Module 4- Patient Assessment Flashcards
What is the acronym for Patient assessment with Trauma patients?
“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
Define OPQRST?
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
Define SAMPLE:
S - signs and symptoms
A - allergies
M - medications
P - past medical history
L - last oral intake
E - Events prior to this event
What 2 acroynms are used for obtaining history from patient and what are they used for ?
SAMPLE : used for systematically obtaining Patients pertinent history
OPQRST: used to get more information about the pain/injury
Explain what pulse oximetry measures:
The amount of Oxygen in a persons blood
Describe factors and limitations in interpreting pulse oximetry findings
Factors:
- Sufficient Perfusion
- Normal body temp.
- 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
How do you use pulse oximetry to help determine the need for supplemental oxygen?
It can tell how much oxygen is in the blood indirectly which can let you know if PT needs supplemental oxygen
What vital signs do you obtain that are a part of your BASELINE vital signs?
- Respiration
- Pulse rate
- Skin
- Capillary refill
- Pupils
- Blood pressure
- Pulse Ox (SpO2)
- Body temperature and blood - - glucose
- Pain scale
- Capnography
What is the normal range of “Heart rate” for Adults, elderly, children and infants?
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
What is normal range for ETCO2 rate?
35-45
What is the normal range of “Respiration rate” for Adults, elderly, children and infants?
Adults : 12-20
Adolescent (12-15): 12-20
School-age child (6-11): 18-25
Preschooler (3-5): 20-28
Toddler (1-2): 22-37
Infant (>1 month) : 30-53
Neonate: 40-60
What is the normal range of “Blood pressure” for Adults, elderly, children and infants?
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
For pupils,
what are you looking for in the PT?
Reactivity, size and equal on both sides
Abnormal : constricted versus constricted
What causes
- dilated pupils
- pinpoint pupils
- unequal pupils
- non reactive pupils
- Dilated pupils:
Cardiac arrest, drug use (LSD, cocaine, amphetamines)
- pinpoint:
CNS disorder, narcotics use (oxy, heroine, fentanyl)
- Unequal:
Stroke, head injury
- Nonreactive :
Cardiac arrest, brain injury, drug intoxication, overdose
What are the 5 steps in Primary Patient Assessment?
- Form a general impression of the patient
- Assess level of consciousness (AVPU)
- Determine C/C
- Support ABC’s
- Decision on load&go or stay&play
When is it recommended to check the blood glucose level
- When the PT AVPU or GCS is abnormal
- If they are diabetic PT
What 3 things are assessed for respiration?
- Rate
- Rhythm
- Quality
What factors make up the vital signs?
- Responsiveness:
AVPU, GCS
- Respiratory:
Respiratory rate, depth, Pulse OXimetry
- Cardiovascular:
Blood pressure, pulse
- Others:
Pupils, Blood glucose, neurogenic functions (PMS)
What 3 sounds are heard without a stethoscope?
Snoring
Gurgling
Stridor or crowing
What 3 sounds are heard with a stethoscope?
Wheezing
Crackles (Rales)
Rhonchi
What potentially causes Snoring?
Tongue partially blocking the upper airway at the level of the pharynx
What potentially causes Gurgling?
Fluid in the upper airway
What potentially causes Stridor/Crowing?
Partial obstruction of the upper airway at the level of the larynx
What potentially causes Wheezing?
Constriction (narrowing) and inflammation reducing the internal diameter of the bronchioles in the lungs
What potentially causes Crackles (Rales)?
Fluid surrounding and filling the alveoli
What potentially causes Rhonchi?
Mucus blocking the larger bronchioles
Define open ended questions and closed ended questions:
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
When assessing pulse rate and/or respirations, if the medic notes an irregularity, how long should that medic count to obtain an accurate reading?
Full Minute
What are the five components of SCENE-SIZE UP?
