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EMT 1 > Module 4- Patient Assessment > Flashcards

Module 4- Patient Assessment Flashcards

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1
Q

What is the acronym for Patient assessment with Trauma patients?

A

“MARCH” OR “XABCDE”

M - massive hemorrhage
A - airway
R - respiration
C - circulation
H - hypothermia

-

X - eXsanguinating hemorrhage
A - airway
B - breathing
C - circulating
D - disability
E - expose/environment

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2
Q

Define OPQRST?

A

O - onset
P- provocation/palliation (what brings it on)
Q- quality (is it sharp, stabbing , dull)
R- region/radiation (does it radiate)
S - severity
T - time

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3
Q

Define SAMPLE:

A

S - signs and symptoms
A - allergies
M - medications
P - past medical history
L - last oral intake
E - Events prior to this event

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4
Q

What 2 acroynms are used for obtaining history from patient and what are they used for ?

A

SAMPLE : used for systematically obtaining Patients pertinent history

OPQRST: used to get more information about the pain/injury

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5
Q

Explain what pulse oximetry measures:

A

The amount of Oxygen in a persons blood

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6
Q

Describe factors and limitations in interpreting pulse oximetry findings

A

Factors:

  • Sufficient Perfusion
  • Body of normal tempature
  • No nail polish or anything that would obstruct reading

Limitations:

  • Low Perfusion to area where monitor attached
  • Lag time: Does not provide direct measurement of O2 in blood
  • Does not indicate the amount of oxygen being off-loaded to cells, the oxygenation status of the cells, or the ability of the cells to use the oxygen
  • Medical conditions such as shock, anemia, and CO2 poisioning can give inaccurate readings
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7
Q

How do you use pulse oximetry to help determine the need for supplemental oxygen?

A

It can tell how much oxygen is in the blood indirectly which can let you know if PT needs supplemental oxygen

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8
Q

What vital signs do you obtain that are a part of your BASELINE vital signs?

A
  • Respiration
  • Pulse rate
  • Skin
  • Capillary refill
  • Pupils
  • Blood pressure
  • Pulse Ox (SpO2)
  • Body temperature and blood - - glucose
  • Pain scale
  • Capnography
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9
Q

What is the normal range of “Heart rate” for Adults, elderly, children and infants?

A

Adults : 60-100

Adolescent (12-15): 60-100

School-age child (6-11): 75-118

Preschooler (3-5): 80-120

Toddler (1-2): 98-140

Infant (<1): 100-180

Birth-1 month: 100- 205

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10
Q

What is normal range for ETCO2 rate?

A

35-45

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11
Q

What is the normal range of “Respiration rate” for Adults, elderly, children and infants?

A

Adults : 12-20

Adolescent (12-15): 12-16

School-age child (6-11): 18-25

Preschooler (3-5): 20-28

Toddler (1-2): 22-37

Infant (<1): 30-60

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12
Q

What is the normal range of “Blood pressure” for Adults, elderly, children and infants?

A

Adult: 120/80

Adolescent (12-15 yo): 110-131/ 64-83

Preadolescent (10-12 yo): 102-120 / 61-80

School aged (6-9 yo): 97-115 / 57-76

Preschooler (3-5 yo): 89-112 / 46-72

Toddler (1-2 yo): 86-106 / 42-63

Infant: (1-12 yo): 72-104 / 37-56

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13
Q

For pupils,
what are you looking for in the PT?

A

Reactivity, size and equal on both sides

Abnormal : constricted versus constricted

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14
Q

What cause pinpoint pupils and dilated pupils?

A

pinpoint - Opiot overdose (heroin, oxy)

Dilated - cocaine

stroke or trauma

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15
Q

What are the steps in Primary Patient Assessment?

A
  1. Form a general impression of the patient
  2. Assess level of consciousness (Mental Status/AVPU)
  3. Assess the airway
  4. Assess breathing
  5. Assess oxygenation
  6. Assess circulation
  7. Establish Patient Priorities
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16
Q

When is it recommended to check the blood glucose level

A
  • When the PT AVPU or GCS is abnormal
  • If they are diabetic PT
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17
Q

What 3 things do are assessed for respiration?

