patient assesment Flashcards
(what are different stages of grief?
-shock
-denial
-anger
-bargaining
-depression
-acceptance
what is the differance between visceral pain and referred pain?
visceral pain originates from internal organs while referred pain is pain felt in a location different from the source due to shared nerve
what kind of pain is described as dull, aching or squeezing and difficult to pinpoint?
visceral pain
what kind of pain happens in the same nerve and misinterprets where pain is coming from and give an example?
referred pain
example pain from a heart attack is felt on left arm
serious medical emergency occurs when someone vomits blood due to internal bleeding in the upper digestive tract
hematemesis
what are 2 types of ischemic strokes?
embolic and thrombolic
This stroke happens when blood clot forms elsewhere and travels to the brain
embolic
This stroke happens when a blood clot forms within a blood vessel in the brain
thrombotic
what is the purpose of PCR? (prehospital care report)
provides a legal record of the incident
example of CTAS 1 calls
-VSA
-cardiac arrest
-major trauma
-shock states
example of CTAS 2 calls
-Severe pain
-stroke
- head injuries
- asthma
- sexual assault
Example of CTAS 3 call
minor allergic reaction
suspected abuse and neglect what to do?
Document findings, provide details and identify injuries
most common type of child abuse is
neglect
large majority of child abuse is reported by?
outside resourses
common type of injury in child abuse is
soft tissue injury
what is internal sense of ones gender called?
gender identity
what conition is a medical condition where there isn’t enough blood flow to a part of the body, leading to a shortage of oxygen and nutrients?
ischemic
Something relating to or affected by the formation of blood clots within blood vessels
thrombotic
what is invasive ventilation?
placement of artificial airway
what is non invasive ventilation?
any form of mechanical ventilation without an artificial airway
What is inflation of stomach with air called?
gastric distention
during gastric distention would you get resistance on the BVM?
yes
what are the 2 tubes inserted into the stomach to remove contents with suction?
Orogastric tube and nasogastric tube
This is a small hole on the side of the endotracheal tube (ETT) it helps air flowing if the main opening of the tube gets blocked. This makes sure the patient can still breathe even if the tip of the tube is against something. Like the wall of the airway
Murphys eye
Explain how to insert an ETT?
-Insert it from the right side of the mouth and move the tongue to the left
-look for vocal cords ( white bands in the throat)
-continue to inset the tube until the proximal end of the cuff is 1-2 cm past the vocal cords
What is the cuff in an ETT?
The cuff is a small inflatable balloon near the end of the ETT. After the tube is placed, the cuff is inflated to seal the airway, preventing any air from leaking and stopping fluids from entering the lungs
What is CPAP
Stands for continuous positive airway pressure. It is a noninvasive way to help a patient breathe by delivering air through a tight fitted mask
When is CPAP used?
It is used when a patient is having trouble breathing but still breathing in their own
What conditions is CPAP used for?
- congestive heart failure ( helps push fluid out of the lungs
-COPD ( keeps airway open and prevents collapse - Asthma ( reduces airway resistance)
- pneumonia ( helps oxygen get into the lungs)
Sleep apnea ( prevents airway collapse during sleep
Indications for CPAP
- person is alert and able to follow commands
- moderate to severe respiratory distress
- pulse oximetry of less than 90%
Contraindications for CPAP
- patient is unresponsive
- respiratory arrest or agonal respirations
- patient unable to speak
- Hypoventilate or hypotention
Most CPAP devices are set to deliver a fixed FiO2 level of?
30-35%
Explain the parameters and modes of the ventilators
Mode- how the ventilator interacts with the patient
Parameter - resp rate ( RR) tidal volume ( VT) O2 % I spirally time Ti and peak inspiration pressure ( pip)
what are indications for ventilators?
-apnea
-ventilatory &respiratory failure
what are potential negative effects of ventilators?
- increased Intrathoracic pressure
-pneumothorax (barotrauma)
-reduced blood flow
how many vertebraes in:
cervical
thoracic
lumbar
sacrum
coccyx
cervical - 7
thoracic - 12
lumbar - 5
sacrum - 5
coccyx - 4
What’s lordosis
An excessive inward curvature of the spine, usually in the lumbar region ( lower back) leading to a swayback appearance
What is kyphosis
An excessive outward curvature of the spine usually in the thoracic region ( upper back) leading to a hunched posture
What is scoliosis
A sideways ( lateral) curvature of the spine, often appearing as an “s” or “ c “ shape when viewed from the back
How do you assess the spine?
Palpate the spine when the patient is supine or on one side. Use the thumb to touch each spinous process
What are the two types of nervous system?
