Medical PT assessment Flashcards
What does SCENE stand for?
S - Safety
C - Cause
E - Environment
N - Number of patients
E - Extra resources required
What are the 3 outcomes of medical patient assessment?
- Acute care (ED, PPCI, MTC)
- Community or primary care (hospital wards, DN, OOGP)
- Discharge with worsening
What is covered in your primary surve?
C - Cat haem
A - airway
B - Breathing
C - Circulation
D - Disability
E - Evaluation
What should be completed after an intervention?
Full reassessment starting from A
What is required for every vulnerable pt (inc children), unless in a life threatening emergency ?
An appropriate chaperone
What should you be observant of when making a general impression of a PT?
- Colour
- Position and tone
- Behaviour
- Any abnormal noises
- Any significant blood loss
What does ACVPU stand for?
A - alert
C - Confused
V - Voice
P - pain
U - Unresponsive
How would you assess if someone is Alert?
Orientated and conversing on arrival
How would you assess if someone is Confused
New onset confusion, disorientated to time and place.
use family to refer to PT normal.
Pt is otherwise alert.
How would you assess if someone is alert to voice?
Verbal command to the PT
How would you assess if someone is alert to pain?
Alert only to a tactile stimulus, E.g giving them shake or tap.
When assessing airway what are you looking for?
- Obstructions
- Loose teeth
- Foreign bodies
- Vomit
- Infection
- Blood
- Swelling
- Trauma
- Dry muccus membranes.
When assessing air what are you listening for?
- Noisy airflow (Snoring, gurgling ect)
When assessing airway what are you smelling for?
- Any abnormal smells (Sweet = DKA, Alcohol ect)
What are you feeling for in airway assessment?
AIrflow through oral cavity
What is the first step when managing an airway?
Manoeuvres (E.g Head tilt chin lift, postural drainage)
Following an airway procedure what needs to be completed to demonstrate skill?
Airway log
When assessing breathing, what are you initially assessing for?
Rate, Quality and depth
When assessing breathing in primary survey, what are you looking for?
- Pallor (Cyanosis)
- Adequacy of chest movement
- Symmetry
- Inspect anterior and posterior elements
When assessing breathing in the primary survey, what are you feeling for?
- Stability of the chest wall
- Depth
- Equal rise an fall
What is the normal SPO2 range for a PT with COPD?
88% - 92%
What is the expected SPO2 range for a normal PT without previous respiratory history?
94% - 98%
When should assisted ventilation be considered?
< 10
>30
If the PT SPO2 is <90% on 15 l/min O2
When assessing circulation, what are you main considerations other than external bleeding?
- Epistaxsis
- Haemostasis
- Haematemasis
- Malaena
- Internal bleeding
When assessing a pulse, what are you looking for?
- Strength
- Regularity
- Rate
If a radial pulse isn’t present, where is the next place to check for a pulse?
Carotid
If a pulse is present in the radial what is the PTs estimated systolic blood pressure?
80-90 systolic
If a pulse is present in the Carotid what is the PTs estimated systolic blood pressure?
50+ mmHG
If a pulse is present in the femeral what is the PTs estimated systolic blood pressure?
70+ mmHG
When assessing skin, what are you looking for?
- Rashes
- Motteling
- Cyanosis
- Cold peripheries
- Skin turger
What are the early signs of Hypovalaemic shock?
- Poor Pallor
- Cold peripheries
- Abnormal behaviour
- Tachypneoia
- Tachycardia
When are you looking for as part of you disability assessment?
- ACVPU,
- PEARL
- Purposeful limb movements
- Sensory function
- Blood glucose (If appropriate)
- FAST test (If appropriate)
Under what circumstances must a Blood Glucose be taken?
- Diabetic Patients
- Impaired LOC
- Alcohol consumption
- Seizures
- Syncope and falls
- Paediatrics
When should a FAST test be completed?
- Any sensory or motor deficit
- Any new onset confusion
What is covered under the environment section of the primary survey?
- BP
- Temperature
What is the NEWS 2 threshold for a pre-alert?
