiratory; respiratory; shock; severe bleeding; primary cardiac arrest
49
(primary assessment) in most cases, identifying and correcting life-threatening issues begins with the ..., followed by ... and ... (ABC)
when a patient is in cardiac arrest, the ABCs should be assessed ... to minimize the time to first compression.
when a patient has life-threatening bleeding, its more appropriate to address life threats to ... first, following a sequence of ..., ..., and .. (CAB)
airway; breathing; circulation; simultaneously; circulation; circulation; airway; breathing
50
(primary assessment) as you move through the primary assessment, stay alert for signs of ... to prevent death/permanent disability to your patient, you must ensure that the airway remains ... (...) and ...
airway obstruction; open; patent; adequate
51
(primary assessment) patients of any age who are talking/crying have an ...
watching and listening to how patients speak may provide important clues about the ... of their airway and the status of their ...
if you identify an airway problem, stop the assessment process and work to clear the patient's airway
open airway; adequacy; breathing;
52
(primary assessment) with a patient who is unresponsive or has a decreased LOC, immediately assess the ...
patency of the airway
53
(primary assessment) if there is a potential for trauma, use the jaw-thrust maneuver to open the airway. if you cannot obtain a patent airway using the jaw-thrust maneuver or if it can be confirmed that the patient did not experience a traumatic event, use the ... to open and maintain a patent airway
head tilt chin lift maneuver
54
(primary assessment) signs of obstruction in an unconscious patient:
obvious .., ... or other obstruction
... breathing, such as snoring, bubbling, gurgling, crowing, stridor, or other abnormal sounds
extremely ... or ... breathing
trauma; blood; noisy; shallow; absent
55
(primary assessment) once you have made sure the patient's airway is open, make sure the patient's breathing is present and adequate. A patient who is breathing without assistance is said to have .. respirations or .. breathing
spontaneous; spontaneous
56
(primary assessment) as you assess the patient's breathing, ask the following questions:
is the patient breathing? is it adequate? is the patient hypoxic?
... should be performed for patients who are not breathing or whose breathing is too slow/too shallow p
positive-pressure ventilations
57
(primary assessment) if the patient is breathing adequately but remains hypoxic, administer ...--> the goal for oxygenation for most patients is an SpO2 of about 94 to 99%
oxygen
58
(primary assessment) if a patient seems to develop difficulty breathing after your primary assessment, you should immediatley ... the airway.
reevaluate
59
```
(primary assessment) observe how much effort is required for the patient to breathe:
presence of ...
use of ...
...
....
... position
... position
... breathing
```
```
retractions;
accessory
nasal flaring
2-3 word dyspnea
tripod
sniffing
labored
```
60
(primary assessment) ...: occurs when a person, particularly a child, has difficulty breathing--> increased effort and rate
...: occurs when the blood is inadequately oxygenated or ventilation is inadequate to meet the oxygen demands of the body. The ultimate result of respiratory failure if it is not corrected.
respiratory distress; respiratory failure
61
(primary assessment) circulation is evaluated by assessing the patient's ..., ..., and ... condition
mental status; pulse; skin
62
(primary assessment) assess pulse--> often referred to as a heartbeat, the pulse is the ... wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries
pressure
63
(primary assessment) to determine if a pulse is present, you will need to palpate (feel) the pulse:
in responsive patients who are older than 1 year, you should palpate the ... pulse at the ....
In unresponsive patients older than 1 year, you should palpate the ... pulse in the ...
palpate the ... pule, located at the ... area (inside) of the ..., in children younger than 1 year
radial; wrist; carotid pulse; neck; brachial; medial; upper arm
64
(primary assessment) if you cannot palpate a pulse in an unresponsive patient, begin ...
If an AED is available, turn it on and follow the voice prompts, following your local protocol.
CPR
65
(primary assessment) If the patient has a pulse but is not breathing, provide ... at a rate of 10-12 breaths/min for adults and 12-20 breaths/min for an infant/child.
Monitor the patient's ... If the patient becomes pulseless, start CPR and apply the AED
ventilations; pulse
66
(primary assessment) perfusion is assessed by evaluation a patient's ..., ..., ..., and ... --> a normally functioning circulatory system perfuses the skin with oxygenated blood.
skin color, temperature, moisture, and capillary refill
67
(primary assessment) the skin's color is determined by the .. circulating through vessels and the ... and type of ... that is present in the skin
blood; amount; pigment
68
(primary assessment) poor peripheral circulation will cause the skin to appear ..., ..., ..., or ... When the blood is not properly saturated with oxygen, it appears ...