Central nervous system ( CNS)
Peripheral nervous system ( PNS)
This consists of the brain and spinal cord. It processes information and controls body functions
Central nervous system ( CNS)
This consists of nerves outside the CNS that connect the brain and spinal cord to the rest of the body
Peripheral nervous system ( PNS)
The peripheral nervous system includes which 2 nervous systems?
Somatic nervous system ( SNS)
Autonomic nervous system ( ANS)
This nervous system controls voluntary movements eg: moving your arms
Somatic nervous system
This nervous system controls involuntary functions eg: heart rate, digestion
Autonomic nervous system ( ANS)
The autonomic nervous system is divided into what 2 nervous systems?
Sympathetic nervous system
Parasympathetic nervous system
What is sympathetic nervous system in charge of?
Flight or flight response
What is the parasympathetic nervous system in charge of?
Rest and digest response
3 main parts of the brain are?
Remember CBC
( think, balance, survive)
Cerebrum - cognition ( thinking memory, voluntary movement)
Brainstem - breathing ( heart rate breathing survival functions)
Cerebellum - stability ( balance, coordination, fine movements)
All nerves with the exception of cranial nerves are channeled to the brain via ?
The spinal cord
These nerves carry signals to the brain eg: feeling pain heat cold or touch
Sensory nerves
These nerves carry signals from the brain to the muscles eg: moving arms, legs or blinking
Motor nerves
These are special nerves that connect directly to the brain not the spinal cord. Controls head and neck functions like facial expressions, eye movement and swallowing eg: smiling tasting food hearing sounds
Cranial nerve
What are the 12 cranial nerves in order?
Mnemonic to remember them in order is “ oh oh oh, to touch and feel very green vegetables, AH!”
Olfactory ( CN 1) - smell test
Optic ( CN 2) - vision test
Oculomotor ( CN 3) - pupil reaction and eye movement
Trochlear ( CN 4) - eye movement (downward)
Trigeminal ( CN 5) - facial sensation and jaw movement
Abducens ( CN 6) - eye movement. (Lateral eye movement)
Facial (CN 7). - facial expressions ( test: smile raise eyebrows)
Vestibulocochlear ( CN 8) - hearing and balance
Glossopharyngeal ( CN 9) - gag reflex and taste
Vagus ( CN 10) - voice and swallowing
Accessory ( CN 11) - shoulder shrug and head turn
Hypoglossal ( CN 12) - tongue movements
The neurological exam, at a bare minimum you should:
- determine the patients baseline mental status
- cranial nerve function
- Distal motor function
- distal sensory function
In trauma global changes in mental status are more indicative of?
Intracranial mass lesions ( brain issue)
In trauma decreased extremity motor function is more indicative of?
A spinal lesion ( a spinal cord issue)
This occurs when blood flow to the brain is either cut off or reduced, resulting in lack of blood and oxygen to the brain
A stroke
What’s the leading cause of adult disability?
Stroke
This kind of stroke happens due to blockage in an artery preventing normal blood and oxygen flow to the brain
Ischemic stroke
87% of strokes are?
Ischemic
What are two types of Ischemic strokes?
Embolism
Thrombosis
This kind of strike happens when blood clot or plaque fragment from elsewhere in body gets lodged in the brain
Embolism
In this kind of stroke blood clot formed in one place and blocks a blood vessel where it forms
Thrombotic
This stroke happens when a blood vessel in the brain bursts causing bleeding inside the brain
Hemorrhagic stroke
What are 2 types of hemorrhagic strokes?
Intracerebral hemorrhage
Subarachnoid hemorrhage
This is the most common type of hemorrhagic stroke, it occurs when a blood vessel inside the brain bursts and blood spills into the brain tissue itself. This disrupts brain function and can cause swelling, brain damage or even death
Intracerebral hemorrhage
In this kind of hemorrhagic stroke a blood vessel bursts near the surface of the brain and blood collects up outside of the brain between the brain and skull
Subarachnoid hemorrhage
What’s a ministroke called?
Transient Ischemic attack ( TIA)
This kind of stroke produces stroke like symptoms, it’s caused by a blood clot, no permanent damage, approximately 15% of all strokes occur after this stroke and it is a medical emergency
TIA ( transient ischemic attack)
What are controllable risk factors of a stroke?
High blood pressure
High cholesterol
Diabetes
Tobacco use
Alcohol use
Physical inactivity
Obesity
Heart disease
Atrial fibrillation
What are non controllable risk factors for a stroke?
Age
Gender
Race
Family history
Previous stroke or TIA
What are common stroke symptoms?
-Slurred speech
-Weakness or numbness to unilateral face arm or leg
-aphasia ( mute)
-unilateral facial droop
-Swallowing problem
What symptoms accompany hemorrhagic stroke?
