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PCT > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

Check environment for

A 
Dangers to self and pt
No fire, wire, gas, glass
No needles or weapons 
No violence
Know exits
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2
Q

MOI

A 
Method of injury or illness:
MVC
Exposure (weather or bee sting)
CP
Trauma
Psychiatric
Drug OD
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3
Q

What to do if multiple casualties

A

Call for more ambulances if needed

If one or both ambulatory and family or friends can put both in one ambulance

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4
Q

Additional resources

A 
Police
Fire
Ambulances(ACP, supervisor, air ambulance)
Hydro
Animal rescue 
CAS
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5
Q

PPE

A 
Helmet
Goggles
Mask
Gloves
Gown / isolation suit
Safety footwear
High-visibility clothing
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6
Q

How to approach a pt

A

Always from the front
Introduce yourself
Obtain consent
Avoid demeaning terms

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7
Q

Empathy when approaching the pt

A

Ask about feelings
Be sensitive to pt feelings / experiences
Avoid entering pt personal space
Use appropriate language

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8
Q

Things to note about pt when entering scene

A

LOC - drowsy, stupor ( unaware of surrounding) obtunded ( unresponsive to stimuli), coma ( pt cant be aroused no eye movement)

Posture, gait, motor activity

Dress, grooming, hygiene, odors

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9
Q

When to control c spine

A

Traumatic MOI
MVC
Have pt stay still, partner or other resource hold c spine still until R/O spinal injury

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10
Q

What to do if suspect pt has acute altered LOC (5 steps)

A
  1. Confirm clear airway and insert oro/ naso airway
  2. If pt apneic or has inadequate respirations assist ventilation
  3. Try to find cause of altered LOC (aeiou tips) and further asses and manage
  4. Do a secondary survey to asses head to toe
  5. Do trauma assessment if obvious or possible trauma
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11
Q

What is chief complaint

A

Main reason ambulance is called

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12
Q

What was pt doing prior to event

A

OPQRST - for pain

SAMPLE

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13
Q

When does physical assessment begin

A

When you set eyes on pt

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14
Q

When does pt assessment formally start

A

With history

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15
Q

What is purpose of physical exam

A

Investigate areas that you suspect are involved in pts primary problem

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16
Q

What is foundation of physical assessment based on

A

Inspection
Palpation
Auscultation
Percussion

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17
Q

What is primary problem

A

Medical cause of the c/c (physical or emotional)

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18
Q

What is secondary problem

A

Additional contributing medical injury/illness/ condition leading to pts presentation

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19
Q

What is final problem

A

What is determined to be main resulting factor for pts condition after assessment and tx

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20
Q

What are two transport calls to choose from

A

Load and go

Stay and play

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21
Q

What is differential diagnosis

A

Working diagnosis / variety of potential causes to help choose tx path

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22
Q

What to check for airway

A

Is it patent
Do you need to reposition head tilt jaw lift
Any foreign bodies to clear
Decreased LOC? Insert airway protector
Use oropharyngeal airway unless gag intact (or trismus ( lock jaw)
Use nasopharyngeal if cant do oro
Never nasopharyngeal on head trauma pt

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23
Q

What to check for breathing

A 
Look for chest rise and fall
Listen for air movement nose and mouth
Listen for quality of breaths
Observe if accessory muscles being used
Feel for: chest movement symmetry
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24
Q

What are accessory muscles for breathing

A

Between ribs, neck, stomach

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25
Q

What is flail chest

A

Two or more ribs fractured in two or more places

- chest will move paradoxically

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26
Q

What is pneumothorax

A

Punctured or collapsed lung ( spontaneous or traumatic)

Chest will not move symmetrically as lung not filling up with air due to rupture within lung

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27
Q

What is crackles breath sounds

A

Loose fluid or congestion

- pneumonia, CHF

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28
Q

What is wheezes breath sound

A

Bronchoconstriction

- asthma, anaphylaxis

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29
Q

What is Rhonchi breath sound

A

Low pitched rattle

-cystic fibrosis, COPD

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30
Q

What is Rub lung sound

A

Harsh, grating noise

- infection, pulmonary embolism

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31
Q

What is stridor lung sound

A

High pitched wheeze

- croup, airway obstruction

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32
Q

What is silent chest lung sound

A

Inability to hear lung sounds

- pneumothorax, asthma exacerbation

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33
Q

Bradypnea

A

<8 breaths / min

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34
Q

Tachypnea

A

> 28 breaths/min

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35
Q

Eupnea

A

Normal for pt age ( 12-20 breaths/min for adults)