A
  • Rate
  • Quality
  • Rhythm
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18
Q

What factors make up the vital signs?

A
  • Responsiveness:

AVPU, GCS

  • Respiratory:

Respiratory rate, depth, Pulse OXimetry

  • Cardiovascular:

Blood pressure, pulse

  • Others:

Pupils, Blood glucose, neurogenic functions (PMS)

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19
Q

What 3 sounds are heard without a stethoscope?

A

Snoring
Gurgling
Stridor or crowing

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20
Q

What 3 sounds are heard with a stethoscope?

A

Wheezing
Crackles (Rales)
Rhonchi

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21
Q

What potentially causes Snoring?

A

Tongue partially blocking the upper airway at the level of the pharynx

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22
Q

What potentially causes Gurgling?

A

Fluid in the upper airway

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23
Q

What potentially causes Stridor/Crowing?

A

Partial obstruction of the upper airway at the level of the larynx

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24
Q

What potentially causes Wheezing?

A

Constriction (narrowing) and inflammation reducing the internal diameter of the bronchioles in the lungs

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25
Q

What potentially causes Crackles (Rales)?

A

Fluid surrounding and filling the alveoli

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26
Q

What potentially causes Rhonchi?

A

Mucus blocking the larger bronchioles

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27
Q

Define open ended questions and closed ended questions:

A

Open Ended Questions:

requires the patient to respond with a descriptive or more detailed answer

Closed Ended Questions:

Requires the patient to respond with a “Yes” or “no” answer

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28
Q

When assessing pulse rate and/or respirations, if the medic notes an irregularity, how long should that medic count to obtain an accurate reading?

A

Full Minute

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29
Q

What are the five components of SCENE-SIZE UP?

A
  1. Standard precautions
  2. Assess for safety hazards
  3. Determine MOI/NOI
  4. Number of patients
  5. Determine need for additional resources
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30
Q
A
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31
Q

Explain the purposes and goals of performing a scene size-up on every EMS call

A
  • allows to for the EMT and PT to remain safe
  • enables for max amount of resources to be available for the PT
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32
Q

How do you determine the pulse rate?

A

count for 30 seconds x 2

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33
Q

What are the 4 types of Pulse Quality and their descriptions?

A

Thready - weak and rapid
Weak - as stated
Strong - Normal finding
Bounding - Usually Strong

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34
Q

What 4 qualities do you assess skin for?

A

Color
Temperature
Condition
Capillary Refill

35
Q

What are the importance of taking accurate vital signs?

A
  • Accurate vital signs gives EMT a accurate picture of what is going on with the PT
36
Q

Explain the process of auscultating lung sounds?

A
37
Q

What are the different Pulse Points With patient’s age and level of responsiveness?

A

Birth -1 year: Brachial

> 1 year : Radial

38
Q

Explain systolic and diastolic blood pressure:

A

Systolic blood pressure :

Is the pressure in your arteries as your heart contracts and pumps blood

Diastolic Blood pressure:

Is the pressure in your arteries as your heart relaxes and fills with blood

39
Q

how do you perform orthostatic blood pressure?

A
  1. Place PT in supine position and take blood pressure and heart rate
  2. Stand PT up and after 2 minutes reassess BP and HR
  3. Positive finding:

If HR increases by 10-20 bpm and Systolic blood pressure decreases by 10-20 mmHg

40
Q

Why would performing orthostatic blood pressure be necessary?

A

It would be necessary to determine if there has been significant blood loss or fluid volume in PT

41
Q

What is a positive finding with orthostatic blood pressure and what does it indicate?