- severe headache
-nausea - vomiting
- LOC
- pupils ( unequal, sluggish, fixed/dilated)
- intolerance to lights
What are stroke mimics ( you’d think it’s a stroke but it’s not)
-alcohol intoxication
-cerebral infraction
-drug OD/toxicity
-epidural hemtoma
-hypogycemia
-metabolic disorder
-Neuropathies ( Bell’s palsy)
-seizure and post seizure
-brain tumor
What are stroke treatment options
- medical management - IV - tPA is the clot busting drug
Intra arterial thrombolysis - is a technique where doctors use catheter to administer tPA directly into blood clot blocking blood flow to part of the brain
Mechanical thrombectomy - uses a device to retrieve the clot
Los Angeles motor scale ( LAMS)
Facial droop
-absent = 0
-present = 1
Arm drift
-absent = 0
-drifts down = 1
-falls rapidly = 2
Grip strength
-normal = 0
-weak = 1
-no grip = 2
What do you do to evaluate joints for obvious deformity?
Diminished strength, atrophy ( shrinking) or asymmetry
How to diagnose shoulder
How to assess shoulder problems?
-Often can be determined
By noting the patients posture
-glenohumeral joint dislocation may manifest as the loss of normal contour of the shoulder
-check the patients range of motion
For what problem do we do this assessment?
- palpate between the epicondyles and the olecranon
Elbow problems
For what kind of problem would we inspect and compress the metacarpophalangeal joints and check capillary refill, symmetry of radial pulses and overall limb temperature?
Hand and wrist problems
For what kind of problem would we identify any shortening and or rotation
Knee and hip problems
In what kind of problem would we measure distal pulses over the dorsalis pedia and posterior tibialis. Assess capillary refill and overall limb temperature
Ankle and feet problem
What does the peripheral vascular system consist of?
Just remember this mnemonic “all veins can leak”. ( AVCL)
Arteries
Veins
Capillaries
Lymphatic vessels
These carry oxygen rich blood away from the heart
Arteries
These carry oxygen poor blood back to the heart
Veins
These are tiny vessels where oxygen and nutrients change with tissues
Capillaries
These drain excess fluid and help fight infection
Lymphatic vessels
-This is a small structure, which is not palpable on external examination
- hollow muscular organ
- opens via the cervix into the vagina
Inner lining thickens in response to hormonal stimulation
- receives sperm via the vagina and cervix
Uterus
Testes, reproductive ducts, prostate, penis, urethra and scrotum are parts of?
Male genitalia
- filled with shock absorbing linings and fluid
- held together by ligaments
- allows the body to perform mechanical work
Joints
What problem can be determined simply by noting the patients posture
Shoulder problem
What joint in the shoulder, when dislocated may manifest as the loss of normal contour of the shoulder
Glenohumeral
When would you palpate between the epicondyles and olecranon?
To check for elbow problems
What would you be checking for when you
- compress the metacarpophalangeal joints
- check capillary refill, symmetry of radial pulses and overall limb temperature
Hand and wrist problems
When would
You identify any shortening and or rotation in the lower extremity?
Knee and hip problem
This is a part of your circulatory system which moves blood through your body. It includes all blood vessels outside the brain and heart, specifically the arteries, veins and capillaries that supply oxygen and nutrients to your arms, legs and organs
Peripheral vascular system
These carry oxygen rich blood away from the heart
Arteries
These carry oxygen poor blood to the heart
Veins
These tiny vessels are where oxygen and nutrients pass into tissues
Capillaries
What artery supplies the heart?
The coronary artery
What arteries supply the brain?
Carotid and vertebral arteries
This is a crucial part of the body’s immune system and fluid balance.
Lymphatic system
What are the 5 Ps of acute arterial insufficiency?
Pain
Pallor
Parasthesia
Poikilothermia
Pulselessness
What is the body’s master control system?
Nervous system
All nerves except the cranial nerves are channeled to the brain via?
The spinal cord
These nerves receive external signals and send them to the brain for processing and motor response
Sensory nerves
These nerves run from the spinal cord to the body outwardly
Motor nerves
These nerves run from the body to the cord inwardly
Sensory nerves
These nerves go directly to and from the brain
Cranial nerves
This system is a division of the peripheral nervous system that controls involuntary bodily functions such as heart rate, digestion and respiration. It operates without conscious control
Autonomic nervous system ( ANS)
What are the 2 autonomic nervous system
Sympathetic nervous system
Parasympathetic nervous system
-fight or flight
-prepares the body for stress or emergencies
-dilates pupils and bronchioles
-releases epinephrine (adrenaline) from the adrenal glands
Sympathetic nervous system
-Rest and digest
-promotes relaxation and energy conservation
-decreases heart rate and blood pressure
-stimulates digestion, salivation and urination
- constructs pupils and bronchioles
Parasympathetic nervous system
An electrocardiogram (ECG) records the electrical activity of the heart using ……………. On the skin. …………. Refers to how this electrical activity is captured and represented, while …………….. involves interpreting the ECG waveform to assess heart function
Electrodes
Encoding
Decoding
What technique to use when delivering a patient report?
