Clinical Assessment Flashcards
New Medical layout
DR.ABCDE. VS. HT reassess
D - Danger
R - response (AVPU)
A - Airway clear
B - Breathing (respiratory rate & Spo2)
C - Circulation - pulse, capillary refill
D - disability (AVPU, Temperature, Pupils)
E- Exposure, Examine, Evaluate (top to toe, SAMPLE)
VS - Vital Signs
HT - History taking
Some examples of Dangers co-responders have been confronted with?
Pets
People
Needles/Sharps
Explosives and Flammable materials, beware of gas, petrol, consider electricity (isolate if safe to do so).
Traffic
Pandemic Virus
Environmental factors
Assess the casualty on the AVPU scale
A - alert (awareness of your presence)
V - voice (not fully alert, only responds to verbal stimuli)
P - pain (response is only to appropriate painful stimuli)
U - Unresponsive (no response to any stimuli)
Catastrophic bleeding
This is described as bleeding that will cause death in minutes if not controlled.
Look for blood spurting, or large pools of blood around the casualty.
What must you do?
Must control catastrophic bleeding before moving on.
Must request immediate back up if you find any catastrophic bleeding.
Most catastrophic bleeding is seen in trauma emergencies..
Common examples?
Arterial bleeding from Gunshots, stab wounds, self-harm, etc
Amputation
Catastrophic bleeding needs to be stopped quickly.
In the first instance bleeding should be controlled via:
Direct pressure with Bandaging - apply directly pressure to a wound over Bandaging/gauze.
Where bleeding cannot be controlled via direct pressure these methods can be used
Improvised Tourniquet - example Tuff cut Scissor and Triangular bandage
CAT Tourniquet - if available this can only be applied to a catastrophic bleed from a limb.
Airway
We need to ensure the airway is open before proceeding with the rest of your patient assessment.
Each patient will present differently and the airway assessment will be different for a responsive unresponsive casualty.
For example an unresponsive casualty would need more management than a responsive casualty.
However the principles remain the same:
Which is? LLF
Look - for any signs of obstruction
Listen - for any abnormal airway sounds
Feel - for air movement as the patient breathes
Treat and manage as you find.
. If during your primary survey you identify a time critical feature you must treat and manage it immediately.
For example a patient who is alert but upon an Airway assessment you:
Look - they appear to be choking, clutching their neck.
Listen - find absence of breathing.
Feel - are unable to feel air
What do you do for LOOK
Approach the Casualty and look at their mouth and nose.
Is there evidence of any airway obstruction?
Look at their body position, could that be directly affecting their airway.
What do you look for if the patient is choking or struggling to breathe?
Fluid - vomit, blood, excessive saliva
Swelling - from Anaphylaxis, burns or infection.
Foreign object - food, other small objects
AIRWAY
LISTEN
Listen for audible airway sounds during your assessment.
What are you listening for?
Stridor - high pitched airway sounds caused by upper airway narrow.
Audible Wheeze - lower pitched sounds mostly heard on expiration. (Can be present with COPD and Asthmatic patients)
Gurgling - from fluid within the airway.
Snoring - usually caused by the soft tissue of the pharynx and tongue relaxing in unresponsive patients.
Absent - conduct head tilt, chin lift. If still absent start basic life support.
FEEL
Can place ear close to patient to feel for air movement against your cheek.
Or feel body for chest movement
RESPIRATORY
Breathing
Is essential for survival and a deteriorating patient will show signs of worsening breathing.
The assessment should include:
Respiratory rate
And rhythm, depth and expansion
Respiratory rate
How to determine their respiratory rate.
Count the patient breaths over 10 seconds x 6 or 15 seconds x 4
If the patients RR is within normal (12-20) parameters or high (above 20) we at least know at this this stage it is adequate to sustain life.
However an unusually increased RR could signal that they may be in distress which means we do what?
We proceed to the next stage of assessment
Rhythm, depth and expansion what do you look for?
Abnormal rhythm of breathing - this could indicate exhaustion or pain on breathing.
Depth - patient should not be hyper-expanding their chest to take deep breaths, or taking shallow breaths.
The expansion of the chest should be equal, if not consider a pneumothorax, air trapped within the chest cavity, on the non expanding side. Check for a chest injury.
Circulation
We can for adequate perfusion usng
Look
Listen
Feel
If in shock?
skin colour may be come inadequately perfused - this will lead to their skin becoming pale
Circulation
Capillary refill time
CRT is a great tool in assessing a patients perfusion.
Who can CRT be conducted?
Centrally on a patients chest or forehead.
Or peripherally on their finger
Circulation
Capillary refill time
A normal result is when the blood flow returns within what
Abnormal result is when the blood flow takes
2 seconds or less.
3 seconds or longer to return.
An abnormal response is evidence of inadequate perfusion, this could be because they have a low blood pressure.
Disability .at this stage we are looking for life threatening conditions that effect the brain.
We are looking for injuries to the brain.
We need to conduct two tests where are?
BEFAST
PUPILLARY RESPONSE
What does BEFAST stand for?
Why do we use it?
We use it to rule in, or out a possible stroke.
Balance - sudden onset of abnormal balance
Eyes - sudden visual changes/ disturbances
Face - facial drop
Arms - unable to raise arms and keep them there.
Speech - slurred speech
Time - if they test positive for any of the above it’s time to request further immediate clinical support. Also note the onset time.
PUPILLARY RESPONSE
Check pupils to make sure that both pupils are:
Equal in size
Round
Reactive to a light (use pen torch) and accommodate to objects near and far.
PUPILLARY RESPONSE
What does PERRLA stand for?
Pupils
Equal
Round
Reactive to
Light and
Accommodation