A

positive finding is

  • HR increases by 10-20 bpm
    Systolic BP decreases by 10-20 mmHg
  • Indicates that significant fluid loss has occurred
42
Q

Define and describe the mechanism of injury and nature of illness:

A

(MOI)- Mechanism of Injury : refers to PT how the patient was injured

(NOI) Nature of Illness:
Refers to PT who is not injured but suffering from a medical condition

43
Q

When should you have a high index suspicion for injuries?

A
  • Falls
  • Motor vehicle crashes (MVA)
  • Motorcycle crashes
  • Recreational vehicle crashes (for example, a snowmobile or all-terrain vehicle)
  • Contact sports involving intentional or unintentional collision
  • Recreational sports (such as skiing, diving, or basketball)
  • Pedestrian collision with a car, bus, truck, bike, or other force
  • Blast injuries from an explosion
  • Stabbings
  • Shootings
  • Burns
44
Q

What are the different types of skin colors and their causes?

A

Pallor (White) - Shock, blood loss

Cyanosis (Blue/gray) - inadequate of oxygenation

Flushing (Red)- Heat exposure/late CO2 poisoning

Jaundice (Yellow)- Liver disease

vital si

45
Q

What are the 4 types of pupil reactive states and their causes?

A
  • Dilated:

Cardiac arrest (pupils will also be fixed), drug use such as LSD, amphetamines, or cocaine

  • Constricted:

Central nervous system disorder or narcotics use

  • Unequal:

Stroke, head injury, artificial eye (occasionally a normal finding), eye drops, or eye trauma

  • Nonreactive:

Cardiac arrest, brain injury, eye drops, or drug intoxication or overdose

46
Q

What is the pneumonic for GCS scale?

A

E - 4 - 1
V - 5 - 1
M - 6 - 1

E (Eye)
V (Verbal)
M (Motor)

47
Q

What is AVPU?

A

A - Alert
V - Verbal
P - Pain
U - Unresponsive

48
Q

What is GCS scale
?

A

The Glasgow Coma Scale (GCS) is used to rank the patient’s level of consciousness by assigning a numeric score from to 3-15

49
Q

What scale is used to assess mental status and PT’s level of consciousness?

A

AVPU = Mental status

GCS Scale = Level of consciousness

50
Q

What are the blood pressure rates that indicate HYPOtensive by age?

A

Adult: <90

Children (10-18): <90

Children (0-10 yo): <70

Infants - 1 yo: < 60

51
Q

what does DCAP-BTLS stand for?

A

D - Deformities
C - Contusions
A - Abrasions
P- Punctures and Penetrations
B- Burns
T - Tenderness
L- Laceration
S- Swelling

52
Q

What are the 5 rights of medication administration?

A

the right patient
the right drug
the right dose
the right route
the right time

53
Q

What are the steps in a secondary exam?

A

Physical exam
Baseline Vital signs
History

54
Q

What is the pneumonic for Scene Size up?q m a

A

SMNAC

S - scene safety
M- MOI/NOI
N- # of patients
A- additional resources
C - C spine consideration

55
Q

What are the steps in Patient assessment?

A
  1. Scene size up with and Consider SMR (Spine Mobile restriction)
  2. Primary assessment
  3. Decide to “Load and Go” or “Stay and play”
  4. Perform secondary assessment
56
Q

How often should you reassess vitals in high priority and low-priority patients?

A

High Priority: Every 5 minutes

low-Priority: Every 15 minutes

57
Q

Explain the four ways in which primary assessment can go:

A

Non-threatening life Injuries

  1. Modified Medical:
  2. Modified Trauma

Life threatening Injuries:

  1. Rapid Trauma:
  2. Rapid Medical
58
Q

What are the different locations of the pulses?