High blood pressure may cause the skin to be abnormally ... and ...
changes in skin color may also result from chronic illness
pale; white; ashen; gray; blue; flushed; red
69
(primary assessment) normal skin temp will be ... to the touch (normal body temp is 98.6 F (37 C))
abnormal skin temps are .., ..., ..., and ...
warm; hot; cool; cold; clammy
70
(primary assessment) .. skin is normal.
| Skin that is .., ... (often called diaphoretic), or excessively ... and ... suggests a problem
dry; wet; moist; dry; hot
71
(primary assessment) capillary refill is often evaluated in ... patients to assess the ability of the circulatory system to ... the capillary system in the fingers and toes
pediatric; perfuse
72
(primary assessment) capillary refill time can be affected by the patient's ..., ..., ..., and the ...
age; history; medications; environment
73
(primary assessment) to test capillary refill:
place your thumb on the patient's ... and gently compress
remove the pressure
as the underlying capillaries refill with blood, the nail bed returns to its normal ... color
with adequate perfusion, the color in the infant/child's nail bed should be restored to its normal color within ... seconds
fingernail; pink; 2 seconds
74
(primary assessment) in trauma patients, identify and control major external bleeding. this step should occur before addressing airway or breathing concerns.
bleeding from a large vein is characterized by a ... flow of blood
bleeding from an artery is characterized by a ... flow of blood.
steady; spurting
75
(primary assessment) run gloved hands from the patient's head to toe, pausing periodically to see if your gloves are ...
controlling external bleeding is often very simple--> apply ...; if direct pressure is not quickly successful/if there is an obvious arterial hemorrhage of an extremity, apply a ...
bloody; direct pressure; tourniquet
76
(primary assessment) scan the patient's body to identify injuries that must be managed/protected before the patient is transported.
Take ... to ... seconds to perform the rapid scane.
This is not a systematic/focused physical exam--> that will be performed during the ...
60; 90; secondary assessment
77
(primary assessment) the primary assessment assists in determining ...
transport priority
78
```
(primary assessment) high-priority patients include those with any of the following conditions:
...
poor ...
difficulty ...
uncontrolled ...
responsive but unable to ...
severe ... pain
... skin or other signs of ...
complicated ...
severe ... in any area of the body
```
```
unresponsive
general impression
breathing
bleeding
follow commands
chest
pale; poor perfusion
childbirth
pain
```
79
(primary assessment) if a spinal injury is suspected/found on assessment, consider ...
spinal immobilization
80
(primary assessment) the golden hour (the golden period) is the time from ... to ... care, during which treatment of shock and traumatic injuries should occur bc survival potential is best--> aim to ..., ..., ..., and begin transport to the appropriate facility within .. minutes (often referred to as the "...") after arrival on scene
injury; definitive care; assess; stabilize; package; 10; platinum 10
81
```
(primary assessment) some patients will benefit from immediate transport, while others are better served on scne. transport decisions are based on:
patient's ...
availability of ...
... of transport
..
```
condition; advanced care; distance; local protocols
82
(history taking) history taking provides detail about the patient's ... and an account of the patient's signs and symptoms
chief complaint
83
```
(history taking) be sure to document the following info:
... of the incident
patient's ...
patient's ...
patient's ...
past ...
patient's current ...
```
date; age; gender; race; medical history; health status
84
(history taking) to investigate the chief complaint, begin by making intros, make the patient feel comfortable, and obtain permission to treat.
ask a few simple and direct Qs
refer to the patient as Mr., Ms., or MRs., using the patient's ... name
.. questions will help determine the chief complaint
use eye contact to encourage the patient to continue speaking and repeat statements back to show understanding
last; open-ended;
85
```
(history taking) if the patient is unresponsive, info about the patient, pertinent past medical history, and clues about the immediate incident may be obtained from:
... present
a person who may have ... the situation
...
...
other patient medical history ...
```
family members; witnessed; bystanders; medical alert jewelry; documentation
86
(history taking) Use the OPQRST mnemonic for gathering additional info about the patients present illness and current symptoms:
O: ...--what were you doing when the symptoms began?
P: ... or ..--does anything make the symptoms better or worse?
Q: ...--what does the symptom feel like?
R: .../...--where do you feel the symptom? does it move anywhere?
