PARAMED. CH 13 Pt Assessment Flashcards
Field Impression
Based on patient history and chief complaint.
What you THINK is the problem.
Scene Size Up
Evaluate the overall safety and stability of emergency scene
Access and Egress
Enter and exit. Consider a ‘snatch and grab’ by doing absolute least to secure patient.
Methemphetamines
Growing numbers of abuse. Can become violent. Talk a lot.
MOI
Mechanism of Injury - way in which trauma occurs
NOI
Nature of Illness - general type of illness a patient is experiencing
Multiple Patients same symptoms
Food poisoning or Carbon Monoxide posioning
Primary Assessment
Most time intensive portion of Assessment. Focus on and manages life threats in 60-90 seconds. (ABC’s)
General Impression
Based almost solely on patient presentation and chief complaint
Observations of patient
Made in conscious objective and systematic manner
Mental Status
AVPU Alert Verbal Pain Unresponsive
Skin Color Red
Fever, Hypertension, Allergic Reactions, and CO Posioning
Skin Color White
Hypovolemic and Fright
Skin Color Blue
Hypoxemia
Skin Color Mottled
Shock
Vessels Dialate
Skin becomes warm and pink.
Vessels Constrict
Skin becomes pallor or white
Dryness or moisture of skin
Determines by sympathetic nervous system
Skin hot, dry
Excessive heat (heat stroke)
Skin hot, wet
Increased internal temperature
Skin cool, dry
Exposure to cold
Skin cool, wet
Shock
Rapid Exam
Quick thorough palpating of body in 60-90 seconds
High Priority Patients
Poor general impression, unresponsive, altered, impaired breathing, hypoperfusion, childbirth, chest pain with systolic less than 100, uncontrolled bleeding, severe pain, multiple injuries
Patient Hx
Gain info. About pt and learn events surrounding incident
Chief Complaint
Why someone called 911 today
Hx of Present Illness
OPQRST and SAMPLE
Signs and Symptoms
What happened and when
Past Medical Hx
Learn about pt’s pertinent or chronic underlying medical conditions
Pertinent Negatives
A lack of certain signs and symptoms ( nausea vomiting LOC SOB chest pain diarrhea )
Diplopia
Blurred Vision
Tinnitus
Ringing in ears
Rhinnorhea
Runny nose
Polydipsia
Excessive Thirst
Polyphagia
Excessive Hunger
Hemoptysis
Coughing up blood
Coughing
Color or phlegm being produced
Cardiac
Questions towards heart and vessels, orthopnea, edema and past cardiac hx
Hematology
Hx of blood (anemia, bruising)
Lymph Nodes
Swell due to infections with release of WBC’s
Hematemesis
Blood in vomit
GI/GU
Ask about… appetite, digestion, bowel movements, food allergies, diarrhea, bowel regularity, changes in stool ( size shape smell Color), flatulence, jaundice and past GI Hx
Dysuria
Painful urination
Nocturia
Night pee
Hematuria
Blood in urine
Neurologic
Ask about… Hx seizures or syncope, loss of sensation, weakness in extremities, paralysis loss of coordination or memory, muscle twitches or tremors, facial assymetry
Differential Diagnosis
Working hypothesis of nature of the problem
Facilitation
Use techniques to make patient feel open
Reflection
Pausing to cinsider something significant told
Clarification
Asking about more hx when something is unclear or vague
Confrontation
Make pt aware that something is not consistent with their behavior
Interpretation
Inferring cause of pts distress then asking pt if inference is correct
Neonates
Ask about congenital anomalies, feeding issues, jaundice, Illness or developmental landmarks
Secondary Assessment
Objective information is obtained
Blood Pressure
Force exerted on walls of vessels. Product of cardiac output and peripheral vascular resistance
Systolic
Created by LV when contracting
Diastolic
Residual pressure in system when LV is at rest
Low Diastolic
Means less myocardial perfusion
Temperature
Beware of extrinsic factors that could alter readings. Earwax.
