General Assessment Flashcards
What are the components of a patient assessment?
Scene Assessment/Survey Primary Assessment/Survey Baseline Vitals Identify any Priority Patients Transport/Treatment Decisions Detailed Secondary Assessment/Survey Ongoing Care
When approaching a scene during the scene survey, what should you be looking for?
Preparation Responding Hazards MOI Patients Involved
The preparation should be done at shift change, what should this include?
Vehicle Check
Equipment Check
System Status
When responding, what should you be considering?
Weather Road Delays: Any construction, what detours do I need to take Dispatch Info The ambulance itself Any extra resources
What are the priorities of scene safety?
You Your crew Any other responding personnel The patient Bystanders
What should your Personal Protective Equipment (PPE) include?
Gloves Eyewear Vests Helmets Boots
What should your scene assessment or windshield survey include?
HEMP
Hazards
Environment
MOI
Patients Involved (#)
What are some Hazards you should be watching for?
Traffic Power Poles Bystanders Fire Weapons Vehicles Animals
What should be done with unsafe scenes before providing patient care?
They should be made safe
What could an unsafe scene be or include?
MVC or rescue scenes Toxic substances Crime scenes Unstable surfaces/structures Violent/Hostile environment Farm emergencies
What is a Mechanism of Injury?
It is the force applied to (or taken away) from the body and how the body reacts to it
What should you be looking for with regards to an MOI
Strength
Direction
Nature of the Forces
What is Newton’s First Law of Motion?
An object, whether at rest or in motion, remains in that state unless acted upon by another force
What is the Conservation of Energy?
Energy can’t be created or destroyed, it can only change form
What are some significant MOI’s
Ejection from a vehicle Death in the same passenger compartment Falls > 6 feet or the pt's height Rollover High-speed vehicle collision Auto-ped collision Motorcycle crash Unresponsive or altered mental status Penetrations of the head, chest, or abdomen
What is the Primary Assessment?
It is used to determine the nature of the illness
During the Primary assessment, what are you using to determine the nature of the illness
Bystanders, family or the patient
The scene can give you clues
The patients illness may be very different from the chief complaint
What are the overall steps of a primary assessment?
Form a general impression Stabilize c-spine as needed Assess baseline level of response Assess airway Assess breathing Assess circulation Complete an RBS as needed Assess priority of the patient
What is the General Impression?
It is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport
What is your assessment of c-spine based on?
MOI
History of the event
General Impression
What is a Patient Assessment?
It is a problem-oriented evaluation establishing priorities of care
It is based on existing and potential threats
What are some signs to look for when assessing Appearance?
Level of Consciousness Signs of Distress Apparent State of Health Vital statics Sexual Development Skin color and obvious lesions Posture, gait, motor activity Dress, grooming and personal hygiene Odours of breath or body Facial expression
When assessing level of responsiveness, what scale do we use?
AVPU Alert Alert to Voice Alert to Painful stimuli Unresponsive
When assessing the airway in the primary survey, what are we looking for?
To determine if it is patent or obstructed
How do we assess airway patency
Determine if the patient can speak
Note any signs of airway obstruction or respiratory insufficiency such as stridor, wheezing, gurgling
Inspect the oral cavity for foreign objects
When assessing breathing, what are we evaluating?
Level of Consciousness
Rate (Tachypnea or Bradypnea)
Depth
Symmetry of chest wall movement
When assessing breathing, what are we looking for when we expose the chest
Structural integrity
Tenderness
Crepitus
Also observing if any accessory muscle use
Signs of distress
Audible sounds (quick ascultation of bases and apex)
Listen to the patient when they talk
What are we looking for when we assess circulation?
Consists of evaluating the pulse and skin and controlling any bleeding if necessary
Rate (Tachycardic or Bradycardic)
Force
Compare Carotid and Radial
If it is required to complete a rapid body survey, what does it consist of?
It is a quick head-to-toe and control any of the following if required:
- signs of severe external bleeding
- signs of internal hemorrhage
- fractures
Evaluate the skin color, moisture and temperature
What are some signs of Inadequate Circulation?