- Standard precautions
- Assess for safety hazards
- Determine MOI/NOI
- Number of patients
- Determine need for additional resources
Explain the purposes and goals of performing a scene size-up on every EMS call
- to keep EMT and PT safe
- to know what resources are needed
How do you determine the pulse rate?
count for 30 seconds x 2
What are the 4 types of Pulse Quality and their descriptions?
Thready - weak and rapid
Weak - as stated
Strong - Normal finding
Bounding - Usually Strong
What 4 qualities do you assess skin for
“CCCT”?
Color
Condition
Capillary Refill
Temperature
What are the importance of taking accurate vital signs?
- Accurate vital signs gives EMT a accurate picture of what is going on with the PT
Explain the process of auscultating lung sounds?
What are the different Pulse Points With patient’s age and level of responsiveness?
Birth -1 year: Brachial
> 1 year : Radial
Explain systolic and diastolic blood pressure:
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
how do you perform orthostatic blood pressure?
- Place PT in supine position and take blood pressure and heart rate
- Stand PT up and after 2 minutes reassess BP and HR
- Positive finding:
If HR increases by 10-20 bpm and Systolic blood pressure decreases by 10-20 mmHg
Why would performing orthostatic blood pressure be necessary?
It would be necessary to determine if there has been significant loss of blood or fluid volume in PT
What is a positive finding with orthostatic blood pressure and what does it indicate?
positive finding is
- HR increases by 10-20 bpm
Systolic BP decreases by 10-20 mmHg - Indicates that significant fluid loss has occurred
Define and describe the mechanism of injury and nature of illness:
(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
When should you have a high index suspicion for injuries?
- 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
What are the different types of skin colors and their causes?
Pallor (White) - Shock, blood loss
Cyanosis (Blue/gray) - inadequate of oxygenation
Flushing (Red)- Heat exposure/late CO2 poisoning
Jaundice (Yellow)- Liver disease
Mottling (grey-blue) - circulatory issues, infections, autoimmune disorders, etc
What are the 4 types of pupil reactive states and their causes?
- 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
What is the pneumonic for GCS scale?
E - 4 - 1
V - 5 - 1
M - 6 - 1
E (Eye)
V (Verbal)
M (Motor)
What is AVPU?
A - Alert
V - Verbal
P - Pain
U - Unresponsive
What is GCS scale
?
The Glasgow Coma Scale (GCS) is used to rank the patient’s level of consciousness by assigning a numeric score from to 3-15
What scale is used to assess mental status and PT’s level of consciousness?
AVPU = Mental status
GCS Scale = Level of consciousness
What are the blood pressure rates (systolic) that indicate HYPOtensive by age?
Adult
Children (10-18 yo)
Children (1-10 yo)
Infants - 1 yo
Adult: <90
Children (10-18): <90
Children (0-10 yo): <70
Infants - 1 yo: < 60
what does DCAP-BTLS stand for?
D - Deformities
C - Contusions
A - Abrasions
P- Punctures and Penetrations
B- Burns
T - Tenderness
L- Laceration
S- Swelling
What are the 5 rights of medication administration?
the right patient
the right drug
the right dose
the right route
the right time
What are the three main steps in a secondary exam?
Physical exam
Baseline Vital signs
History
What is the pneumonic for Scene Size up?q m a
SMNAC
S - scene safety
M- MOI/NOI
N- # of patients
A- additional resources
C - C spine consideration
What are the steps in Patient assessment?
- Scene size up with and Consider SMR (Spine Mobile restriction)
- Primary assessment
- Decide to “Load and Go” or “Stay and play”
- Perform secondary assessment
How often should you reassess vitals in high priority and low-priority patients?
High Priority: Every 5 minutes
low-Priority: Every 15 minutes
Explain the four ways in which primary assessment can go:
Non-threatening life Injuries
- Modified Medical:
- Modified Trauma
Life threatening Injuries:
- Rapid Trauma:
- Rapid Medical
What are the different locations of the pulses?