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36
Q

Hypopnea

A

Decreased rate and depth of breath

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37
Q

Hyperpnea

A

Increased rate and depth of breath

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38
Q

Orthopnea

A

SOB when pt lies down

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39
Q

Dyspnea

A

Difficult/ laboured breathing

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40
Q

Paroxysmal nocturnal dyspnea

A

Onset of SOB at night / while sleeping ( sleep apnea)

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41
Q

Apnea

A

Absence of breathing

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42
Q

What are the 8 + 2 vital sign measurements

A 
HR
Respiratory rate
BP
Body temp
SpO2
Skin
Pupils
LOA (GCS)

cardiac monitor
Blood glucose

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43
Q

How many vitals does every pt need min

A

2 sets even if not going to ER

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44
Q

What HR rate, rhythm and quality refer to

A

Rate : # pulses in 1 min
Rhythm: pattern and regularity of intervals btw beats
Quality: strength( weak, strong, thready, bounding)

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45
Q

What is normal HR

A

Btw 60-100 bpm

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46
Q

What is bradycardia

A

HR of 59 bpm or lower

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47
Q

What is Tachycardia

A

HR of 100 bpm or higher

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48
Q

What is rate, rhythm, effort and quality in reference to respirations

A 
Rate: # breaths in 1 min
Rhythm: affected by speech, emotions
-( abnormal  respiration in pt with altered mental status is serious concern)
Effort: how hard pt works to breath
Quality: depth and pattern of breathing
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49
Q

What is bradypnea

A

Slow breathing

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50
Q

What is Tachypnea

A

Fast breathing

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51
Q

Respiration comparisons

A

CAO pt taking 10 breaths / min may be norm but if unresponsive or only taking 10 breath/min could = problem

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52
Q

What is BP

A

Force of blood against arteries walls as heart contracts and relaxes

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53
Q

What is systolic BP

A

Maximum force of blood against arteries when ventricles contract

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54
Q

What I’d diastolic BP

A

Force of blood against the vessel wall when ventricles relax ( measure of systemic vascular resistance and correlates well to blood vessel size)

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55
Q

What is hypertension

A

BP higher than norm

Usually > 140/90

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56
Q

What is hypotension

A

BP lower than norm

Based on pts normal BP

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57
Q

What is normotension

A

BP 90/100 systolic and less than 140 systolic

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58
Q

What is pulse pressure

A

Diff btw systolic and diastolic pressures

Wide or narrow pulse pressure can be concerning

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59
Q

What is perfusion

A

Passage of blood through organ or tissue

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60
Q

What are Korotkoff sounds

A

Sound of blood hitting arterial walls

Sounds hear while taking BP

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61
Q

What variables can affect BP result

A

Pt anxiety, position, previous activities, movement

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62
Q

Equipment used to measure BP

A

Palpation, auscultation, doppler

Non-invasive BP asses

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63
Q

In what context do we take BP

A

Must be correlated to other vital signs and pt condition to be of value

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64
Q

How to check temp

A 
1st note with hand (dorsal surface)
Tympanic (ear) used by ems
Oral
Rectal
Axillary
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65
Q

What is normal temp

A

37°c or 98.6°F

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66
Q

What is plae skin color indicate

A

Vasoconstriction, blood loss or both

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67
Q

What does cyanosis indicate

A

Inadequate oxygen or poor perfusion due to suffocation or hypoventilation

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68
Q

What does flush skin indicate

A

Heat exhaustion, vasodilation, fever or late CO poisoning

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69
Q

What does jaundice indicate

A

Possible liver disease or other organ failure

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70
Q

What are contusions

A

Bruises

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71
Q

What does ashen skin indicate

A

Often cardiac issue or heart attack

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72
Q

What is normal skin presentation

A

Pink warm and dry

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73
Q

What can moist, clammy skin indicate

A

Possible shock, hyperthermia, cardiac emergency

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74
Q

What can dry skin indicate

A

Dehydration or spinal injury

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75
Q

What can skin turgor tell you

A

If there is fluid loss or dehydration

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76
Q

What is hyperthermia

A

Increased core body temp > 38°C

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77
Q

What can hyperthermia cause

A

Heat cramps, exhaustion, stroke

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78
Q

What is hypothermia

A

Decreased core body temp <35°C

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79
Q

What can hypothermia cause

A

Leads to organ shut down

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80
Q

What can cause dilated pupils

A

Stimulants, hypoxia, cardiac arrest, intracranial hemorrhage, dim lighting, eye drops