S: ...--on a scale of 0 to 10, how would you rate your symptom?
T: ...--has the symptom been constant or does it come and go?
```
onset;
provocation; palliation
quality;
region; radiation
severity
timing
```
87
(history taking) identify pertinent negatives: negative findings that warrant ... or ...
pertinent negatives are often helpful in identifying a patient's problem and choosing an appropriate treatment
no care; intervention
88
(history taking) ... are complaints that cannot be felt/observed by others
... are objective conditions that can be seen, heard, felt, smelled or measured by you or others
symptoms; signs
89
(history taking) ue the mnemonic SAMPLE to obtain the following info:
S: ... and ...
A: ..
M: ...
P: ... --Does the patient have any history of medical, surgical,, or trauma occurrences?
L: ...--when did the patient last eat/drink?
E: ...
```
signs and symptoms
allergies
medications
pertinent past medical history
last oral intake
events leading up to the injury/ilness
```
90
(history taking) critical thinking is an essential component in assessing a patient. It involves:
...--seeking facts to help your clinical decision making and scene management.
...--considering what the info gathered means
...-putting together the info that you have gathered and validated and synthesizing it into a plan to manage the scene and/or care for the patient
gathering; evaluating; synthesizing
91
(history taking) taking history on sensitive topics:
alcohol and drugs:
signs may be confusing, hidden, or disguised
many patients may deny having any problems
the history gathered from a chemically dependent patient may be unreliable
do not judge the patient, and be professional in your approach
physical abuse or violence:
... all physical abuse or domestic violence to the appropriate authorities
follow state laws and local protocols
do not accuse; instead, immediately involve law enforcement
report
92
(history taking) taking history on sensitive topics cont:
sexual history:
consider all female patients of childbearing age who report lower abdominal pain to be ... unless ruled out by history or other info.
Questions to ask when faced with this prehospital scenario:
- when was your last ..?
- are your periods ..?
- if the patient is bleeding: how many .../... have you used?
- do you have urinary ... or ...?
- what is the severity of ..., and are there any ...?
- are you ...?
- is there a possibility you may be ..?
- are you taking ...?
```
pregnant;
menstrual period
normal
sanitary pads; tamponds
frequency; burning
cramping; foul orders
sexually active
pregnant
birth control pills
```
93
(history taking) (history taking) taking history on sensitive topics cont:
sexual history:
inquire about urinary symptoms with male patients:
- is there ... associated with urination?
- do you have any ..., .., or an .. in urination?
- do you have ... or difficulty ..?
- has there been any ...?
- have you had recent ... encounters?
when appropriate, ask about the potential for ... diseases in all patients
```
pain;
discharge, sores, increase; burning; voiding
trauma
sexual
sexually transmitted diseases
```
94
(history taking) special challenges in obtaining patient history include:
...--> patience is extremely important when dealing with patients and their emergency crises
using a ... question that requires a simple yes/no answer may work best
consider whether the silence is a clue to the patient's chief complaint
silence; close-ended
95
(history taking) special challenges in obtaining patient history include:
...: gathering details about a patient's medical condition may be difficult if he/she talks around your Q or you have a difficult time refocusing the patient's convo
reasons why a patient may be overly talkative:
excessive ... consumption
...
ingestion of ..., ..., or ...
underlying ... issue
overly talkative; caffeine; nervousness; cocaine; crack; methamphetamines; psychologic
96
(history taking) special challenges in obtaining patient history include:
multiple symptoms:
often true of ... patients
... the patient's complaints as you would in triage; start with the most serious and end with the least serious
older; prioritize
97
(history taking) special challenges in obtaining patient history include:
...:
consider the context of the situation and recognize that the observed anxiety may be a sign of a serious underlying medical condition
frequently, anxious patients can be observed in emergency scenes that involve a large number of patients, such as during a disaster
anxiety
98
```
(history taking) special challenges in obtaining patient history include:
anxiety:
some anxious patients show signs of psychological shock, such as:
...
...
... of breath
... in the hands and feet
.. or ...
loss of ...
```
```
pallor
diaphoresis
shortness
numbness
dizziness; light-headedness
consciousness
```
99
```
(history taking) special challenges in obtaining patient history include:
anxiety can be an early indicator of:
... level
...
...