A

Central pulses:

  • Carotid artery
  • Femoral artery

Peripheral Pulses:

  • Radial artery
  • Brachial Artery
  • Popliteal Artery
  • Posterior Tibial Artery
  • Dorsalis Pedis Artery
59
Q

Where can each of the 7 pulse locations be felt at

A

Central pulses:

  • Carotid artery: On neck between trachea and muscle mass
  • Femoral artery: Groin

Peripheral Pulses:

  • Radial artery : Proximal to thumb and palmar surface of wrist
  • Brachial Artery: Middle of inside of the army between bicep and tricep
  • Popliteal Artery: Crease behind the knee
  • Posterior Tibial Artery: behind the ankle bone
  • Dorsalis Pedis Artery : on the top of the foot on the great-toe side.
60
Q

What is normal range for blood sugar?

A

70-140

61
Q

What are the components of the Secondary Assessment?

A
  • Physical exam
  • Baseline vitals signs
  • History
62
Q

What is the 4 ANO?

A

Place: address/city/state

Time: date/year/month

Person: what is your name

Events: current events in the world or day

63
Q

What are the two types of electrodes in a 12-lead?

A

Limb Electrodes (4):

-RA, LA, RL, LL

Precordial Electrodes (6):

  • V1,V2,V3,V4,V5,V6
64
Q

How to do a 4 lead?

A

(Salt and pepper)
RA, LA

(Christmas tree) “Presents go underneath”
LL,RL

65
Q

Where do the leads go on a 12 - lead?

A

RA - Right arm or wrist
LA - Left arm or wrist
LL - Left lower leg
RL - Right lower leg
V1 - 4th intercostal space Right sternal
V2 - 4th intercostal space Left sternal
V3 - Midway between V2 and V4
V4 - 5th intercostal space, Midclavicular line (Nipple line)
V5- Midway between V4 and V6
V6 - Mid axillary line (armpit)

66
Q

What is the following for Nitroglycerin:

Indications:
Contraindications:
Medication form:
Dosage:
Action:
Side effects:

A

Indications:
- To increase coronary perfusion in angina and acute myocardial infarction

Contraindications:
- BP systolic is less then 90 mmHg or has gone up by 30 points
- HR is less then 50 bpm
- Suspected head injury
- Suspected head injury
- PT is child or infant
- Max dose of 3 have been administered
- ED meds taken with 12-48 hours

Medication form:
-Tablet or sublingual spray

Dosage:
0.3-0.4 mg sublingual or 400 mcg SL per dose (can be repeated within 3-5 max dose 3)

Action:
- Potent vasodilation
- Nitroglycerin causes blood vessels to relax, or dilate, which will decrease workload on the heart

Side effects:
- Headache
- Decrease in BP
- Burning at the site of administration

67
Q

Define the following terms in regards to medication:

Indication
Contraindication
Dose
Administration
Action

A
  • Indication:
    Most common use(s) for medication when treating a specific Condition
  • Contraindication:
    Situations in which a medication should not be given to a patient due to a potentially harmful outcome
  • Dose
    The amount of medication that is to be given to PT
  • Administration
    Refers to the way the medication is given
  • Action
    The effect the medication has on the body
68
Q

Describe the difference between the objective and subjective signs and symptoms?

A

Objective information:
is measurable or verifiable in some way

Subjective information:
is based on an individual’s perceptions or interpretations

69
Q

What is DCAP-BTLS ?

A

is an acronym used by first responders to assess a patient’s soft tissue injuries and conditions

70
Q

what does DCAP-BTLS stand for ?

A

D- Deformities
C- Contusions
A- Abrasions
P- Punctures/Penetrations

B- Burns
T- Tenderness
L- Lacerations
S- Swelling

71
Q

Define the following terms in regards to medication Oxygen:

Indication
Contraindication
Dose
Administration
Action

A

Indication:
- S/S of hypoxia
- asst. ventilations with PPV
- SpO2 reading <94%
- S/S of heart failure and shock
- unresponsive PT

Contraindication:
- None in emergency situations

Dose:
- 1-6 lpm via nasal cannula
- 6-10 lpm face mask
- 10-15 lpm non-rebreather mask

Action:
- Reverse hypoxia
- increase tissue oxygenation and hemoglobin saturation