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81
Q

What can cause constricted pupils

A

Opiates use, bright light, head injury

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82
Q

What is miosis

A

Excessive constriction of pupil

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83
Q

What can cause unequal / ispilateral pupil dilation dilation

A

CVA, previous head injury, post cataract removal

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84
Q

What would slow reactivity of pupils indicate

A

Hypoxia or decreased perfusion

MI, Substance abuse, cardiac arrest, sever shock can cause fixed pupils

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85
Q

What are the 3 categories of GCS

A

Eye opening, verbal, motor

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86
Q

What are the scores for eye opening on GCS

A

4 spontaneous
3 to voice
2 to pain
1 unresponsive

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87
Q

What are the scores for verbal responses on GCS

A 
5 oriented
4 confused
3 inappropriate words
2 incomprehensible sounds
1 unresponsive
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88
Q

What are scores for motor responses on GCS

A 
6 obeys commands
5 localizes (pain)
4 withdraws (pain)
3 flexion (decorticate)
2 extension (deceribrate)
1 unresponsive
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89
Q

What is flexion or Decorticate

A

When first com into body/ chest toes point straight down body tensed

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90
Q

What is Extension or Deceribrate

A

When fists and arms tense straight parallel to body toes point straight head bends back whole body tense

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91
Q

What does the general survey consist of

A

Take in :

  • appearance
  • vital signs
  • additional assessment as needed
    • cardiac monitoring, BG, neuro exam
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92
Q

What can Appearance tell you

A 
LOC
signs of distress
State of health
Vital statistics
Skin color, lesions
Posture, gait, motor activity
Dress, grooming, hygiene
Odors breath and body
Facial expression
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93
Q

What are 2 LOA

A 
Altered = GCS less than norm for pt
Unaltered = GCS that's normal for pt
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94
Q

What is hypoglycemic in children under 2

A

< 3.0 mmol/L

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95
Q

What is hypoglycemic level in pt 2 and older

A

4.0 mmol/L

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96
Q

Hyperglycemia level

A

Dependent on pt norm

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97
Q

Normal BG

A

4.0 to 7.0 mmol/L but DM pt may have a diff normal

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98
Q

What happens when core body temp reaches 39°C

A

Neurons of brain start to denature

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99
Q

What happens when core body temp reaches 41°C

A

Brain cells start to die and seizures may occur

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100
Q

What happens when core body temp dips below 34°C

A

Body’s warming mechanisms begin to fail

101
Q

What happens when core body temp goes under 31°C

A

Heart sounds diminish and cardiac irritability increases

102
Q

Resp rate and HR pt 0-3 months

A

30-60 resp and 90-180 HR

103
Q

Resp rate and HR pt 3-6months

A

Resp rate 30-60 HR 80-160

104
Q

Resp rate and HR pt 6-12 months

A

Resp 25-45

HR 80-140

105
Q

Resp rate and HR pt 1-3 years

A

Resp 20-30

HR 75-130

106
Q

Resp rate and HR pt 6 y/o

A

Resp 16-24

HR 70-110

107
Q

Resp rate and HR pt 10 y/o

A

Resp 14-20

HR 60-90

108
Q

Resp rate and HR adult

A

Resp 12-20

HR 60-100

109
Q

What is upper limit of child pulse

A

150 - (5 times age )

110
Q

What is normotension for kids aged 1 to 10

A

> 90 mmHg + (2x age in years)

111
Q

What is hypotension calculation kids aged 1 to 10

A

< 70 mmHg + (2x age in years)

