Patient Assesment Flashcards
What are five steps of patient assessment for trauma patients?
Scene size up Initial assessment Focused history/physical exam Detailed physical exam Ongoing assessment
What are five objectives of scene size up?
BSI/Scene Safety Mechanism of injury/nature of illness Number of patients Request additional assistance Consider C-spine immobilization
What are three factors to evaluate the mechanism of injury of the patient?
The amount of force applied to the body
The length of time the force was applied
The area of the body involved
What are four objectives of initial assessments?
Form a general impression of the patient
Assess mental status
Assess ABCs
Identify priority patients
What does obtunded mean?
The patient does not perceive the environment fully and responds to stimuli appropriately but slowly
What does stuporous mean?
The patient is aroused by intense stimuli only. Motor response and reflex reactions are usually intact unless the patient is paralyzed
For alert patients, what four things do you check to assess the patient’s orientation?
Memory of: Person (who they are) Place (where they are) Time (day,month,year) Event (what happened)
What three things do you check for when assessing circulation?
Pulse
Bleeding
Skin condition (temp, moisture, color)
What is the lining of the eyelid called?
Conjunctiva
What are the three steps in a focused history/physical exam for trauma patients with a significant mechanism of injury?
Rapid trauma assessment
Baseline vitals/SAMPLE
Transport
What are the three steps of focused history/physical exam for patients with no significant mechanism of injury?
Focused assessment based on chief complaint
Baseline vitals/SAMPLE
Transport
What are three goals of focused history/physical exam?
Identify the patient’s chief complaint
Understand the specific circumstances surrounding the chief complaint
Direct further physical examination
What are occult injuries?
Injuries you can’t see with your eyes
What does DCAP-BTLS stand for?
Deformities Contusions Abrasions Puncture/penetration Burns Tenderness Laceration Swelling
What is subcutaneous emphysema?
Air under the skin
What are retractions?
When the skin pulls around the ribs during inspiration
What is paradoxical motion?
When one section of the chest falls on inspiration while the remainder of the chest rises
What is paradoxical motion associated with?
Flail chest
What causes Rales (crackles)?
Oxygen passing through moisture in the bronchoalveolar system or from closed alveoli opening abruptly
FLUID IN SMALLER AIRWAYS
What two things are Rales associated with?
Congestive heart failure
Bronchitis
What is Rhonchi?
Continuous sounds with a lower pitch and a rattling quality
What four things is Rhonchi associated with?
Congestive heart failure
Pulmonary edema
Bronchitis
Pneumonia
FLUID IN LARGER AIRWAYS
When is Rhonchi usually heard?
During exhalation
What four things cause stridor?
Bacterial epiglottitis
Viral croup
Swelling from upper airway burns
Partial foreign body airway obstruction
What is wheezing?
A high-pitched whistling noise that is usually more prominent during exhalation
What three things is wheezing associated with?
Asthma
Bronchitis
Other processes that cause constriction of the bronchioles (bronchospasm)
When is mild wheezing typically heard?
Expiration
When is moderate wheezing typically heard?
Inspiration and expiration
What is severe wheezing?
Wheezing that is often faint or difficult to hear indicating severe bronchospasm
What is pleural friction rub?
A low pitched, dry, rubbing sound caused by movement of inflamed pleural surfaces as they slide against one another during breathing
What four things is pleural friction rub associated with?
Pleurisy
Viral infection
Tuberculosis
Pulmonary embolism
What five things do you assess the abdomen for?
Tenderness Rigidity Swelling Guarding Distention
What is ecchymosis?
Bruising of the skin
What are two causes of ashen or pale skin?
Hypovolemia
Hypoxia
What are six possible causes of red/flushed skin?
High blood pressure CO poisoning (late) Significant fever Heatstroke Sunburn Allergic reaction
What is a cause of jaundice skin?
Liver disease/dysfunction
What are four possible causes for hot skin?
Significant fever
Sunburn
Hyperthermia
Heavy excercise
What are two causes for cool skin?