Altered or decreased LOC Distended neck veins Pale, cool, diaphoretic skin Restlessness Thirst
What do baseline vitals include?
LOC
Pulse
Respirations
Blood Pressure
What is included in a pulse assessment?
Rate:
- Normal Range: 60-100 bpm
- Average (adult): 72 bpm
- Tachycardia > 100 bpm
- Bradycardia
What are the peripheral pulse sites?
Temporal - lateral to the eye orbit
Carotid - medial to and below the angle of the jaw
Brachial - just medial to the biceps tendon
Radial - thumb side of the wrist
Ulnar - little finger side of the wrist
Femoral - Just below the inguinal ligament
Popliteal - just behind the knee
Dorsalis pedis - top of the foot
Posterior tibial - behind medial malleolus
What are we looking for when assessing respirations?
Rate:
- Normal range for adults is 12-20 bpm
Rhythm:
- Regular, regular-irregular, irregular-irregular
Volume:
- Deep or shallow
Audible noises
Tachypnea > 20 bpm
Bradypnea
Describe Tachypnea
Increased respiratory rate
Describe Bradypnea
Decreased respiratory rate
Describe Apnea
Absence of breathing
Describe Hyperpnea
Normal rate, but deep respirations
Describe Cheyne-Stokes respirations
Gradual increases and decreases in respirations with periods of apnea
Describe Biot’s respirations
Rapid, deep respirations (gasps) with short pauses between sets
Describe Kussmaul’s Respirations
Tachypnea and hyperpnea
Describe Apneustic respirations
Prolonged inspiratory phase with shortened expiratory phase
What is Blood Pressure
It is the force of blood against the arteries walls as the heart contracts and relaxes
It is measured in mmHg
Expressed as a fraction, Systolic/Diastolic
What is the Systolic portion of blood pressure
It is the maximum force of blood against the arteries when the ventricles contract (pumping pressure)
What is the diastolic portion of blood pressure?
It is the force of blood against the vessel walls when the ventricles relax
It is the measure of systemic vascular resistance (correlates well to blood vessel size)
It is the resting pressure
What are the ways a blood pressure can be assessed?
Auscultation
Palpation
Non-Invasive
What is the normal Systolic range in adults?
Adult Male: 100-140 mmHg, up to the age of 50
Adult Female: 90-130mmHg, up to the age of 50
What is the normal diastolic range in adults?
Adult Male/Female: 60-96mmHg
What is the 80-70-60 guideline?
It gives a rough estimate of the patients systolic blood pressure by palpating pulse sites.
Radial - 80mmHg or higher
Femoral - 70mmHg or higher
Carotid - 60mmHg or higher
Define Pulse Pressure
Difference between systolic and diastolic blood pressure
Define Perfusion
Passage of blood through and organ or tissue
Define Korotkoff Sounds
Sound of blood hitting the arterial walls
What are some major criteria to identify priority patients?
Poor general impression Unresponsive Responsive but cannot follow commands Difficultly breathing Hypoperfusion Complicated child birth Chest pain and BP below 100 systolic Uncontrolled bleeding Severe pain Multiple injuries
What are the four types of patients?
Trauma patient with significant MOI
Trauma patient with isolated injury
Responsive medical patient
Unresponsive medical patient
When assessing a Major trauma patient, what are the four components of assessment we are looking for?
Primary assessment
Rapid trauma assessment
Packaging
Rapid transport and ongoing assessment
What are predictors of serious internal injury?
Ejection from vehicle Death in the same passenger compartment Fall from higher than 6 meters Rollover of vehicle High speed MVC Vehicle-passenger collision Motorcycle crash Penetration of the head, chest or abdomen
What should field management be limited to in major trauma patients
Airway control, ventilatory support, spinal immobilization, major fracture stabilization
In a major trauma patient, when should the IV be started and administered
Perferrably enroute to the hospital
What are the four components of an isolated-injury trauma patients?