112
Q

What is normal BP in adult

A

120/80

113
Q

What is adult normotension SBP

A

SBP > 100 mmHg

114
Q

What is adult hypotension SBP

A

< 90mmHg

115
Q

What is adult Hypertension range

A

SBP > 140 but depends on pt norm and Hx

116
Q

How long should normal cap refill take

A

< 2 seconds

117
Q

What SpO2 range do you aim for

A

92 to 96 %

118
Q

What is largest organ in human body

A

The skin including hair and nails

119
Q

What approx % of total body weight is skin

A

16% average about 20lbs

120
Q

What two layer of skin

A

Dermis

Epidermis

121
Q

What are the 5 layers of tissue of the scalp

A 
Skin
Ct
Aponeurosis (membrane connecting muscles)
Loose tissue
Periosteum (tissue around bones)
122
Q

What is exophthalmos

A

Abnormal protrusion of the eyeball

123
Q

What is ptosis

A

Drooping of upper eyelid

124
Q

What is Cullen’s sign

A

Discoloration around the umbilicus suggesting intra-abdominal hemorrhage

125
Q

What is Grey-Turner’s sign

A

Discoloration over the flanks suggesting intra-abdominal bleeding

126
Q

What is Ascites

A

Fluid accumulation in abdomen - from liver cirrhosis

127
Q

What is Borborygmi

A

Loud, prolonged, gurgling bowel sounds (stomach growling) an hour glass stomach

128
Q

What 6 things can cause asymmetrical distension in abdomen

A 
Hernias
Tumors
Cysts
Bowel obstruction 
Enlarged abdominal organs 
Distended bladder
129
Q

What could a pulsatile mass indicate

A

Leaking or ruptured AAA

130
Q

What could indicate mono

A

Enlarged spleen

131
Q

What are 5 possible causes of rectal bleeding

A 
Trauma
Hemorrhoids 
Anal fissure
Crohn's/ colitis 
Cancer
132
Q

What demographics are hemorrhoids common in

A

Elderly and pregnant

133
Q

Observe, palpate and inspect musculoskeletal and joint for these 6 things

A 
Pain
Swelling
Deformities 
Symmetry
Tissue changes
Crepitus
134
Q

What is included in complete examination of extremities

A 
Wrists and hands
Elbows 
Shoulders
Ankles and feet
Knees 
Hips
135
Q

What should you be checking on extremities

A 
Swelling
Tenderness 
Increase heat
Redness 
Decreased function 
Stability
Hips/ pelvis squeeze once and push down
136
Q

What is peripheral vascular system

A

System that delivers oxygenated blood to the tissues of the extremities

137
Q

Name 6 signs that something could be going on with peripheral vascular system

A 
Swollen or asymmetrical extremities 
Pale or cyanosis 
Weak or diminished pulses
Skin cold to the touch
Absence of hair growth
Pitting edema
138
Q

What are the 4 questions you are trying to answer when doing neuro exam

A
  1. Are the findings symmetrical or unilateral?
  2. If unilateral, where do they originate?
  3. Is there weakness or full paralysis?
  4. Is there numbness or pain?
139
Q

What are the 5 areas of a Neuro exam

A
  1. Metal status and speech
  2. Cranial nerves
  3. Motor system ( grips, pedals)
  4. Sensory system
  5. Reflexes
140
Q

What should you be looking for when evaluating mental status and speech

A 
AVPU
Appear and and behaviour 
Speech and language 
Mood
Thought and perceptions 
Insight and judgment 
Memory and attention
141
Q

How to act when examining infants and children

A
  • dont treat them like adults
  • diff age groups have specific fears and characteristics
  • position yourself at eye level, use soft voice, smile often
  • may have to explain more often
142
Q

Age specific emax differences for 0-6 months

A 
Easy to perform assessment 
Keep them warm
Poor head control if any
Belly breathers
Observe fontanelles

Skin color and nasal flaring indicate dyspnea

143
Q

Age specific exam differences for 7 months to 3 years

A 
Usually less cooperative 
Unreliable Hx
Separation anxiety 
Injury may be viewed as punishment 
Approach quietly
Use simple direct questions
144
Q

Age specific emax differences for 4-10 y/o

A 
Usually cooperative 
Can provide limited Hx 
Separation anxiety 
Injury may be viewed as punishment 
Approach quietly
Allow child to help with exam
Reluctant to discuss pain/ discomfort in privates
Advise child of any unexpected pain
145
Q

Age specific emax differences for 11-18 y/o

A
  • Generally calm and helpful
  • Concerned about modesty, pain, disfigurement, disability, death
  • require reassurance during exam
  • privacy
  • if possible separate from friends and family
  • consider the possibility of alcohol, drugs and pregnancy
146
Q

