EMR Chapters 12 and 13 Flashcards
Skin Signs
The three characteristics you will be evaluating our color, temperature, and moisture. All three can be assessed by observing the patient’s face and feeling the forehead. When assessing skin color in light skinned patients, observe the skin of the face, noting if it appears pink, which is normal, or if it is pale or flushed (reddish) or yellow. In dark skinned individuals, observe the palms, nail beds, and inside of the lips to look for pink appearance. Skin that is not being a perfused well will appear pale or cyanotic (bluish). Skin that is receiving an abnormal amount of blood flow might appear flushed. Skin that is yellow in appearance is said to be jaundiced and maybe an indication of an underlying condition related to the liver. Next, use the back of hand to assess skin temperature. If the skin appears warm (normal), cool, or hot. At the same time, you are assessing color and temperature, you can assess for moisture. No it the skin appears dry, or moist. Moisture diaphoresis can be classified as mild, moderate, or severe diaphoresis. The condition of being sweaty is referred to as being diaphoretic.
Capillary refill
The time that it takes for the capillaries to refill after being blanched. Normal capillary refill time is two seconds or less. A delayed capillary refill time may be a sign of impaired circulation due to injury, or a sign of poor perfusion due to shock.
Pupils
As an emergency medical responder, you will be assessing the eyes for the following very specific characteristics: pupil, size and shape, equal of pupil size, and reactivity to light. When you first look at the eyes, note their general condition and identify any obvious injury or deformity. Pay particular attention to the pupil. Note the size and shape of each pupil. Many EMS penlight have a pupil gauge printed on the side to aid in the determination of pupil size. ensure both pupils are around. Observe both pupils to determine if they are the same size. When you encounter a patient with an equal pupils, always ask if this is a normal condition for him. One of the important signs of good perfusion pupils that respond briskly to the presence or absence of light. Pupils should respond to the sudden introduction of light by constricting and, in contrast, should dilate when light the people is blocked.
Both pupils should react to the change in light with the same speed. Peoples that respond slowly to the change in light are documented as sluggish. Pupils that do not respond at all are referred to as fixed. This can be seen in some patients with severe head injury or in cardiac arrest; the pupils gradually become fixed and dilated.
An acronym that is widely used in EMS to help providers remember the characteristics of pupils:
P- pupils
E- equal
R- round
R- reactive
L- light
BP-DOC
when assessing a trauma patient, you may use a memory aid, such as BP-DOC, to help you remember what to look for during any physical exam. Use with trauma patients when performing a head to toe assessment. The letters stand for:
B- bleeding
P- pain
D- deformities
O- open wounds
C- crepitus (a grating noise or sensation often felt with broken bones)
Tracheal deviation
A shifting of the trachea to either side of the midline of the neck caused by the buildup of pressure inside the chest (tension pneumothorax). Assessed during the secondary assessment.
Jugular vein distention (JVD)
An abnormal bulging of the veins of the neck, indicating cardiac compromise, or possible injury to the chest. Assessed during the secondary assessment.
Accessory muscle use
The use of the muscles of the neck, chest, and abdomen to assist with the breathing effort. Assessed during the secondary assessment.
Paradoxical movement
Movement of an area of the chest wall in the opposite direction to the rest of the chest during respiration. An indication of chest wall trauma. Assessed during the secondary assessment.
Guarding
The protection of the area of pain by the patient; the spasms of muscles to minimize movement that might cause pain. Inspected during the secondary assessment.
Dorsalis pedis pulse
The pulse located on the top of the foot
Track marks
Small dots of infection, scarring, or bruising that may form a track along a vein; maybe an indication of IV drug abuse.
Reassessment
When performing the reassessment, repeat the primary assessment, reassess, vital signs, and check any interventions to ensure they are still effective. Reassess the patient, watching closely for any changes in his or her condition. Seriously ill or injured patients should be reassessed every five minutes. A good role to follow is that by the time you finish a reassessment from start to finish, it is time to start over with the beginning of the next reassessment. Patients who are not seriously ill or injured should be reassessed no less than every 15 minutes.
When additional UMS providers arrive at the scene, it is important to communicate with them well. Give the responding EMTs, a verbal report, including name, and age of patient, chief complaint, mental status, airway, breathing, and circulatory status, physical findings, patient, history, interventions applied, and the patients responses to them.
Types of patients
Trauma patients are a result of an accident, such as a fall, car, crash, etc. You are looking for the MOI, which is the mechanism of injury to see how the condition is.
Medical patients are a result of things such as heart attacks, abdominal pain, diabetic emergencies, seizure, labor. You are looking for the NOI or nature of injury.
Order of patient assessment
First you size up the scene for both trauma and medical patients. This includes personal safety, using PPE as well as patient safety. You may require additional resources such as police, power company, life, flight, fire department, as well as a back up medical personnel.
Secondly, you perform a primary assessment, which is designed to detect and correct any immediate life-threatening problems that you can quickly correct. During this assessment, you first assess mental status using AVPU then you check the patients ABC. You must check if their airway is open, you must check whether they are breathing, and you must check their circulation of whether there is a pulse or not. If there in shock, you may not be able to feel the pulse. You must also check for severe bleeding, and whether it is uncontrolled. You cannot move forward until you fix the things wrong with this assessment you must fix the threats or they’ll die.
Then, perform a secondary assessment. For a medical stable patient meaning their condition remains the same and they are responsive, you perform a focused assessment first then obtain the patient history, then their vital signs. For an unstable medical patient meaning their condition changes, and they could be unresponsive, you must first perform a rapid assessment or a head to toe assessment then obtain their patient history, then their vital signs. a stable trauma patient, which means they have a non-significant MOI, you must first perform a focused, trauma assessment, focusing on their chief complaint, then obtain their vital signs, and lastly, their patient history. For an unstable trauma patient, which means they have a significant MOI, such as bleeding, you must perform a rapid trauma assessment, or a head to toe, then obtain their vital signs, then their patient history.
