Chapter 9 Flashcards
Patient assessment divided into 5 main parts::
- …
- … assessment
- … taking
- … assessment
- …
scene size-up primary history secondary reassessment
a … is a subjective condition the patient feels and tells you about
a … is an objective condition you can observe/measure about the patient
symptom; sign
the treatment EMTs provide patients is based on …, not an …
symptoms; exact diagnosis
(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.
conditions; situational awareness
(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.
situational awareness
(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
safe; effective operations
(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
firefighters
utility
hazardous materials
law enforcement
(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 …
difficult terrain
(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
traffic safety; personnel; traffic markers; positioning
(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 …
environmental; weather; physical terrain
(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 …
considered for the patient
(scene size-up) if appropriate, help protect … from becoming patients as well
bystanders
(scene size-up) some forms of hazards: … … (sharp metal, broken glass, slip-and-fall hazards) … (hazardous materials) … … .. … …
environmental physical chemical electrical water fire explosions physical violence
(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
violent; distraught; angry; gangs; unruly
(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.
both; traumatic injury
(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 …
physical forces; type; amount; long; where; mechanism of injury
(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.
brain; spinal cord; eyes
(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 …
broad area; broken; damaged
(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 …
specific point of contact; open wound; infection
(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.
nature of illness; how;
(scene size-up) be aware of scenes with … who are exhibiting similar signs or symptoms. Could indicate an … for you and your partner
multiple patients; unsafe scene
(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.
care for your patient
(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
clothing
(scene size-up) ... are protective measures that have traditionally been recommended by the CDC for use in dealing with: ... .. ... other potential exposure risks of ...
standard precautions; objects; blood; body fluids; communicable disease
(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
(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
(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
(scene size-up) when there are multiple patients, you should use the … system, identify the number of patients, and then begin …
incident command; triage
(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
(scene size-up) some situations may require: more … and … resources
ambulances; specialized
(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
(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
(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
(primary assessment) you must physically examine the patient and assess … (LOC) and …, …, and … (…s)
level of consciousness; airway; breathing; circulation; ABCs
(primary assessment) the initial … is formed to determine the priority of care and is the first part of your primary assessment
general impression
(primary assessment) general impression includes making a note of the person's: ... ... ... level of ... overall ...
age; sex; race; distress; appearance
(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
(primary assessment) define whether your patient’s condition is …, stable but potentially …, or … to direct further assessment and treatment
stable; unstable; unstable
(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
(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
(primary assessment) conscious with an altered LOC may be due to …, but can also be caused by medications, drugs, alcohol, or poisoning
inadequate perfusion
(primary assessment) to assess for responsiveness, use the mnemonic …, and choose on description:
AVPU
(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
(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
(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
(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
(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
(primary assessment) conditions that cause sudden death: ... ... failure ... arrest ... ... ...
airway obstruction; respiratory; respiratory; shock; severe bleeding; primary cardiac arrest
(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
(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
(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;
(primary assessment) with a patient who is unresponsive or has a decreased LOC, immediately assess the …
patency of the airway
(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
(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
(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
(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
(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
(primary assessment) if a patient seems to develop difficulty breathing after your primary assessment, you should immediatley … the airway.
reevaluate
(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
(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
(primary assessment) circulation is evaluated by assessing the patient’s …, …, and … condition
mental status; pulse; skin
(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
(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