Lecture 5: Primary and Secondary Assessments Flashcards
What is kinetic energy equal to?
Kinetic energy= 1/2 mass x velocity^2
In the concept of kinetic energy which is more important, mass or velocity?
Mass is less important than velocity
What is the ideal depth and rate of chest compressions?
depths of at least 5cm
rate of 110/ min
What should you attempt before an IO?
Attempt IV
What does AHA stand for?
American heart association
What are the services available at cardiac arrest centers?
Hemodynamic support
Neurological expertise
Emergency cardiac catheterization
targeted temperature management
When is defibrillation used?
For cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia
What should you administer for a cardiac arrest due to an opioid overdose?
Administer naloxone
What are the steps to follow for cardiac arrest during pregnancy?
EMS should notify healthcare facilities in advance to ensure all resources are available for both infant and mother
focus on maternal resuscitation with prep for perimortem caesarean delivery if necessary
Perform left uterine displacement during CPR to improve perfusion
What is the order of assessment during primary survey?
U(EMS/911) ABC
What is the order of treatment in the primary assessment?
CABd(defib)
What should be done right after primary assessment in situations where a secondary assessment is indicated?
Pulse ox should be place and SpO2 should be noted
What should you do if there is a pulse but the breathing is absent in an adult?
2 initial breaths followed by 1 breath every 5-6seconds
How do you determine level of responsiveness?
With AVPU or the modified Glasgow
What does AVPU stand for?
Alert
Verbal
Painful
Unresponsive
If someone is alert and responsive x4 what does that mean?
alert and responsive x4 means the person is conscious and is able to answer question regarding person, place, time and event correctly
If someone is unconscious what Glasgow’s do they have?
they have a glasgow of 3
What is the highest and lowest number you could on the glasgow?
15 and 3
What is the mnemonic to remember the Glasgow coma scale?
EVM-456
What is the Eye opening scale of the GCS?
4= spontaneous
3= to voice
2= to pain
1= no response
What is the verbal response scale of the GCS?
5= oriented and converses
4= disoriented and converses
3= inappropriate words
2= incomprehensible sounds
1= no response
What is the motor response scale of the GCS?
6= obeys commands
5= localizes pain
4= flexion/withdrawal
3= flexion/ abnormal
2= extension
1= no response
What does a GCS lower than 8 require?
it requires aggressive resuscitation. Under 8, intubate
When do you determine the actual GCS score?
At the end of secondary assessment as part of the vitals. Taken then and every 5 minutes after that
What are the painful stimuli used to elicit a response when someone is suspected to be unconscious?
Triceps pinch
Nailbed pressure
No more sternal rub since ILCOR 2005
A survival rate as high as 90% has been reported when defibrillation is achieved within how many minutes of the collapse?
within the first minute
What is the order of treatment of the secondary assessment?
DEFG
disability
epithelial
fracture
General
What does SAMPLE stand for?
Signs and symptoms
Allergies
Medication
Past medical history
Last intake
Events leading to incident
What does OPQRST stand for?
Onset
Provoke
quality
radiate
severity
time
What should you do when assessing the head?
Observe for discharge
Assess pupil size
Observe for bruising behind ears
Reassess airway
Look for blood or clear fluid coming from ears, nose or mouth
What should you do when assessing the neck?
Assess for abnormalities in the airway, tracheal deviation, jugular vein distension/ flatness, cervical trauma
How would you assess the chest and back?
Assess for abnormalities
Look and listen for more subtle signs of breathing difficulties
What should you do when assessing the abdomen?
gently feel the top of the abdomen
palpate for: rigidity and tenderness
What should you do when assessing the pelvis?
observe for incontinence and or blood
place hands on both side of pelvis: in-flare, alternate rotation.
DO NOT open book a potential pelvic fracture
If you suspect a pelvic fracture while assessing the pelvis what should you do?
Maintain manual stabilization until a pelvic binder is attached. Remember to rule out femoral fractures before applying a SAM pelvic binder
What should you do when assessing the lower and upper extremities?
Palpate for deformities
PMSC x2
When should vitals be done in a sport medicine setting?
within 3-5 minutes of arrival and every 5 minutes thereafter (if stable- every 15 minutes)
What are the 4 vital signs?
Pulse,
Vent rate,
BP,
Pulse Ox
What are the average pulse values?
adult: 60-80 bpm
child: 80-100 bpm
toddler: 100-120
athlete: 50-60
What are some interpretations of a rapid/shallow ventilatory rate?
shock, bleeding, heat exhaustion
What are some interpretations of a rapid/deep ventilatory rate?
cheyne-stokes, neurologic, metabolic
What are some interpretations of a prolonged expiratory ventilatory rate?
Lower airway obstruction, asthma
What are some interpretations of a prolonged inspiratory ventilatory rate?
upper airway obstruction
What are some interpretations of a deep gasping labored ventilatory rate?
obstructive, chest injury
What are some interpretations of an absent ventilatory rate?
obstructive, respiratory arrest, many cases
What are some interpretations of a bright frothy coughed up blood ventilatory rate?
lung injury
What are the different systolic rate of the different pulses?
radial pulse: 80 mmHg
Brachial pulse: at least 70 mmHg
Femoral pulse: at least 70 mmHg
Carotid pulse: at least 60 mmHg
When should you start O2 therapy?
Below 93% O2 saturation
Should you give supplemental O2 for acute stroke/MI when their SpO2 is between 93-100%?
NO
What are some interpretations of a cool/clammy skin?
shock, bleeding, heat exhaustion
What are some interpretations of a hot/moist skin?
reaction to increased temperature, exercise
What are some interpretations of a hot/dry skin?
heat stroke, high fever
What are contraindications to rectal temperature taking?
cardiac issues (vagus nerve stimulation)
Hemorrhoids
Recent rectal surgery
Diarrhea
What are the different GCS scores possible for a brain injury?
Concussion: GCS from 15-13 (minor brain injury)
GCS: 12-8 (moderate brain injury)
GCS: 7-3 (severe head injury, intubate)
What can indicate the presence of life-threatening TBI?
GCS< 14 in combo with abnormal pupil exam
What is a decorticate posture?
elbows/ wrist flexed to chest legs in extension
What is a decerebrate posture?
elbows extended, forearm pronated, wrist flexed
What should the vitals look like when in physiological shock?
decreased BP
Increased pulse
Increased ventilatory rate
What should the vitals look like when in neurogenic shock
decreased BP
No change in pulse
What should the vitals look like with Cushings signs?
increased BP
decreased pulse
increased temperature
change in ventilatory rate
increase in intercranial pressure
