Midterm 1 (Mod1-6) Flashcards
Initial assessment questions…
- is my patient sick?
- how sick?
(trauma)
- is my patient hurt?
- how hurt?
Mental status…
- prime indicators of how sick a patient is
- changes in state of consciousness
- establish a baseline as soon as you encounter a patient
AVPU process
-alert (person, place, day, event) (bottom 3 may be critical patients) -responsive to verbal stimuli -responsive to pain -unresponsive
Glasgow coma scale
- most reliable method of assessing mental status and neurological function
- assigns a point value for eye opening, verbal response, and motor response
- less then 10 serious dysfunction
- less then 8 airway control
- lowest score 3
- highest score 15
- in alert patients do it with ABC
- in non alert do it separate
Airway status focuses on these 2 questions…
- is the airway open and patent?
- is it likely to remain so?
- sonorous sounds (adjust)
- gurgling or bubbling sounds (suction)
Airway status simple to complex
- easiest problem to solve is position
- spine injury drives what decision to open airway
Airway status assessment is the same regardless of age
- talking or crying will give clues to airway adequacy
- for all unconscious patients establish responsiveness and look, listen and feel for breathing
Suctioning and mechanical means to keep the airway open
-oro or nasopharyngeal
Airway status order
- position
- suction
- adjuncts
Breathing questions
- is the patient breathing?
- if so adequate?
- supplemental O2 may not be needed if patient isn’t breathing enough then you would have to help them breathe
Minute volume
- RR x TV
- amount of air actually moved into and out of the lungs each minute
- note patients breathing rate, work of breathing and breath sounds, skin colour, and LOC or mental status
Techniques to assess breathing
- look, listen and feel
- look for rise and fall of the chest
- listen for breath sounds
- feel for air movement
- listen to patient breathe in and out
- striator in, wheezes out
- primary you can only listen to 2 places
Circulation pulse
- rapid check of cardiovascular status
- info about rate, strength and regularity
- force of pulse
- rhythm
- quality
- report findings
Circulation skin colour, temp, and moisture
-use back of hand to assess warmth
Identify priority patient
- will benefit from less time at the scene and rapid transport
- patients in need of interventions that cannot be performed in the prehospital setting except under extreme circumstances
OPQRST
- onset (how it came on)
- provocation/palilation
- quality
- region/radiation
- severity
- time
Responsive medical patient questions…
- dietary habits
- meds
- allergies
- exercise
- alcohol or tobacco
- recreational drug use
- sleep patterns and disorders
- immunizations (anyone over 50 flushots) (kids ask childhood ones)
Responsive medical patient questions focused physical examination
- driven by info gathered during initial
- most common complaints will involve the head, heart, lungs, or abdomen
- respiratory pain
focused physical exam unresponsive
- disadvantage
- next most reliable source of info
- position patient (recovery, neutral alignment)
- thorough assessment (head, neck, abdomen, pelvis, posterior body and extremities)
- unstable conditions get rapid transport and ongoing assessment
mechanisms that have the potential to produce life threatening injuries
- ejection from any vehicle
- death of another patient in the same compartment
- high speed (over 50) motor collision
- vehicle pedestrian collision
- motorcycle collision
- penetrating wounds to the head, chest or abdomen
mechanisms that have the potential to produce life threatening injuries
- ejection from any vehicle
- death of another patient in the same compartment
- high speed (over 50) motor collision
- vehicle pedestrian collision
- motorcycle collision
- penetrating wounds to the head, chest or abdomen
- seatbelts
- airbags
- child safety seats
rapid trauma assessment
- between initial and focused
- specialized tool
- usually performed on patients with any significant MOI
- make sure that the patients C spine is manually immobilized
- organized and systematic
minor injuries
- MOI is obvious
- isolated injuries
- little signs of systemic involvement
detailed physical exam
- wont have to do it much
- takes 15 minutes
- modify to chief complaint
- seeks to find complaints or problems that were not identified
- can do on long transports
evaluate mental status
- appearance and behaviour appropriate?
- posture and general motor response
- evaluate the patients speech and language by listening to what the patient says how he or she says it
- pay attention to patients thought process/perceptions
- assess insights along with judgements the patient makes
- assess attention and memory
- evaluate new learning ability
Assessment
- platform upon which quality prehospital care is built
- 2 primary components (info gathering and physical examination)
Information helps… and first question
- helps you make key prehospital care decisions
- first question is always, “does my patient have any life threatening conditions?”
fundamental components
- identify problems
- set priorities
- develop a care plan
- execute the plan
gathering information
- primary source of info is usually the patient
- other sources include the patients family or friends or eyewitnesses to the emergency event
- info from the scene itself
care similar to a mystery
- you are the detective
- the mystery is finding out what is wrong with your patient
first and foremost concern
- your safety and the safety of other paramedics
- you are of no value if you get injured and cant provide care
BSI protocols
- gloves
- eye protection
- fitted mask (N95)
- always better to err on the side of caution
scene safety collision and rescue scenes
- multiple risks
- unstable vehicles
- moving traffic
- jagged metal and broken glass
- fire/explosion
- downed power lines
toxic substances
- lawn and garden chemicals
- smoke
- proper body and respiratory protection
crime scenes
- always the possibility for more violence
- law enforcement should enter and secure first
unstable scenes
- consider waiting in vehicle until scene is secured and safe
- if you think you can pull it off safely remove patient from scene with you
unstable surfaces
- snow/ice
- rain
- terrain issues
behavioural emergencies
- common/challenging
- meth abuse and distribution
- never hesitate to call for backup
protecting patient/bystanders
- establish perimeter around the emergency scene
- environmental issues -heat/cold
medical emergency/trauma
- one could cause the other
- multiple possibilities
- MOI
medical calls
- quickly determine why we were called
- NOI
when to call additional resources
- more than 1 patient
- obese patients
initial assessment observations
- you must be more conscious, objective and systematic about your observations
- identify and manage life threatening problems
airway status invasive procedures
- supraglottic airway
- endotracheal intubation
determining priority patients
- poor general impression
- unresponsive
- responsive but doesnt follow commands
- difficulty breathing
- hypoperfusion or shock
- complex child birth
- chest pain systolic under 90
- uncontrolled bleeding
- severe pain
- multiple injuries
responsive medical patients
- working initial diagnosis
- chief complaint
- history of the present illness
coast map
- consciousness
- orientation
- activity
- speech
- thought
- memory
- affect
- perception
nervous system assessment
- mental status
- motor response
- cranial nerve function
- reflexes
- sensory response
ongoing assessment steps
- compare LOC with baseline assessment
- review the patients airway
- reassess breathing
- stay alert for ventilatory fatigue
- reassess circulation
- make sure bleeding is controlled
- reassess pulse
ongoing assessment care plan
- have you addressed all life threats
- do you need to revise priorities
- reassess transport plan
ongoing assessment vital signs
- compare them with expected outcomes from your therapies
- look for trends or patterns
- revisit complaints and make sure they’re looked after
