CHAPTER 9 Flashcards
The secondary muscles of respiration. They include the neck muscles (sternocleidomastoids), the chest pectoralis major muscles, and the abdominal muscles
Accessory muscles
Any deviation from alert and oriented to person, place, time and eventm or any deviation from a patient’s normal baseline mental status; may signal disease in the central nervous system or elsewhere in the body
altered mental state
To listen to sounds within an organ with a stethoscope
auscultate
A method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally early in the assessment process
AVPU scale
A slow heart rate, less than 60 beats/min
bradycardia
An indication of air movement in the lungs, usually assessed with a stethoscope
breath sounds
A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure
Capillary refill
A noninvasive method to quickly and efficiently provide information on a patients ventilatory status, circulation, and metabolism; effectively measures the concentration of carbon dioxide in expired air over time
capnography
A component of air that typically makes up 0.3% of air at sea level; also a waste product exhaled during expiration by the respiratory system
carbon dioxide
The reason a patient called for help; also, the patient’s response to questions such as “What’s wrong?” or “What happened?”
Chief complaint
In incident management, the position that oversees the incident, established objectives and priorities, and develops a response plan
Command
The delicate membrane that lines the eyelids and covers the exposed surface of the eye
conjunctiva
Crackling, rattling breath sounds signaling fluid in the air spaces of the lungs; formerly called rales
crackles
A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sounds or crinkly feeling
crepitus
A blue-gray skin color that is caused by a reduced level of oxygen in the blood
cyanosis
A mnemonic for assessment in which each area of the body is evaluated for deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations and swelling
DCAP-BTLS
Characterized by light or profuse sweating
diaphoretic
The pressura that remains in the arteries during the relaxation phase of the heart’s cycle (diastole) when the left ventricle is at rest
diastolic pressure
Any injury that prevents the patient from noticing other injuries he or she may have, even severe injuries; for example, a painful femur or tibia gracture that prevents the patient from noticing back pain associated with a spinal fracture
distracting injury
Shortness of breath or difficulty breathing
dyspnea
A disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange and carbon dioxide; it is one form of chronic obstructive pulmonary disease
emphysema
A type of physical assessment typically performed on patients who have sustained nonsignificant mechanisms of injury or on responsive medical patients. The type of examination is based on the chief complaint and focuses on one body system or part
focused assessment
Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts
frostbite
The overall initial impression that determines the priority for patient care; based on the patient’s surroundings, the mechanism of injury, signs and symptoms, and the chief complaint
general impression
The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best; also called Golden Period
Golden Hour
Involuntary muscle contractions (spasms) of the abdominal wall to minimize the pain of movement and protect the inflamed abdomen; a sign of peritonitis
guarding
A step within the patient assessment process that provides detail about the patient’s chief complaint and an account of the patient’s signs and symptoms
history taking
Blood pressure that is higher than the normal range
hypertension
Blood pressure that is lower than the normal range
hypotension
A condition in which the internal or core body temperature falls below 95 degrees (35 Celcius)
hypothermia
Yellow skin or sclera that is caused by liver disease or dysfunction
jaundice
The forces, or energy transmission, applied to the body that cause injury
mechanism of injury
Widening of the nostrils, indicating there is an airway obstruction
nasal flaring
The general type of illness a patient is experiencing
nature of illness
A mnemonic used in evaluating a patient’s pain: Onset, Provocation/palliation, Quality, Region/radiation, Severity and Timing
OPQRST
The mental status of a patient as measured by memory of a person (name). place (current location), time (current year,month and approximate date) and event (what happened)
orientation
To examine by touch
palpate
The motion of the portion of the chest wall that is detached in a flail chest; the motion – in during inhalation, out during exhalation - is exactly the opposite of normal chest wall motion during breathing
Paradoxical motion
Negative findings that warrant no care or intervention
Pertinent negatives
A painful, tender, persistent erection of the penis; can result from spinal cord injury, erectile dysfunction drugs, or sickle cell disease
Priapism
A step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats
primary assessment
An assessment tool that measure oxygen saturation of hemoglobin in the capillary beds
pulse oximetry
A step within the patient assessment process performed at regular intervals during the assessment process to identify and treat changes in a patient’s condition. This should occur every 5 minutes for a patient in unstable condition and every 15 minutes for a patient in stable condition
Reassessment
The way in which a patient responds to external stimuli, including verbal stimuli (sound), tactile stimuli (touch), and painful stimuli
responsiveness
Movements in which the skin pulls in around the ribs during inspiration
retractions
Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways
rhonchi
A brief history of a patient’s condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to injury or illness
SAMPLE history
A step within the patient assessment process that involves a quick assessment of the scene and surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care
scene size-up
The tough, fibrous, white portion of the eye that protects the more delicate inner structures
sclera
A step within the patient assessment process in which a systematic physical examination of the patient is performed. The examination may be a systematic exam or an assessment that focuses on a certain area or region of the body, often determined t hrough the chief complaint
secondary assessment
Respirations characterized by little movement of the chest wall (reduced tidal volume) or poor chest excursion
shallow respirations
Knowledge and understanding of one’s surroundings and the ability to recognize potential risks to the safety of the patient or EMS team
situational awareness
The ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency
size-up
An upright position in which the patients head and chin are thrust slightly forward to keep the airway open; the optimum position for the uninjured child who requires airway management
sniffing position
Breathing that occurs without assistance
spontaneous respirations
A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope
stridor
A characteristic sensation felt on palpation of the skin, caused by the presence of air on soft tissues
subcataneous emphysema
Subjective findings that the patient feels but that can be identified only by the patient
sympton
The increased pressure in an artery with each contraction of the ventricles (systole)
Systolic pressure
A rapid heart rate, more than 100 beats/min
tachycardia
Longitudinal force applied to a structure
traction
The process of sorting patients based on severity of injury and medical need to establish treatment and transportation priorities
triage
The upright position in whicch the patient leans forward onto outstretched arms with the head and chin thrust slightly forward
tripod position
A severe breathing problem in which a patient can speak only two or three words at a time without pausing to take a breath
two-to three-word dyspnea
The narrowing of a blood vessel, such as with hypoperfusion or cold extremities
vasoconstriction
The key signs that are used to evaluate the patient’s overall condition, including respirations, pulse, blood pressure, level of consciousness, and skin characteristics
vital signs
A high pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma, bronchiolitis, and chronis obstructive pulmonary disease
wheezing
5 steps to the assessment process:
- Scene size-up
- Primary assessment
- History taking
- Secondary assessment
- Reassessment
Scene Size up:
Ensure scene safety
Determine mechanism of injury/nature of illness
Take standard precaustions
Determine number of patients
Consider additional/specialized resources
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 primary assessment
Determine priority of patient care and transport
History taking:
Invesigate the chief complaint (history of present illness)
Obtain SAMPLE history
Secondary Assessment: Medical:
Systematically assess the patient
Assess vitals signs using the appropriate monitoring device
Seconday Assessment:
Trauma
Systematicall assess the patient
Asses vital signs using the appropriate monitoring device
Reassessment:
Repeat the primary assessment Reassess vital signs Reassess the chief complaint Recheck interventions Identify and treat changes in the patient's condition Reassess the patient -unstable patients every 5 min -stable patients every 15 min
True or False: The order in which assessment is performed is fixed?