SBAR (situation, background, assessment, recommendation)
Vital times to be kept and documented
Time of call
Time of dispatch
Time of arrival at the scene
Time with patient
Time of medication administration
Time of departure from the scene
Time of arrival at medical facility
Time back in service
Abdominal edema typically caused by liver failure
Ascites
An abnormal whoosh like sound of turbulent blood flow moving through a narrowed artery
Bruit
Distinct areas of skin that correspond to specific spinal or cranial nerve levels where sensory nerves enter the central nervous system
Dermatomes
Localized bruising or blood collection within or under the skin
Ecchymosis
Contraction of the abdominal muscles in patients
Guarding
The perception that the heart is beating very strongly, felt upon palpitation of the chest wall, this finding suggests hypertrophy, also called a lift
Heave
Protrusion of any organ through an opening into an body cavity where it does not belong
Hernia
A blotchy pattern in skin caused by vasoconstriction or inadequate circulation, a typical finding in states of severe protracted hypoperfusion and shock
Mottling
An abnormal whoosh like sound heard over the heart that indicates turbulent blood flow around cardiac valve
Murmur
Lack of colour, paleness
Pallor
A fracture that occurs in an area of bone that has been abnormally weakened by a medical condition, such as metastatic cancer, or the use of corticosteroids
Pathological fracture
The delivery of oxygen and nutrients to the cells, organs and tissues of the body. Also involves the removal of wastes
Perfusion
A fracture that occurs when abnormal forces are applied to normal bone structures
Physiologic fracture
Reflex reactions such as babinski, grasping and sucking signs, normally found in very young patients
Primitive reflexes
The wave of pressure created as the heart contracts and forces blood out of the left ventricle and into the major arteries, palpated at a point where an artery passes close to a bone
Pulse
Involuntary motor responses to specific sensory stimuli, such as tapping the knee or working the eyelash
Reflexes
Redness, one of the classic signs of inflammation
Rubor
Lung sound produced by a partial loss of intrapleural integrity, when an abnormal collection of fluid has accumulated between a portion of the visceral and parietal pleural, resulting in pleuritic pain
Rubs
A harsh, high pitched, crowing inspiratory sound, such as the sound often heard in acute laryngeal obstruction
Stridor
A humming vibration that can be palpated through the chest wall, suggesting an underlying bruit or murmur
Thrill
Narrowing of a blood vessel, such as with hypoperfusion or cold extremities
Vasoconstriction
Widening of the diameter of a blood vessel
Vasodilation
The ability or inability to see, and how well one can see
Visual acuity
The impairment of language that affects the production or understanding of speech and the inability to read or write
Aphasia
If a thoracic aneurysm is suspected perform …………..
Bilateral blood pressures
This is a fracture that is not immediately visible on x rats. It is often small or hidden within complex bone structures, making it difficult to detect
Occult fracture
Partial or complete blockage of a blood vessel leading to reduced or obstructed blood flow
Vascular occlusion
These conditions can be benign or malignant and involve abnormal growth of placental tissue. It’s a rare group of disorders that arise from abnormal trophoblastic cells which are a part of the placenta during pregnancy
Gestational trophoblastic disease ( GTD)
This occurs when a fertilized egg implants itself outside the uterus most commonly in the fallopian tube
Ectopic pregnancy
A soaked normal size pad or tampon can hold approximately how much blood?
5 ml
Normal blood loss during menstruation is?
10- 35 ml
Serious conditions that may mimic a stroke
-Drug ingestion
-Hypoglycemia
-Severe hypertension
-Central nervous system ( CNS) infection eg: meningitis
If ETCO2 is unavailable and a patient shows signs of cerebral herniation hyperventilate the patient as follows:
Adult - 20 breaths a per minute
Child - 25 breaths per minute
Infant - 30 breaths per minute
Signs of cerebral herniation include a deteriorating GCS <9 with any of the following
1: dilated and unreactive pupils
2: asymmetric pupillary response
3: a motor response that shows either unilateral or bilateral decorticate or decerebrate posturing
If signs of cerebral herniation attempt to maintain ETCO2 values at
30-35 mmHg
This refers to the manner or pattern of walking including the rhythm, speed and coordination of movement
Gait