No significant MOI
Shows no signs of systemic involvement
They do not require an extensive history
They do not require a comprehensive physical exam
What are the differences in a responsive medical patient?
The history takes precedence over the physical exam
The physical exam is aimed at identifying medical complications rather than signs of injury
What are the components of an unresponsive medical patient?
Initial assessment
Rapid medical assessment
Brief history from bystanders or family
What does the secondary assessment include?
History
Vitals
Detailed secondary (head-to-toe) assessment
What is one of the main challenges in completing a history
To get as much relevant patient information and history to provide rational for treatment and transport decisions
What are some obstacles when trying to collect a patient history
Establishing a rapport in a patient that you have just met
Conduct primary and secondary assessments and implements treatments simultaneously
Do so within the time constraints of effective prehospital care and the patients primary problem
Define Chief Complaint
It is the main reason that you were called to attend to the patient
Differentiate from the primary cause
Define Differential Diagnosis
The working diagnosis that you come up with based on the patient’s signs and symptoms and the variety of potential causes
What is Rapport?
By asking the patient the right questions you will discover their chief complaint and symptoms
By responding with empathy, you will win their trust and encourage them to discuss their problems with you
When you are setting the stage during history taking, what are you doing?
Looking for the patients chart if there is one available (nursing home, hospital transfer)
Ensure that insight does not turn into bias
As much as possible choose an environment that allows for the most effective interaction
What are some good ways to use language and communication?
Use appropriate language
Use an appropriate level of questioning, but do not appear condescending
Generally start with open-ended questions and progress to more closed questions
Avoid a pre-arranged script of questions, modify questioning in response to the patients response
When using Active Listening, what does it mean to use Facilitation?
Eye contacts, facial gestures, posture, verbal cues
When using Active Listening, what does it mean to use Reflection?
To repeat your patient’s words back to them
When using Active Listening, what does it mean to use Clarification?
What means one thing to you may mean something different to the patient, so ensure to explain what you are saying to the patient and understand what they are saying to you
What are some topics that your patient’s may experience problem’s talking to you about, sensitive topics?
Sexual activities, violence, physical deformities
In a comprehensive history, what is the preliminary data?
Date and Time Age Sex Race Birthplace Occupation
In a comprehensive history, what is the chief complaint?
It is the main reason that you were called, the primary cause
Ask the patient, “What seems to be the problem?”
When completing a comprehensive history and you are using OPQRST-ASPN ,what does it mean?
Onset of the problem Provocative/Palliative factors Quality Region/Radiation Severity Time Associated Symptoms Pertinent Negatives
When completing a comprehensive history, what is a SAMPLE history?
Signs and Symptoms Allergies Medications Past/Present Medical History Last... Events preceeding
When completing a comprehensive history, what is included in a Past History?
General state of health Childhood diseases Adult diseases Psychiatric illnesses Accidents or injuries Surgeries or hospitalizations
When completing a comprehensive history, what is included in the current health status?
Current medications and rx information Allergies Tobacco Alcohol, drugs and related substances (use/misuse) Diet
When discussing medications with the patient, what are you asking?
Are they compliant?
What is the dose and frequency
What is included in a current health status?
Screening tests Immunizations Sleep patterns Exercise and leisure activities Environmental hazards Use of safety measures Family history Home situation Daily life Important exercises Religious beliefs The patients outlooks
What is a review of systems?
It is a functional inquiry
It is a system-by-system series of questions designed to identify problems your patient has not already identified
Mainly determined by patient chief complaint, condition and clinical status
What systems are included in a review of systems?
General (Overall) Skin HEENT Respiratory Cardiac Gastrointestinal Urinary Genitalia Peripheral Vascular MSK Neurologic Hematologic Endocrine Psychiatric
What are some special challenges when questioning patients?
Silence Overly talkative patients Multiple symptoms Anxiety Depression Sexually attractive or seductive patients Confusing behavior Patients needing reassurance Anger Intoxication Crying Limited intelligence Language problems Hearing Speech To busy talking with family or friends
What are some causes of dilated or unresponsive pupils?