```
low blood glucose
shock
hypoxia
100
(history taking) special challenges in obtaining patient history include:
anger and hostility:
every patient encounter has a high potential for ... and ...--> friends, family, or bystanders may direct their anger and rage toward you
remain calm, reassuring and gentle
if the scene is not safe/secured, retreat until it is secured
verbal hostility; physical violence
101
(history taking) special challenges in obtaining patient history include:
intoxication
do not put an intoxicated patient in a position where he/she feels ... and has no way out--> the potential for violence and a physical confrontation is high when a patient is intoxicated
alcohol dulls a patient's senses, which will make it difficult for an intoxicated patient to inform you that something feels ...
threatened; painful
102
(history taking) special challenges in obtaining patient history include:
crying:
a patient who cries may be sad, in pain, or emotionally overwhelmed
remain calm and patient, reassuring, and confident, and maintain a ..
soft voice
103
(history taking) special challenges in obtaining patient history include:
depression:
depression is among the leading causes of disability worldwide
symptoms include:
...
a feeling of ...
..
...
... and ... disorders
a decreased ...
the most effective treatment in handling a patient's depression is being a ...
```
sadness
hopelessness
restlessness
irritability
sleeping; eating; energy level;
good listener
```
104
(history taking) special challenges in obtaining patient history include:
confusing behavior/history:
conditions such as hypoxia, stroke, diabetes, trauma, medication use, and other drug use could alter a patient's ... of events--> ... is the most common cause of confusion
in older patients, it is not uncommon to encounter a patient who has dementia, delirium, or Alzheimer's disease
explanation; hypoxia
105
(history taking) special challenges in obtaining patient history include:
limited cognitive abilities:'
keep your questions ..., and limit the use of medical terms
be alert for ... answers, and keep asking questions
in cases of patients with severely limited cognitive function, rely on the presence of family, caregivers, and friends to supply answers to your questions
simple; partial;
106
(history taking) special challenges in obtaining patient history include:
cultural challenges:
do not use ... language
patients from some cultures may prefer to speak only with health care providers of the same ...
gain the assistance of the patient's friends/family members and enlist the help of health care providers of the same culture/background, if possible
medical; gender
107
(history taking) special challenges in obtaining patient history include:
language barriers:
find an ..., if possible
if not, determine whether the patient understands who you are
keep questions straightforward and brief, and use hand gestures
be aware of the language diversity in you community
interpreter
108
(history taking) special challenges in obtaining patient history include:
hearing problems:
ask questions ... and ...
use a ... to function as a hearing aid for the patient
learning simple ... during your career will help in the communication process
use a pencil and paper
slowly; clearly
stethoscope
sign language
109
(history taking) special challenges in obtaining patient history include:
visual impairments:
identify yourself ... when entering the scene
it is important that you put any items that have been moved back into their previous position
during the assessment and history taking process, explain each step in the vital signs assessment. notify the patient before preparing to ... the patient and move him/her on the stretcher
verbally; lift
110
(secondary assessment) if the patient is in stable condition and has an isolated complaint, you may choose to perform the secondary assessment ...
If the secondary assessment is not performed at the scene, it is performed in the ... en route to the hospital
at the scene; back of the ambulance
111
(secondary assessment) there will be situations where you may not have time to perform the secondary assessment--> you may have to continue to manage life threats identified during the ... en route to the hospital
primary assessment
112
(secondary assessment) the purpose is to perform a systematic physical examination of the patient--> the physical exam may be a systematic head-to-toe, secondary assessment or an assessment that focuses on a certain area/system of the body, often determined through the chief complaint (a focused assessment)
guidelines on how and what to assess during a physical examination:
... -- look at the patient for abnormalities
... -- touch or feel the patient for abnormalities
... -- listen to the sounds a body makes by using a stethoscope
inspection; palpation; auscultation
113
(secondary assessment) the mnemonic ... reminds you what to look for when inspecting and palpating various body regions
compare findings on one side of the body with the ... when possible
DCAP-BTLS; other side
114
(secondary assessment) systematically assess the patient--secondary assessment: the goal is to identify ... or identify ... that may not have been identified the 60-to-90-second exam during the primary assessment
hidden injuries; causes
115
(secondary assessment) focused assessment: performed on patients who have sustained ... MOIs or on .. .medical patients. This type of exam is typically based on the chief complaint. the goal of a focused assessment is to focus your attention on the body part/systems affected by the ... problems
nonsignificant; responsive; priority
116
(secondary assessment) Respiratory system:
expose the patient's chest
look again for signs of ..., as well as trauma to the ... and/or ..