72
Q

Describe the GCS scale

A
  • EYE-OPENING (1-4 Points)
  1. Does not open eyes in response to anything.
  2. Opens eyes in response to painful stimuli.
  3. Opens eyes in response to voice.
  4. Opens eyes spontaneously.
  • VERBAL RESPONSE (1-5 Points)
  1. Makes no sounds.
  2. Incomprehensible sounds.
  3. Utters incoherent words.
  4. Confused, disoriented.
    Oriented, converses normally.
  • MOTOR ACTIVITY (1-6 Points)
  1. Makes no movements.
  2. Decerebrate (extensor) posture (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backward).
  3. Decorticate (flexor) posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest).
  4. Withdrawal from painful stimuli.
  5. Localizes to painful stimuli.
  6. Obeys commands.
73
Q

AVPU questions:

A
  • Person:

What is your name?
Who is this person with you?

  • Place:

Where are you right now?
What city are you in?

  • Time:

What is today’s date?
What day of the week is it?

  • Event:

What happened to you?
Do you know why EMS was called?

74
Q

List steps in rapid secondary assessment:

A
  • Inspect (look) for DCAP-BTLS
  • Palpate (feel) for tenderness, swelling, unusual chest movements, angulated extremities, bleeding
  • Auscultate (listen) for presence and equality of breath sounds
  • Listen for sucking sounds, gurling, stridor, and crepitation
  • Use your sense of smell to detect any unusual breath smells from mouth, body, clothing, etc.
75
Q

Under what circumstances would you perform a rapid secondary assessment?

A
  • significant MOI encountered at scene
  • PT has an AMS
  • unsure of extent of injury
  • cannot clearly identify MOI
  • multiple injuries are suspected
  • critical findings were identified in primary assessment
76
Q

Prior to rapid secondary assessment, what should be established first as part of scene size up?

A

Spinal motion restriction

77
Q

A&O x 4 includes:

A

Person, place, time, event

78
Q

List what each of the categories of AVPU mean?

A

A : Alert

  • Person, place, time, event

V: Verbal

  • PT respond with inappropriate words
  • PT responds with incomprehensible words
  • PT responds with eye opening or obeying a command
  • PT has no response to verbal stimulus

P: Pain

  • Purposeful movements at removing the stimulus
  • non purposeful movements such as flexion or extension away from stimulus
  • No response
  • U:
    Unresponsive
79
Q

A trachea shifted to one side is a late indication of ….

A

a significant amount of air trapped in the pleural space of the chest cavity

(the result of a severe lung or chest injury)

80
Q

Jugular Vein Distention (JVD) is a sign of …

A

serious injury to the chest, lungs, or heart

81
Q

What is the number one goal of primary assessment?

A

To identify and began treatment of imminent or immediate life threats

Aka

Identifying and treating life threats about to happen or happening currently

82
Q

What are the different parts of the primary assessment? (Long version)

A
  1. General Impression:
  • What’s going on in the scene
  • What’s going on with the PT
  • Treat Life threats immediately if found

(Observe PT age, gender, distress level and appearance)

  1. Assess level of consciousness

(Is the PT alert, oriented and awake is your PT
-What do they look like when they approach)

  • AVPU scale

(With ALERT
assess if they are A&O scale)

  1. Assess Airway, breathing, and circulation

ABC if no bleeding present
CAB if they have major bleed

  1. Perform rapid exam
  2. Determine Priority for patient care and transport
83
Q

How should I address yourself or the PT?

A
  • Get at PT’s level
  • say
    “ HI my name is Joseph, I am a EMT , whats your name and whats going on today?”
84
Q

What are the different parts of the primary assessment? (short version)

A
  1. SMNAC
  2. Primary Assessment:
  • General impression
  • AVPU
  • C/C or Life threats
  • ABC or CAB
  • Determine Priority for PT care and transport
    (LOAD AND GO or STAY AND PLAY)
  1. History Taking
  • SAMPLE
  • OPQRST

EMT 1 (14 decks)

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