Pulse Oximetery
Measures amount of oxygen attached to h Hemoglobin in the blood
Full Body Exam
Head-to-toe Exam that includes both looking and palpating
Focused Exam
Performed on no significant MOI or responsive medical patients
A&O
Person place day and event,
GCS
Eye, Verbal, Motor,
Chest pain
Evaluate…. skin, pulse, blood pressure, trauma, assess Jvd, listen to breath sounds, assess pedal edema
Abdominal pain
Evaluate… skin, pulse, bp, look trauma, palpate
SOB
Evaluate… skin, pulse, bp, rate and depth of breathing, assess airway obstruction, listen to breath sounds, assess hypoxemia, assess pedal edema
Dizziness
Evaluate… skin, pulse, bp, adequacy of respirations, LOC, check head for signs of stroke, facial droop, slurred speech, one sided weakness. Hx inner ear problems
GCS Eye Opening
Spontaneous = 4 Verbal = 3 Pain = 2 None = 1
GCS Verbal Response
Oriented = 5 Confused Convo = 4 Speak Nonsense = 3 Mumbles = 2 None = 1
GCS Motor Response
Follows = 6 Localizes = 5 Withdraws = 4 Decorticate = 3 Deceberate = 2 None = 1
Skin in cold environment
Shunts blood away from skin by vasoconstriction
Skin in hot environment
Radiates heat from the body by dialate vessels and bringing closer to the surface of skin
Skin layers
2 layers - Dermis and Epidermis
Turgor
Pulling skin to see withdrawal. In older patients use skin in the chest
Pallor
Present when RBC perfusion to capillary beds of skin is poor (lips or conjunctiva)
Cyanosis
Observed best in face, lips, eyes, nails
Edchymosis
Localized bruising or blood collection under skin
Nail Beau Line
Transverse depressions - severe infection
Nail Clubbing
COPD
Nail Psoriasis
Discoloration and pitting - autoimmune disease
Visual Acuity
Check each eye in isloation
Battle Sign
Discoloration and tenderness of mastoid process
Adventitious Breath sounds
Pathological breath sounds
Wheezing
High pitched whistling sound. If unilateral aspirated foreign body is suspected. If bilateral, suspect asthma.
Rales
Wet breath sounds indicate cardiac failure or infection. (Crackles)
Rhonchi
Congested breath sounds. Low pitch and rattling quality. Indicates fluid in larger airways. Also may indicate aspiration of fluid.
Stridor
Crowing sound often heard without stethoscope. Narrowing, swelling, or obstruction of upper airway. Indicates epiglotittis, croup, inhalation burns, partial foreign body obstruction.
Splitting
Hearts creates two different sounds when beating
S1
“Lub” closure of mitral and tricuspid valves at start of systole.
S2
“Dub” closure of aortic and pulmonary valve at end of systole
S3
Abnormally increasing filling pressures in the atria secondary to moderate to severe heart failure
S4
“Gallop” rhythm, moderately pitched sound occurs before S1. Indicates decreased stretching compliance of the LV or increased pressure in the atria
Korotkoff Sounds
Related to pts bp. Only can hear first and fifth sounds
Bruit
Abnormal whoosh that indicates turbulent blood flow moving through narrow artery
Murmur
Abnormal whoosh like sound heard over heart that indicates turbulent blood flow around cardiac valve
LUQ Pain
Ruptured spleen and/or sickle cell crisis and mononucelosis
LLQ Pain
Especially w, hx of vomiting, constipation, nausea, and fever => diverticulitis
LRQ Pain
Appendicitis
Generalized abdominal pain in Women
Ectopic pregnancy, ruptured ovarian cyst
Orthostatic vitals
tilt test or standing. Volume depleted pt’s cant move fluid to core with normal sympathetic response. Decrease up to 20mmHg and increase in pulse by 20 beats per minute
Ascites
Collection of fluid within abdominal cavity. Typically seen with liver disease
Pathologic Fracture
Normals forces break bone
Physiologic Fracture
Abnormal forces break bones (MVA)
Lordosis
Inward curve of back
Kyphosis
Outward curve of back
Scoliosis
Abnormal wave of back
Primitive Reflexes
Babinski, grasping and sucking signs. Indicates separation of cerebral cortex and brainstem
Cranial Nerve One - Olfactory is
Smell
Cranial Nerve Two - Optic is
Sight
Cranial Nerve Three - Oculomotor is
Pupil constriction
Cranial Nerve Four - Trochlear is
Eye movements
Cranial Nerve Five - Trigeminal is
Chewing. Face, sinuses, teeth.
Cranial Nerve Six - Abducens is
Eye Movements
Cranial Neve Seven - Facial is
Facial Movements
Cranial Nerve Eight - Vestibulocochlear is
Hearing and Balance
Cranial Nerve Nine - Glossopharyngeal is
Tongue, Throat and Ear.
Cranial Nerve Ten - Vagus is
Everything
Cranial Nerve Eleven - Accessory is
Shoulder and Neck movements
Cranial Nerve Twelve - Hypoglossal is
Tongue, Throat and Neck movements
Proprioreception
Understanding and interpretation of an extremity and is part of cerebellum.
Delirium
Actually Sudden Change in menta status.
Dementia
Disease ridden
Parasthesias
Tingling or sensory changes. Indicates spinal lesion.
Dermatones
Distinct areas of skin where sensations correspond to nerves
Becks Triad
Narrowed pulse pressure, muffled heart tones, and JVD associated with cardiac tamponade
Cushings Triad
Slowing pulse, rising BP, abnormal respirations indicates head trauma