Central pulses:
- Carotid artery
- Femoral artery
Peripheral Pulses:
- Radial artery
- Brachial Artery
- Popliteal Artery
- Posterior Tibial Artery
- Dorsalis Pedis Artery
Where can each of the 7 pulse locations be felt at
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.
What is normal range for blood sugar?
70-140
What are the 3 components of the Secondary Assessment?
(PBH)
- Physical exam
- Baseline vitals signs
- History
What is the 4 A&O?
PT is oriented to :
Place: address/city/state
Time: date/year/month
Person: what is your name
Events: current events in the world or day
What are the two types of electrodes in a 12-lead?
Limb Electrodes (4):
-RA, LA, RL, LL
Precordial Electrodes (6):
- V1,V2,V3,V4,V5,V6
How to do a 4 lead?
(Salt and pepper)
RA, LA
(Christmas tree) “Presents go underneath”
LL,RL
Where do the leads go on a 12 - lead?
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)
What is the following for Nitroglycerin:
Indications:
Contraindications:
Medication form:
Dosage:
Action:
Side effects:
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
Define the following terms in regards to medication:
Indication
Contraindication
Dose
Administration
Action
- 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
Describe the difference between the objective and subjective signs and symptoms?
Objective information:
is measurable or verifiable in some way
Subjective information:
is based on an individual’s perceptions or interpretations
What is DCAP-BTLS ?
is an acronym used by first responders to assess a patient’s soft tissue injuries and conditions
what does DCAP-BTLS stand for ?
D- Deformities
C- Contusions
A- Abrasions
P- Punctures/Penetrations
B- Burns
T- Tenderness
L- Lacerations
S- Swelling
Define the following terms in regards to medication Oxygen:
Indication
Contraindication
Dose
Administration
Action
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
Describe the GCS scale
- EYE-OPENING (1-4 Points)
- Does not open eyes in response to anything.
- Opens eyes in response to painful stimuli.
- Opens eyes in response to voice.
- Opens eyes spontaneously.
- VERBAL RESPONSE (1-5 Points)
- Makes no sounds.
- Incomprehensible sounds.
- Utters incoherent words.
- Confused, disoriented.
Oriented, converses normally.
- MOTOR ACTIVITY (1-6 Points)
- Makes no movements.
- Decerebrate (extensor) posture (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backward).
- 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).
- Withdrawal from painful stimuli.
- Localizes to painful stimuli.
- Obeys commands.
AVPU questions:
- 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?
List steps in rapid secondary assessment:
- Inspect (look) for DCAP-BTLS
- Palpate (feel) for tenderness, swelling, unusual chest movements, angulated extremities, bleeding
- Auscultate (listen) for presence and equality of breath sound, sucking sounds, gurling, stridor, and crepitation
- Use your sense of smell to detect any unusual breath smells from mouth, body, clothing, etc.
Under what circumstances would you perform a rapid secondary assessment?
- 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
Prior to rapid secondary assessment, what should be established first as part of scene size up?
C spine consideration
A&O x 4 includes:
Person, place, time, event
List what each of the categories of AVPU mean?
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
A trachea shifted to one side is a late indication of ….
a significant amount of air trapped in the pleural space of the chest cavity
(the result of a severe lung or chest injury)
Jugular Vein Distention (JVD) is a sign of …
serious injury to the chest, lungs, or heart
What is the number one goal of primary assessment?
To identify and began treatment of imminent or immediate life threats
Aka
Identifying and treating life threats about to happen or happening currently
What are the different parts of the primary assessment? (Long version)
- 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)
- 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)
- Assess Airway, breathing, and circulation
ABC if no bleeding present
CAB if they have major bleed
- Perform rapid exam
- Determine Priority for patient care and transport
How should I address yourself or the PT?
- Get at PT’s level
- say
“ HI my name is Joseph, I am a EMT , whats your name and whats going on today?”
What are the different parts of the primary assessment? (short version)
- SMNAC
- 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)
- History Taking
- SAMPLE
- OPQRST