Early shock
Heat exhaustion
What are three causes for cold skin?
Profound shock
Hypothermia
Frostbite
What is a possible causes for clammy/moist skin?
Shock
What is a cause for pupils that are fixed with no reaction to light?
Depressed brain function (head injury/stroke)
What is a cause for pupils that are fully dialated and fixed (brown pupil)?
Increased intracranial pressure
What is a cause for constricted pupils?
Drugs (opiates)
What is a cause for dilated pupils?
Drugs (barbiturates)
What is a cause for pupils with a sluggish reaction?
Severe increase in intracranial pressure
What are four causes of unequal pupil size?
Depressed brain function
Medication placed in eye
Injury or condition of the eye
Congenital anisocoria
What is focal pain?
Pain that is only in a single location
What is diffuse pain?
Generalized area of pain
In trauma patients what 2 steps occur during detailed physical exams?
Detailed head to toe looking for DCAP-BTLS
Reassess vitals
What is petechia?
Small red or purple spot on the skin, caused by a minor hemorrhage (broken capillary blood vessels)
What are battle signs?
Bruising behind the ear associated with skull fractures
What is called when blood or foreign objects are in the anterior chamber of the eye?
Hyphema
What is peri-orbital ecchymosis?
Bruising/discoloration around eyes (raccoon eyes)
What are loud, high-pitched, and hallow sounds noted over the menubrium also known as?
Bronchial sounds
What are soft, breezy, and lower pitch sounds found at the midclavicular line also known as?
Bronchovesicular sounds
What are the finer and somewhat fainter breath sounds noted in the lateral wall of the chest that are from the smaller bronchioles and alveoli also known as?
Vesicular sounds
What is pleurisy?
Inflammation of the pleura
What is the point of maximal impulse (PMI)?
The location of the mitral valve
It is the best place to listen for heart sounds
Where is the point of maximal impulse located?
Normally found at the fifth intercostal space, just medial to the midclavicular line
What is Cullen’s sign?
Bruising in or around the belly button
What is Grey-Turner’s sign?
Bruising along the sides of the abdomen
What is ascites?
The accumulation of serous fluid in the peritoneal cavity
What is hives also called?
Urticaria
What is caput medusa?
Distended veins spreading upward from navel, analogous to varicose vein’s
What does the presence of caput medusa result in the possibility of?
Severe ongoing back up of pressure in the hepatic portal system and should alert you to the possibility of esophageal varices
What is the term called when a patient tenses the abdomen as you touch it?
Guarding
What is Raynaud’s syndrome?
One or more fingers or toes may be strikingly pale/cyanotic and cold to the touch
What three things do you assess with the Cincinnati stroke scale?
Facial symmetry
Pronator drift
Clarity of speech
In Cincinnati stroke scale, how do you test facial symmetry?
Have the patient grin and show teeth
Should be equal on both sides.
In Cincinnati stroke scale, how do you assess pronator drift?
Have the patient close eyes and outstretch their arms with palms face up
Should be equal and not drift away
In Cincinnati stroke scale, how do you assess clarity of speech?
Have pt repeat a phrase you say
“The sky is blue in Cincinnati”
Pt should be able to say it correctly
What nerve is CN 1?
Olfactory nerve
How do you check CN 2 and 3?
Check pupil response to light
How do you check CN 3,4, and 6?
Test for extraocular movement by using the “H” method
What is the “H” method test?
Holding a finger in front of a pts face and moving it in the shape of an H. The pts eyes should follow your fingers
How do you assess CN 5?
Have pt clench teeth and check sensation to forehead,cheek, and chin
How do you assess CN 7?
Have pt smile wide and show teeth
How do you assess CN 9 and 10?
While pt says ah-h-h, watch the uvula for movement, check for gag reflex
How do you assess CN 11?
Have pt shrug shoulders and turn head against resistance
How do you assess CN 8?
Test by checking for ability to maintain upright position for 15-20 seconds with eyes closed
Hypotension with tachycardia is a sign of what?