Cardiac Arrest CNS Injury Hypoxia/Anoxia LSD, Atropine, Amphetamines, Barbiturate Drug Use Lack of Light
What are some causes of constricted or unresponsive pupils?
CNS Injury CNS Disease Narcotic Use Eye Medications Bright Light
What are some causes of unequal pupils?
CVA Head Injury Direct trauma to the eye Eye Medications Prosthetics
When assessing the Skin, what is considered normal?
Color: Pink
Temperature: Warm
Moisture: Dry
When evaluating skin color, what are causes of Pale (Pallor) skin?
Decreased perfusion
Cold Injury
Dehydration
Shock
When evaluating skin color, what are some causes of Cyanosis (blue)?
Cardiorespiratory insufficiency
Cold environment
When evaluating skin color, what are some causes of red color skin?
Fever
Inflammation
CO Poisoning
When evaluating skin color, what are some causes of jaundiced skin?
Liver problems
RBC Destruction
When evaluating skin temperature, what are some causes of cold skin?
Decreased perfusion
Cold related illness/injury
When evaluating skin temperature, what are some causes of hot skin?
Possible fever
Heat related illness/injury
When evaluating skin moisture, what are some causes of clammy skin?
Shock
CV Compromise
Heat Illness/Injury
When evaluating skin moisture, what are some causes of diaphoretic skin?
Shock
CV Compromise
Heat Illness/Injury
What is the approximate temperature that the body works hard at maintaining?
37 degrees Celcius
Where are the four main sites to obtain a temperature?
Oral
Rectal
Axillary
Tympanic
What is the purpose of the physical exam?
It is to investigate areas that you suspect are involved in your patients primary problem
What are the four aspect’s that build the foundation of physical assessment?
Inspection
Palpation
Auscultation
Percussion
What are you looking for when assessing the head? (6)
DCAP-BLS Drainage of fluid or blood from the ears, nose or mouth Raccoon eyes Battle sign Burns of the face, nasal hairs or mouth Pupils PEARLA
When assessing the head and you look in the mouth, what are you assessing? (3)
The color of the mucous membranes
Blood, vomitus, summer teeth, lacerated/swollen tongue
Suctioning as necessary
When assessing the head and you are palpating the bones of the face, what are you assessing?
Looking for the presence of any tenderness, instability or crepitation
When assessing the neck, what are we inspecting for? (2)
DCAP-BLS
Distended neck veins
When assessing the neck, what are we palpating for? (3)
Anterior Neck for tracheal deviation
Cervical vertebrae for tenderness and deformity
Anterior and posterior neck for subcutaneous emphysema
When assessing the chest ,what are we assessing? (3)
DCAP-BLS
Auscultate
Palpating for TIC
What are three types of chest wall abnormalities?
Funnel chest
Pigeon chest
Barrel chest
When assessing the posterior chest, we should palpate for tactile fremitus, what is this?
Vibrations felt during speech
When assessing the abdomen, how many quadrants are we inspecting and palpating?
Four
What are the other three things we are looking for when assessing the abdomen?
DCAP-BLS
Tenderness, rigidity, masses
Nausea, vomitting
What is Cullen’s sign?
It is a discoloration around the umbilicus suggestive of intra-abdominal hemorrhage
What is Grey-Turner’s sign?
It is discoloration over the flanks suggesting intra-abdominal bleeding
What is an ascites?
Swelling in the flanks and abdomen
What is Borborygmi?
It is loud, prolonged, gurgling bowel sounds
What are the five things we are looking for when assessing the pelvis?
DCAP-BLS Incontinence Priapism TIC if no obvious pain Pelvic squeeze
What are the steps of conducting a pelvic squeeze?
Push posteriorly on the iliac crests
Push medially on the iliac crests
Push down on symphysis pubis
DO NOT ROCK THE PELVIS FROM SIDE TO SIDE
When assessing the extremities, what are the four things we are looking for?