- NEWS2 higher than 5
- NEWS2 score of 3 in any parameter
In a diabetic PT, what is the minimum value for a PT to be Hypertensive?
130/80
In a Non-Diabetic Pt, what is the threshold value for Hypertension?
140/90
In what circumstances must an ECG be conducted?
- Syncope
- CP
- Post rosc
- Abnormal pulse (irregular, Tachy, Brady)
- New onset confusion where possible
When forming differential diagnosis, what needs to be considered?
- Any clinically concerning findings?
- Anything else it could be ?
- Diagnosis of exclusion?
- Any pertinent negatives?
- Any further information required?
What needs to be included when taking a patient history?
- Presenting complaint
- History of presenting complaint
- Past medical history
- Prescribed medications
- Allergies
- Family history
- Social history
What information are looking for when obtaining a history of presenting complaint?
- Symptom summary
- Symptom duration
- Event history
- Impact on patient
- Previous occurrences
- Assessment of pain
What does SOCRATES stand for?
- Site
- Onset
- Character
- Radiation
- Associations
- Timing
- Exacerbating and relieving factors
- Severity
When assessing a patients medical history, what needs to be obtained?
- Current illness or disease
- Previous illness or disease
- Previous trauma
-Surgical history - Obstetric/ GYN history
When obtaining details about a patients medication, what information do you require?
- Prescribed medications
- Over the counter medications
- Compliance
- Recent medication changes
- Recreational andd illegal drug use
- herbal remedies
What key pieces of information should be obtained for the social history?
- Who they live with
- Employment status
- Mobility aids
- Main carer
- Care package/ Provider
- Schools (If attending)
- Social worker inc details
When formulating a working impression, what needs to be considered?
- Differential diagnosis
- Current findings
- What can be ruled out
- What is needed to support or reject the working impression.
What needs to be assessed as part of a head assessment?
Inspection of face for: Bruising, wounds, Abnormal swelling and rashes.
Check: Pupil size, GCS
Inspect oral cavity for: Dehyrdration, Bleeding, deformities,
Inspect the nose for: Woulds, Swelling, infection or CSF leak.
What needs to be assessed as part of a neck examination?
Inspect for: Surgical scars, accessory muscle uuse, lacerations, bruising and deformity, Tracheal deviation and jugular vein distention.
What are the red flags during a neck assessment?
Tracheal deviation - ?Pneumothorax
Jugular vein distention - ?HF, Increased WOB.
State the difference between Decorticate and Decerabate presentation.
Decorticate - Flexion facing inwards (Duck)
Decerabatte - Extension outwards (Penguin)
During a chest examination, what needs to be reassessed from the primary survey?
- Rate
- Quality
- Depth
- SPO2
- Skin colour
- Temperature
What do crackles indicate?
Infection
What does a silent chest indicate?
No air entry!
What does Strider indicate?
Obstructed airway
When palpating the chest what are you looking for?
Deformities, Crepitus, Flail segments, Surgical emphysema
How many quadrants are included in an abdo assessment, what are they called?
4 - All together
Left upper/lower, Right upper/lower
What are the red flags during an abdo assessment?
- Bruising
- guarding
-Swelling, - Wounds
- Pulsating masses
- Distention
What might a pulsating mass indicate?
AAA
When would you stop palpation?
- Pulsating mass
- PT isn’t able to tolerate due to pain
When inspecting the lower limbs what are you looking for?
- Rashes
- Localised inflammation
- Bruising
- Swelling
- Odema
- Jaundice
When assessing a lower limb concern, what observation must be taken?
Distal Pulse
What is the MSC entail?
Motor - Test for movement in limbs
Sensation - applying light touch to evaluate sensation
Circulation - Temp and distal pulses
What components should make up your safety netting consideration?
- If diagnosis correct what will happen
- if diagnosis incorrect what will hapen
- What should the PT do if their condition worsens
As part of the worsening advice what should be outlined?
- Recovery timeline
- When any safety nets are likely to take effect (GP appt ect)
- Expected signs and symptoms
- Expected outcome
