Lecture 3/Chapter 10 Flashcards
SAMPLE
Signs and Symptoms, Allergies, Medications, Pertinent Medical History, Last Oral Intake, Events Leading to Injury or Illness
Signs and Symptoms
Evaluate using OPQRST
Allergies
Ask the patient if they are allergic to any medications, food, etc.
Medications
Ask the patient if they have been prescribed with any medications, and, if so, if they have been taking them as prescribed
Pertinent Medical History
Ask the patient if they have had any past medical problems i.e., heart disease, high blood pressure, asthma, diabetes, etc.
Last Oral Intake
Ask the patient what was the last thing they drank and when.
Events Leading to Injury or Illness
Ask the patient what they were doing when their issue began and if they know what caused it
OPQRST
Onset, Provoke and Palliate, Quality, Region and Radiation and Recurrence, Severity, and Time
Onset
Ask the patient if their pain came on gradually or suddenly?
Provoke and Palliate
Ask the patient if anything makes the pain worse or better?
Provoke and Palliate
Ask the patient if anything makes the pain worse or better?
Quality
Ask the patient to describe the pain, i.e., sharp, dull, throbbing, tearing, etc.
Region, Radiation, and Recurrence
Ask the patient where the pain is, does the pain radiate anywhere in their body, and has this pain happened before.
Severity
Ask the patient how they would rate the pain from 0 to 10
Time
How long has the pain been going on
BELLSRPGO
Blood Pressure, Eyes, Lung Sounds, Level of Consciousness, Skin Signs, Respirations, Pulse, GCS, and Oximeter
Blood Pressure
Average is 90-140 over 60-100; preferred method of taking blood pressure is Auscultation, second method is Palpation
How does auscultation work?
Put the correct size cuff on the patient, use stethoscope on the arm and under the cuff, pump it up until you can’t hear the heart pumping anymore, start slowly releasing the pressure. When you hear the first pump sound, record the # (systolic pressure), and when you hear the last pump sound, record the # (diastolic pressure).
Eyes
Check the patient’s pupils using PERLA: are they equal, round, react to light properly, and accommodate
Level of Consciousness
Ask the patient: what is your name, where are we, what time is it currently, and do you know what happened to you?
Lung Sounds
Listen to the right side, left side, middle, and lower lobes. Make sure everything sounds the same
What are the different lung sounds?
Normal: clear bilaterally
Abnormal: noisy breathing
Rales: fluid in the lungs, crackling noise
Wheezing: bronchial constriction; creepy noise
Rhonchi: coarse bubbling
Stridor: upper airway obstruction; high pitched wheeze coming from the trachea/throat
Skin Signs
Check the patient for color, temperature, and moisture. If the patient has dark skin, check the mucus membranes (under eyelids)
Respirations
Check the patient’s breathing for the rate, rhythm and quality
What to look for with rates?
Fast, slow, normal
What to look for with rhythms ?
Regular or irregular
What to look for with quality?
Strong/weak (pulse) or equal chest rise and fall and noises (respirations)
What is the average respiration for adults?
12 to 20 breaths per minute
What is the average respiration for children?
15 to 30 breaths per minute
What is the average respiration for infants?
25 to 50 breaths per minute
Bradypnea/cardia
Respiratory/ pulse rate is less than normal
Tachypnea/cardia
Respiratory/pulse rate is greater than normal
What does the Glasgow Coma Scale check?
Eye Opening, Verbal Response, and Motor Response
What are the ratings for eye opening?
4: spontaneous/tracking
3: response to voice (verbal stimuli)
2: response to pain (painful stimuli)
1: none (unresponsive)
What are the ratings for verbal response?
5: normal conversation
4: disoriented conversation
3: words, but not coherent
2: no words, only sounds
1: none
What are the ratings for motor response?
6: normal
5: localize to pain
4: withdraws to pain
3: decorticate
2: deceberate
1: none
What is the goal oxygen saturation?
94-98% saturation
What is a normal pulse rate for an infant (1 month to 1 year old)?
120-160 bpm
What is a normal pulse rate for a baby (1 year to 3 years old)?
90-150 bpm
What is a normal pulse rate for a toddler (3 years to 6 years old)?
80-140 bpm
What is a normal pulse rate for a kid (6 years to 12 years old)?
70-120 bpm
What is a normal pulse rate for an adult (12 years to 18+ years old)?
60-100 bpm
What is the importance of BSI?
All bodily fluids are potentially infectious, so you must wear at LEAST gloves, but also eye protection, a mask, gown, etc.
PENMAN
Personal and Partner and Patient Safety, Environmental Hazards, Number of Patients, Mechanism of Injury or Nature of Illness, Additional Resources, and Need for Extrication/Spinal Immobility
Personal, Partner, and Patient Safety
Make sure the scene is safe, if not, do NOT enter until it becomes safe
Environmental Hazards
Heat, rain, snow, smoke, crowds, terrain, hazmat
Whatever can hurt your patient can hurt you too.
Mechanism of Injury/Nature of Illness
MOI: auto versus pedestrian
NOI: shortness of breath
Use caution in a scene where multiple people are exhibiting the same symptoms
Additional Resources
Medical: additional units, ALS, psychiatric emergency response team
Non-Medical: Fire suppression, hazmat, rescue, law enforcement
Need for Extrication/Spinal Immobility
Spinal motion restriction is required for us to know
What is the purpose of the Primary Assessment?
To identify and treat life threatening issues in less than 90 seconds
General Impression
Occurs as you approach the patient and look for stability, imminent life threats, any major disabilities, etc. Run AVPU if needed
Obtaining Consent
Introduce yourself, ask the patient’s name/age, ask their chief complaint, and obtain consent for you to help them.
If they refuse treatment, go through the refusal of treatment process.
ABCDEFI
Airway, Breathing, COPS, Deformity and Disability, Expose, Field Impression, and Identify Priority and Transport Decision
A
Assess airway; check for obstructions. If so, remove anything in the airway
B
Is the patient breathing, and if so, adequately? If not, start O2
C
Use COPS to assess circulation
COPS
Capillary Refill: less than 2 seconds is normal
Obvious External Bleeding
Pulse: check wrist if conscious and neck if unconscious
Skin Signs: color, temperature, and moisture
D
Deformity: observe it
Disability: ask about it
E
Expose the patient to visualize their body and palpate to find tenderness
F
Formulate a field impression = what you know about the patient so far
I
Identify priority as either rapid medical or rapid trauma, and the transport decision as ALS or BLS
What are the 4 different patient types?
Responsive Medical, Unresponsive Medical, Major Trauma, and Minor Trauma
What steps do we take for Major Trauma Patients?
Run primary assessment, do rapid trauma, take baseline vitals, do a detailed physical exam, take SAMPLE history, and reevaluate transport decision
What steps do we take for unresponsive medical patients?
Run primary assessment, do rapid trauma, take baseline vitals, do detailed physical exam, take SAMPLE history, reevaluate transport decision, and complete the ongoing assessment
What steps do we take for minor trauma patients?
Run primary assessment, complete focused physical, take baseline vitals, take SAMPLE history, reevaluate transport decision, and continue with ongoing assessment
Physical Exam/Complete Body Check
Do DCAP-BLS-TIC and start with the face, to the neck, to the chest, to the abdomen, to the pelvis and to the legs/arms
DCAP-BLS-TIC
Deformities, Contusions, Abrasions, Punctures and Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, and Crepitus
What is the ongoing assessment?
Repeat primary assessment, reassess/record vitals, repeat focused assessment, and evaluate interventions