inspect the chest for overall ...
listen carefully to .., noting abnormalities
measure the ..., chest ... and ... (tidal volume), and ...
look for ...
look for increased work of ...
airway obstruction; neck; chest; symmetry; breath sounds; respiratory rate; rise; fall; effort; retractions; breathing
117
(secondary assessment) respiratory system cont.:
assess the patient's breathing by watching the patient's chest .. and ...; listening to breath sounds with a ... over each lung; and, if the patient is unconscious, feeling for air through the ... and .. during exhalation
rise; fall; stethoscope; mouth; nose;
118
(secondary assessment) respiratory system cont.:
when assessing breathing, obtain the following info:
respiratory rate: a normal respiratory rate varies widely in adults, ranging from ... to .. breaths/min; children breathe at even ... rates; respirations are determined by counting the number of breaths in a .. second period and multiplying by ...--> the result equals the number of ... per minute
12; 20; faster; 30; 2; breaths
119
(secondary assessment) respiratory system:
respiratory rhythm:
if the time from one peak chest rise to the next is fairly consistent, respirations are considered ...
if the respirations vary or the rate changes ..., the respirations are considered ...
regular; frequently; irregular
120
(secondary assessment) respiratory system:
quality of breathing:
normal breathing is almost ...
breathing accompanied by other sounds may indicate a significant respiratory problem
depth of breathing: '
the amount of air that the patient is exchanging depends on the .. and the ...
tidal volume is a measure of the depth of breathing and is the amount of air that is moved into/out of the lungs during one breath
silent; rate; tidal volume
121
(secondary assessment) respiratory system:
breath sounds:
how and where to listen to assess breath sounds:
you can almost always hear a patient's breath sounds better from the patient's ...
auscultate over the ... (apices), the ... fields, and the ... lungs
lift the clothing/slide the stethoscope under the clothing
place the diaphragm of the stethoscope firmly against the skin to hear the breath sounds
back; upper lungs; midlung; lower;
122
(secondary assessment) respiratory system:
breath sounds-what are you listening for?
... breath sounds--these are clear and relatively quiet during inspiration and expiration
... breath sounds--these suggest an obstruction or narrowing of the lower airways
... breath sounds--these suggest an obstruction of the lower airways
...-wet sounds that may indicate fluid in the lungs
...--congested breath sounds may suggest the presence of mucus in the lungs
...--often heard before listening with a stethoscope and may indicate that the patient has an airway obstruction in the neck or upper part of the chest
determine the quality/character of respirations while counting the number of respirations
```
normal
snoring
wheezing
crackles
rhonci
stridor
```
123
(secondary assessment) cardiovascular system:
look for trauma to the chest, and listen for breath sounds
consider the pulse and respiratory rate and the ...
pay particular attention to rate, quality, and rhythm
consider your findings when assessing the ...
check and compare ... to determine any right and left side differences
consider ... for abnormal heart sounds
blood pressure; skin; distal pulses; auscultation
124
(secondary assessment) cardiovascular system:
pulse rate:'
for an adult, the normal resting pulse rate should be between ... and ... beats/min and could be as much as ... beats/min in older patients
in pediatric patients, generally the younger the patient, the ... the pulse rate
to obtain the pulse rate in most patients, you should count the number of pulses felt in a ... second period and then multiply by two
a rate that is greater than 100 is described as ...
a rate of less than 60 is described as ...
60; 100; 100; faster; 30; tachycardia; bradycardia
125
(secondary assessment) cardiovascular system:
pulse quality:
if the pulse feels of normal strength, you should describe it as being ...
you should describe a stronger than normal pulse as ".."
a pulse that is weak and difficult to feel is described as ".." or "..."
strong; bounding; weak; thready
126
(secondary assessment) cardiovascular system:
pulse rhythm:
determine whether the thythm is regular/irregular
the interval between each contraction should be ..., and the pulse should occur at a constant, regular rhythm
the rhythm is considered irregular if the heart periodically has an ... or ... beat or if a pulse beat is ...
the same; early; late; missed
127
(secondary assessment) cardiovascular system:
blood pressure:
the pressure of circulating blood against the walls of the ...
a decrease in blood pressure may indicate a loss of ... or fluid components, a loss of ... and sufficient ..., or a cardiac ...