Some states of shock
Hypertension, bradycardia, and irregular respirations is a sign of what?
Increased intracranial pressure
What are the five steps of ongoing assessment?
Repeat the initial assessment Reassess vital signs Repeat focused assessment Check interventions Modify treatment is necessary
What are the six R’s of clinical decision-making?
Read the patient Read the scene React Reevaluate Revise the management plan Review performance at the run critique
What are clubbed fingers a sign of?
COPD
What is decorticate posture?
An abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest.
What is decerebrate posture?
Arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly.
What is a cause of decorticate and decerebrate posture?
A severe injury to the brain
What is dysarthria?
Difficulty speaking because of problems with the muscles in speech
What is it called if a patients tongue comes out to the side?
Tongue deviation
What side does the tongue usually deviate to if the patient is have a nerve problem?
The strong side
What is crepitus?
The sound or feeling of bones rubbing together
What is dystonic reaction?
Reaction to medications causing abnormal muscle movement
What is dysconjugate gaze?
Failure of the eyes to turn together in the same direction
What is dolls eyes?
If you turn your head your eyes look in the direction you move you’re head
What does erythema mean?
Redness
What is the mastoid process?
The bone behind the ear
What does a scar over the throat usually indicate?
A carotid endarterectomy
What is barrel chest?
Pt having a rounded chest. Being wide as you are thick
What is it called when the stomach rise then the chest rises?
Seesaw respirations
What are four normal breath sounds in the chest?
Tracheal
Bronchial
Bronchiovesicular
Vesicular
What causes absent breath sounds?
Tension pneumothorax
When you percuss a chest why would you hear a dull sound?
A solid object underneath (fluid in lungs)
When percussing a pt what does hyperresonance mean.
Air underneath (echos)
What is costovertebral?
Where the ribs meet the spine
What is the spinal process?
The tip of vertebrae
Where is the posterior tibial artery?
Medial bump in ankle
Where is the popliteal artery?
Behind the knee
What does protuberant mean?
Bulging outward
What does scaphoid mean?
Concave rather than convex (goes inward)
To assess for life threats in chest what does IPASSAV stand for?
Inspect Palate Auscultate Seal holes Stabilize flail segments Administer oxygen Ventilate if necessary
What is the systolic BPof a patient with a radial pulse?
At least 80
What is the systolic BP of a patient with a femoral pulse?
At least 70
What is the systolic BP of a patient with a carotid pulse?
At least 60
What is orthostatic vitals?
Taking vitals while patient is supine, then sitting up, then standing
Why do you assess orthostatic vitals?
To determine if pt becomes dizzy, HR decreases by 20, or systolic BP decreases by 20 or more while changing position
How are bronchial sounds described like?
Full inspiratory and expiratory phase with the inspiratory phase usually being louder that are normally heard over the trachea
How are bronchovesicular sounds described like?
Full inspiratory phase with a shortened and softer expiratory phase and heard in the hilar region
How are vesicular sounds described like?
Quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase normally found in lung field
What is anisocoria?
State of normally unequal pupil size usually less than 1 mm in approximately 20% of population
What is referred pain?
Pain in two separate locations of the body, without a trail of pain between the two locations
Where do you hear s1 sounds?
At the fifth intercostal space at the left sternal border (tricuspid valve)
What is rhinorreah?
Runny nose
Where are two places that you listen to s2 sounds?
The second intercostal space at the right sternal border (aortic valve)
The left sternal border (pulmonic valve)
What valve is located at the fifth intercostal space at the left sternal border?
Tricuspid valve
What valve is located at the second intercostal space at the right sternal border?
Aortic valve
What valve is located at the second intercostal space at the left sternal border?
Pulmonic valve
What valve is located at the fifth intercostal space, just medial to the mid-clavicular line?
Mitral valve
What is dyplopia?
Double vision
When is strider usually heard during ventilation?
During inspiration
What are the four steps of medical patient assessments?
Scene size up
Initial assessment
Focused history/physical exam Ongoing assessment