DCAP-BLS
TIC
PMS
Compare to the opposite extremity
When assessing the MSK system, what are doing with the joints?
Observing
Inspecting
Palpating
Checking structure and mobility
What are the 6 P’s of assessment on extremities?
Pain Pallor Paresthesia Pulses Paralysis Pressure
What is considered normal cap refill?
Less than 2 seconds
When do you assess the posterior body?
If not already immobilized, do so when log rolling onto backboard
What is considered a normal spinal curvature?
Concave in cervical region
Convex in thorax
Concave in lumbar region
What is Lordosis?
Exaggerated lumbar concavity (Swayback)
What is Kydphosis?
Exaggerated thoracic concavity (hunchback)
What is Scoliosis?
Lateral curvature of the spine
When conducting a neurological exam, what two questions are we trying to answer?
Are the findings symmetrical or unilateral?
If they are unilateral, where do they originate?
What are the five areas of the Neurological exam?
Mental status and speech Cranial nerves Motor system Sensory system Reflexes
What are the seven areas we are assessing when assessing mental status and speech?
Level of response Appearance and behaviour Speech and language Mood Thought and perceptions Insight and judgment Memory and attention
What are some motor activities that you would see with anxiety?
Tense posture
Restlessness
Fidgeting
What are some motor activities that you would see with agitation?
Crying
Hand wringing
Pacing
What are some motor activities that you would see with depression?
Hopeless
Slumped posture
Slowed movements
What are some motor activities that you would see with manic behaviour?
Singing
Dancing
Expansive movements
What are the twelve cranial nerves?
I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Acoustic IX. Glossopharyngeal X. Vagus XI. Accessory XII. Hypoglossal
What is the function of the Olfactory nerve?
Sensory (smell)
What is the function of the Optic nerve?
Sensory (sight)
What is the function of the Oculomotor nerve?
Motor (Pupil construction, rectus muscles)
What is the function of the Trochlear nerve?
Motor (Superior oblique muscles)
What is the function of the Trigeminal nerve?
Sensor (Opthalmic{forehead}, maxillary{cheek}, mandibular{chin})
Motor (Chewing muscles)
What is the function of the Abducens nerve?
Motor (Lateral rectus muscle)
What is the function of the Facial nerve?
Sensory (Tongue)
Motor (Facial muscles)
What is the function of the Acoustic nerve?
Sensory (Hearing and balance)
What is the function of the Glossopharyngeal nerve?
Sensory (Posterior pharynx, taste to anterior tongue)
Motor (Posterior pharynx)
What is the function of the Vagus nerve?
Sensory (Taste to posterior tongue)
Motor (Posterior palate and pharynx)
What is the function of the Accessory nerve?
Motor (Trapezius and sternocleidomastoid muscles)
What is the function of the Hypoglossal nerve?
Motor (Tongue)
What are three pieces of information can be collected as vital signs?
ECG (4, 12, 15 lead)
O2 Sats
Blood Glucose
What is the purpose of an on-going assessment? (4)
To continue monitoring the patient’s status en route and provide treatment as necessary
Detects trends
Determines changes
Assesses intervention’s effects
When doing the on-going assessment, why are we reassessing vital signs?
Observe changes, that occur over time, in the patients condition that may indicate the need for a change in care or treatment
During the on-going assessment, why are we assessing interventions? (2)
To assess the response to the management plan
Continuous assessment of the patient may allow the paramedic to recognize a ‘trend’ in the assessment components
What are the components of an on-going assessment? (7)
Repeat initial assessment - Stable patient, q 15 mins - Unstable patient, q 5 mins Reassess mental status Reassess airway Monitor breathing for rate and quality Reassess the circulation Reestablish patient/transport priorities Don't forget to consider hypo/hyperthermia
What should the radio patch include?
Ambulance Identification Patient profile (age and sex) Chief complaint If trauma, give MOI and major injuries only Mental status Vital signs Treatments already given ETA
