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Patient Assessment > Critically Ill > Flashcards

Critically Ill Flashcards

1
Q

What are the two categories of assessment?

A

primary and secondary

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2
Q

What are the components of the primary survey?

A

CPR, Key vital assessment

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3
Q

How long does the primary survey take?

A

10-15 s

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4
Q

What does primary survey check?

A

immediate threat to life

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5
Q

What are the key vital functions assessment in the primary survey?

A 
ABCDE
a - airway
b - breathing
c - circulation
d - disability
e - expose
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6
Q

What do you do for airway in vital assess?

A 
PROTECT C spin
LOC
ask to speak and to not stop talking
airway patency
open airway
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7
Q

What do you do for breathing in vital assessment?

A

observe chest rise and fall
RR and depth
auscultate

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8
Q

What do you do for disability in vital assessment?

A

Mental status

AVPU

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9
Q

What does AVPU stand for?

A

alert, responds to verbal, responds to pain, unresponsive

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10
Q

What do you do for exposure in vital assessment?

A

take all clothes off and look for shit

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11
Q

What vital signs do you get in primary assessment?

A

HR, RR, BP, mental status, temp, pulse ox

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12
Q

What do you do for CPR?

A 
are you ok?, call for help
Check pulse 10 s
no pulse --> compressions 100/min
2 breaths/30 compression
C A B
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13
Q

What does secondary survey check for?

A

conditions that could become life threatening

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14
Q

What is the CAB of CPR?

A

Compression
Airway
Breathing

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15
Q

What is the recommendation of chest compressions?

A

adult - 2 inches or 1/3 body wideth

kids 1.5 inches

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16
Q

When do you do compression on kids?

A

pulse

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17
Q

What are the parts of the secondary survey?

A

HX - SAMPLE

PE - Head/neck, chest, abdomen, pelvis, extremities, back

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18
Q

What hx do you get aka sample?

A 
S - signs and symptoms
A - allergies
M - medications
P - PMH
L - last meal
E - events preceding/related to illness
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19
Q

What causes blunt trauma?

A

MVA, falls, struck, sports

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20
Q

What causes paradoxical chest movement?

A

flail chest

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21
Q

What are the pulses you check?

A

radial, carotid, femoral

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22
Q

What does a radial pulse mean?

A

minim 80 systolic

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23
Q

What does cartoid pulse mean?

A

minim 60 systolic

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24
Q

What does femoral pulse mean?

A

minim 70 systolic

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25
Q

What is most commonly injured in blunt trauma?

A

spleen

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26
Q

What causes penetrating trauma?

A

firearm, stabbings, impalement, blasts

27
Q

What is most commonly injured in penetrating trauma?

A

liver

28
Q

What do you want to know about burns?

A

body surface and depth

29
Q

What are the energy transfer rules?

A 
20 miles/hour
20 feet/distance
20 minutes trapped
Low velocity GSW 2000ft/s
Shotgun wounds > or
30
Q

What is ecchymotic discoloration around both eyes and what does it mean?

A

raccoon eyes - basilar skull fracture

31
Q

What is bruising around umbilicus and what does it mean?

A

cullens, intraabdominal bleed

32
Q

What is precordial crunching, clicking or knocking sound with heartbeat and what does it mean?

A

Hamman sign

mediastinsitis, pneumothorax, resp failure

33
Q

What is ecchymoic disocloration behind ear and what does it mean?

A

Battle sign - basilar skull facture

34
Q

What is discoloration and induration of skin of flanks and what does it mean?

A

grey-turner, retroperitoneal bleed or hemorrhagic pancreatitis

35
Q

What is severe pain in the subscapular area on left and what does it mean?

A

Kehr - spleen rupture, ectopic preg, GI disease due to phrenic nerve irritation

36
Q

What do you inspect on head?

A

face and scalp for trauma
ears - TM for blood or perf
Eyes - pup size and responsive, lens discoloration, EOM, hemorrhage
Nose - deformity, bleeding
Mouth - blood, vomit, foreign body, teeth
Face/scalp - tender, depressions, creptius, temp

37
Q

What do you do for neck?