False. It is dictated by the patient’s condition
What type of hazards can you encounter?
Physical (sharp objects and broken glass) Slip and fall hazards (spills or leaking fluids) Motor vehicle biohazards Blood and body fluids Chemical hazards Electrical hazards Water hazards Fires Explosions Physical violence
blunt trauma
force of injury occurs over a broad area, and the skin is sometimes not broken but the tissues and organs beneath may be damaged
penetrating trauma
the force of the injury occurs at a specific point of contact between the skin and injury. The object pierces the skin and an open wound carries a higher potential for infection
LOC - level of conscious
ABS’s - Airway, breathing, and circulation
Primary Assessment
When are vitals taken?
Secondary Assessment
Indications for spinal immobilization:
Blunt or penetrating trauma with neck or spine, paralysis or numbness, tingling. Priaprism
Blunt trauma with altered mental status, intoxication, difficulty or inability to communicate
Distracting injuries
Signs of airway obstruction in an unconscious patient:
- obvious trauma, blood, or other obstruction.
- noisy breathing, snoring, bubbling, gurgling, crowing, stridor, or other abnoraml sounds
- extremely shallow or absent breathing
Goal for oxygenation for most patients is an oxygen saturation of
94%-99%
Signs of respiratory distress and failure
Agitation, anxiety restlessness (lethargy, difficult to rouse
Stridor, wheezing (tachypnea with periods of bradypnea or agonal respirations)
Accessory muscle use; intercoastal retractions, neck and muscle use (stenomastoi) (inadequate chect rise/poor excursion
Tachypnea (inadequate respiratory rate or effort)
Mild tachycardia (bradycardia)
Nasal flaring, seesaw breathing, head bobbing (diminished muscle tone)
If you cannot palpate a pulse in an unresponsive patient what do you do?
CPR or AED (NEVER use CPR or AED on a responsive patient)
If a patient has a pulse but not breathing, what do you do?
Provide ventilations at a rate of 10-12 b/m for adults and 12-20 for infants
What is a high priority patient that should be transported immediately
Unresponsive Poor general impression Difficulty breathing Uncontrolled bleeding Responsive but unable to follow commands Severe chest pain Pale skin or other signs of poor perfusion Complicated child birth Severe pain in any area of the body
What are some challenges you might face with patients when dealing with obtaining patient history?
Silence Overly talkative Multiple symptoms Anxiety Anger or hostility Intoxication Crying Depression Confusing behavior or history Limited cognitive abilities Cultural challenges Language barriers Hearing problems Visual impairments
How to perform a secondary assessment of a patient with no suspected spinal injuries:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
Normal Ranges for Respirations:
Adults 12-20 Adolescents 12-16 School aged children 18-30 Preschoolers 22-34 Toddlers 24-40 Infants 30-60
Characteristics of respirations
Normal - breathing is neither shallow or deep
Equal chest rise and fall
No use of accessory muscles
Shallow - decreased chest or abdominal wall motion
Labored - increased breathing effort
Use of accessory muscles
Possible gasping
Nasal flaring, supraclavicular and intercostal retractions in infants and children
Noisy - increase sound of breathin, including snoring, wheezing, gurgling, crowing, grunting and stridor
Normal pulse ranges
Adults and children older than 10 years - 60-100
Preschoolers and school aged children (2-10) 60-140
Infants and toddlers (3months - 2 years) 100-190
Infants (up to 3 months) 85-205
Normal range for blood pressure
Adults 90-130 systolic
Adolescent 110-131 systolic
Child 7 years 96-115 systolic
Child 2 years 88-106 systolic
Infant 85-104 systolic
Neonate 60-84 systolic
Glasgow Coma Scale
Eye opening 4 spontaneous 3 in response to speech 2 in response to pain 1 none
Best verbal response 5 oriented conversation 4 confused conversation 3 inappropriate words 2 incomprehensible sounds 1 none
Best motor response 6 obeys command 5 localizes pain 4 withdraws to pain 3 abnormal flexion 2 abnormal extension 1 none
PEARRL
Pupils Equal And Round Regular in Size React to Light