arteries; blood; vascular tone; arterial constriction; pumping problem
128
(secondary assessment) cardiovascular system:
blood pressure cont:
decreased blood pressure is a late sign of ... and indicates that the critical stage of decompensated shock has begun
abnormally high blood pressure may result in a ... or other critical damage in the arterial system
... pressure is the increased pressure that is caused along the artery with each contraction (...) of the ventricles and the pulse wave that it produces
... pressure is the residual pressure that remains in the arteries during the relaxing phase of the heart's cycle (...), when the left ventricle is at rest
shock; rupture; systolic; systole; diastolic; diastole
129
(secondary assessment) cardiovascular system:
blood pressure cont.
a blood pressure cuff with gauge (...) contains the following components:
a wide outer cuff
an inflatable wide bladder sewn into a portion of the cuff
a ball-pump with a one-way valve
a pressure gauge calibrated in mm Hg
... is the most common means of measuring a patient's blood pressure
sphygmomanometer; auscultation
130
(secondary assessment) cardiovascular system:
blood pressure cont;
the ... (feeling) method does not depend on your ability to hear sounds and should be used in certain cases to obtain a patient's blood pressure
normal blood pressure: a patient has ... when the blood pressure is lower than the normal range and ... when the blood pressure is higher than the normal range
palpation; hypotension; hypertension
131
```
(secondary assessment) neurologic system:
a neurologic assessment should be performed any time you are confronted with a patient who has:
changes in ...
a possible ... injury
...
...
...
...
```
```
mental status
head
stupor
dizziness
drowsiness
syncope
```
132
(secondary assessment) neurologic system:
evaluate the ... and ... to determine the patient's ability to think--> use the ... scale if appropriate to determine the patient's mental status
LOC; oritenation; AVPU
133
(secondary assessment) neurologic system:
the ... (GCS) score can be helpful in providing additional info on patients with mental status changes--> uses parameters that test a patient's ..., best ... and best .. response
provides a numeric score that defines the severity of a patient's ...
glasgow coma scale; eye opening; verbal response; motor; brain dysfunction
134
(secondary assessment) neurologic system:
pupils: the pupil is the black center portion of the eye
the pupils are normally round and of approximately equal size and adjust their size depending on the available ...
the diameter and reactivity to light of the patient's pupils can reflect the status of the brain's ..., ..., and ...
light; perfusion; oxygenation; condition
135
(secondary assessment) neurologic system:
in the absence of light, the pupils will become fully ... and ...
a small number of the population exhibit ... pupils (...)
relaxed; dilated; unequal; anisocoria
136
(secondary assessment) neurologic system:
you should assume the patient has altered brain function as a result of central nervous system depression or injury if the pupils react in any of the following ways:
- become fixed with no reaction to ..
- ... with intro of a bright light and ... when the light is removed
- react ... instead of briskly
- become ... in size
- become ... in size when a bright light is introduced into or removed from one eye
changes in light; dilate; constrict; sluggishly; unequal; unequal;
137
(secondary assessment) neurologic system:
pupils:
depressed brain function can be caused by the following:
injury of the ... or ...
... or ...
brain ...
inadequate .. or ...
... or .. (central nervous system depressants)
```
brain; brain stem
trauma; stroke
tumor;
oxygenation; perfusion;
drugs; toxins
```
138
```
(secondary assessment) neurologic system:
Pupils--> the mnemonic PEARRL is a useful assessment guide: '
P: ...
E: ...
A: ...
R: ...
R: ... in size
L: ...
```
```
pupils
equal
and
round
regular
react to light
```
139
(secondary assessment) neurologic system:
assessing neurovascular status:
perform a hands-on assessment to determine ... and ... response
check for bilateral muscle ... and ...
complete a thorough ... assessment
test for ..., ..., and .., and compare distal and proximal sensory and motor responses and one side with the other
sensory; motor; strength; weaknesses; sensory; pain; sensations; position
140
(secondary assessment)
Anatomic regions:
head, neck and cervical spine:
gently palpate the scalp and skull for any ..., ..., .., ..., and ...
pain; deformity; tenderness; crepitus; bleeding
141
(secondary assessment)
Anatomic regions:
head, neck, and cervical spine:
check the patient's eyes and assess pupillary .., .., and ...
check the color of the ...
assess the patient's ... (zygomas) for possible injury
check the patient's ears and nose for ...
function; shape; response
sclera
cheekbones
fluid
142
(secondary assessment)
Anatomic regions:
head, neck, and cervical spine:
check the ... and .. (maxillae and mandible)
open the patient's mouth, looking for any broken/missing ...