A

inspect JVD, trauma
Listen to carotids
C spine
palpate

38
Q

What do you palpate anterior neck for?

A

deformity, crepitus, tenderness

39
Q

What do you palpate posterior neck for?

A

tenderness, midline, step off

40
Q

What do you do for chest?

A

inspect for trauma
Palpate - sternum, ribs, clavicles
Auscultate breath
Auscultate heart

41
Q

What do you do for abdomen?

A

Inspect trauma, seat belt, cullen, grey turner, distention

Palpate each quadrant

42
Q

What do you do for pelvis?

A

inspect - bruising over wings
Inspect - peritoneum for trauma
Assess stability - A to P on ASIS and pubic symph
DRE

43
Q

What do you do for extremities?

A

Inspect - injury
Palpate
Motor and sensory
Palpate peripheral pulses in all and cap refill

44
Q

How do you roll a person?

A

3 person log roll

45
Q

What do you do for back?

A

Inspect - c spine, trauma

Palpate - entire midline, look for tenderness

46
Q

What is the eye response in glasgow?

A

open spontaneously - 4
open to verb - 3
open to pain - 2
dont open - 1

47
Q

What is the verbal response in glasgow?

A 
oriented - 5
confused but answers -4
inappropraite response - 3
incomprehensive - 2
none - 1
48
Q

What is the motor response for glasgow?

A 
obeys command - 6
purposeful mvmt to pain - 5
withdraws from pain - 4
abnormal flexion, decort - 3
abnormal extension, deceb - 2
none - 1
49
Q

What glasgow means coma?

A

3-8

50
Q

When do you repeat primary survey?

A

every 5 min

51
Q

What do you do for peds?

A

evaluate resp distress

evaluate for dehydration

52
Q

What are signs of dehydration in kids?

A 
mucous membrane dry
skin turgor loss
cool clammy skin
sunken fontanelles
eyes sunken, no tears
cap refill >2 s
53
Q

What are things to note in elderly?

A

Limited mobility of neck/TMJ
Weaker cough/gag reflex (increased risk of aspiration/obstruction)
Increased stiffness of rib cage (increased rate of rib fx)
Respiratory failure progresses quickly -decreased energy reserve
Lower cardiac output
Increased risk for MI with hypotension/hypovolemia (can not compensate)
Beta-blockers prevent compensation of HR in cases of shock or dehydration
Perception of pain reduced
Chronic mental status changes – assessment of responsiveness difficult
Hypothermia risk- skin thin and less subcutaneous fat

54
Q

What is the most common cause of dehydration in kids?

A

vomiting and diarrhea

55
Q

What is retraction at suprasternal notch?

A

obstruction above trachea

56
Q

What is intercostal and subcostal retraction?

A

obstruction in bronchial tree or lower

57
Q

What causes drooling?

A

obstruction of glottis

58
Q

What does inspiratory stridor mean?

A

glottis or epiglottis

59
Q

What does expiratory stridor mean?

A

obstruction below glottis

60
Q

What is evidence of poor perfusion?

A 
Weak distal pulses
Pallor/pale
Cyanosis
Delayed capillary refill (>2 seconds)
Tachycardia (based on patient’s age
61
Q

What are the 5 p of neurovascular compromise?

A

paresthesia, pain, paralysis, pale, pulseless

62
Q

What are signs of TBI?

A 
Decreased level of consciousness (FROM BASELINE)
Unequal pupils
Blurred vision
Severe or persistent headache
Nausea or vomiting
Change in Neurological status
63
Q

What are MVA red flags?

A 
Ejection
Rollover
Extrication > 20 minutes
Death in same passenger compartment
Evidence of high speed crash
-Speed >40 mph
-Major auto deformity (greater than 20 inches)
-Intrusion into passenger compartment greater than 12 inches

Patient Assessment (23 decks)

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