note any unusual ... that may be present in the mouth
palpate the neck for signs of trauma, such as deformities, bumps, swelling, bruising, and bleeding, as well as a crackling sound produced by ... under the skin, also known as ..
upper and lower jaw;
teeth
odors
air bubbles; subcutaneous emphysema
143
(secondary assessment)
Anatomic regions:
chest:
when assessing the chest, inspect, visualize, and palpate over the chest area for injury and signs of trauma, including ..., ..., and ...
when assessing breathing, watch for both sides of the chest to rise and fall together with normal breathing
observe for abnormal breathing signs, including retractions or paradoxical motion
bruising; tenderness; swelling
144
(secondary assessment)
Anatomic regions:
abdomen:
look for trauma to the abdomen and for ...
palpate the abdomen for ..., ..., and patient ...
the abdomen is broken into four quadrants: left upper quadrant (LUQ), left lower quadrant (LLQ), right upper quadrant (RUQ), and right lower quadrant (RLQ)
assess for the presence of ... tenderness
distension; tenderness; rigidity; guarding; rebound
145
(secondary assessment)
Anatomic regions:
pelvis: "
inspect the pelvis for ... and any obvious signs of injury, bleeding, and deformity
if you feel any movement or ... or if the patient reports pain or tenderness, ... may be present
symmetry; crepitus; severe injury
146
(secondary assessment)
Anatomic regions:
extremities:'
inspect each extremity for .., ..., .., ..., obvious .., and ...
palpate along each extremity for ...
check for pulses, motor function, and sensory function
symmetry; cuts; bruises; swelling; obvious injuries; bleeding; deformities;
147
```
(secondary assessment)
Anatomic regions:
posterior body:
inspect the back for ..., ..., and ...
carefully palpate the spine from the neck to the pelvis for tenderness and deformity
```
DCAP-BTLS; symmetry; open wounds
148
(secondary assessment) assess vital signs using the appropriate monitoring device--> these devices should never be used to replace your comprehensive assessment of your patient: think of these devices as ... to the assessment and treatment of your patient
adjuncts
149
(secondary assessment) pulse oximetry:
an assessment tool used to evaluate the effectiveness of oxygenation
it measures the oxygen saturation of hemoglobin in the..
a sensing probe is placed on the finger or the ...
in most patients, the values will fall between 95 and 99%
patients with difficulty breathing should receive O2 regardless of their pulse ox value
capillary beds; ear lobe
150
```
(secondary assessment) pulse ox:
several conditions can give false values: "
...
...
...
...
... exposure
```
```
shock
hypothermia
bleeding
anemia
CO
```
151
(secondary assessment) capnograpy: a noninvasive method that can quickly and efficiently provide info on a patient's ..., ..., and ...
ventilation; circulation; metabolism
152
(secondary assessment) blood glucometry: measures the level of ... in the patient's bloodstream
glucose
153
(secondary assessment) noninvasive blood pressure measurement: the sphygmomanometer (blood pressure cuff) is used to measure blood pressure
... measurement is another method of obtaining blood pressure readings
electronic
154
(reassessment) perform a reassessment at regular intervals during the assessment process--> purpose is to identify and treat ... in a patient's condition
changes
155
(reassessment) repeat the primary assessment
reassess vital signs: compare the baseline vitals obtained during the .. with an and all subsequent vital signs
look for ...
reassess the ... and the ..
monitor ... and ..
primary assessment; trends; mental status; ABCs; skin color and temperature
156
(reassessment) reassess the chief complaint: the purpose is to ask and answer the following questions about the patient's chief complain:
is the current treatment ... the patient's condition
has an already identified problem gotten ..., has it gotten ..
what is the ... of any newly identified problems?
improving; better; worse; nature
157
(reassessment) recheck interventions:
check all interventions--> most important are the patient's ...
ensure management of ..
ensure adequacy of other interventions, and consider the need for new interventions
ABCs; bleeding
158
(reassessment) identify and treat changes in the patient's condition:
if the changes in the patient's condition are improved, simply ... whatever treatments you are providing
if the patient's condition deteriorates, prepare to ... treatments as appropriate
... any changes, whether negative/positive
continue; modify; document
159
(reassessment) reassess patient:
a patient in unstable condition should be reassessed approximately every ... minutes
a patient in stable condition should be reassessed approximately every ... minutes
5; 15