Age specific emax differences for elderly

A 
Allow for extra time
Stay close to pt
Repetition may be required
Dont patronize or offend
Multiple health problems 
Decreased sensory function 
May fail to mention changes in daily activities
Be alert to chronic pain
147
Q

Changes to make when assessing infants and children

A

Scene assessment take in “big picture”
Involve the parents, caregivers (Hx and care)
Kids have less blood and will crash fast
Ask what child’s norm is
Anatomical differences
!airway and breathing ! Watch for resp distress
Be prepared to suction and ventilations
Constantly monitor vitals as they can crash quickly

148
Q

Where are fontanelles located

A
  • Sphenoidal and posterior close during first few months

- anterior closed btw 9 and 18 months

149
Q

What does bulging fontanelle indicate

A

Could be increased pressure inside skull

150
Q

What does concave / sunken fontanelle indicate

A

Infant may be dehydrated or in shock

151
Q

What area do you take pulse usually in infant

A

Brachial

152
Q

Where do you usually check pulse in children

A

Radial or brachial

153
Q

Are BP readings essential for children

A

Not for children under 3

154
Q

What could cold hands and feet indicate in infants and children

A

Possible shock

155
Q

What to continuously observe about infants and children

A

Skin color
Breathing rate
Breathing quality
Cap refill

156
Q

7 tips for secondary assessment of pediatric pts

A
  1. Asses child on parent lap
  2. Radiate confidence, competence, friendliness
  3. Be at eye level and do toe to head exam
  4. Keep eye contact while explaining everything in way they can understand calmly
  5. Kids take words literally so watch wording
  6. Be honest even if it will hurt
  7. Keep painful things for last
157
Q

What comes after Hx and physical exam

A

Record finding on pt chart in as much depth and detail you can

158
Q

What is the pt assessment

A

A problem oriented evaluation establishing priorities of care

  • based on existing potential threat
  • rule in and out diff diagnosis
159
Q

Role of pt care provider (6)

A
  • provide scene control
  • gather scene info
  • talk to relatives / bystanders
  • obtain vital signs
  • perform interventions
  • act as triage group leader
160
Q

Components of patient assement (4)

A
  1. Primary assessment ( AEMCA)
  2. Focused Hx and secondary assessment
  3. Ongoing assessments
  4. Detailed secondary assessment
161
Q

As you walk on scene what do you need to observe and take in (10)

A
  • Is it Medical or Trauma
  • Body substance Isolation
  • Scene safety
  • Location of all pts
  • MOI
  • Nature of illness
  • possible # of casualties
  • Scene hazards
  • Best access and egress routes
  • Begin triage as soon as you possible
162
Q

Who is top safety priority at scene

A

You the paramedic and your crew

163
Q

When may you need more resources

A 
Multiple casualty event
Hazmat emergency 
Violent incident or potentially violent
Fire, gas leaks, downed wires 
Special rescue situations
164
Q

4 possible signs of danger aat a scene

A
  1. Violence or indication violence may take place
  2. Signs of intoxication or illegal drug use
  3. Weapons of any kind
  4. Any unusual behavior from bystanders
165
Q

Techniques to help calm a pt with a behavioral emergency

A
  • maintain comfortable distance
  • be clear about who you are and what you can do to help
  • ask questions in calm, reassuring voice speaking directly to pt
  • encourage pt to tell you what is troubling them
  • acknowledge it feeling, respond honestly to questions
  • no quick moves
  • act quietly and slowly
  • dont threaten, belittle, challenge or argue
  • dont play along with visual or auditory disturbances
  • involve friends and family if pt wants
  • maintain eye contact if appropriate
166
Q

When to suspect a vehicle is unstable

A 
Always but especially:
If it's on tilted surface like hill
If part of it is stacked on another vehicle 
If it's on a slippery surface 
If its overturned
167
Q

What are hazards involved in rescuing pt with confined space emergency

A

Low O2 levels

Poisonous or explosive atmosphere

168
Q

What to note in cold environment extraction

A
  • O2 devices loose malleability = less effective
  • Aluminum stretches and cylinders cool fast - can cause frostbite on contact
  • nitrile gloves become stiff
  • blankets need to be available
169
Q

“Reach throw row go tow”

What is reach

A

Holding out object to pt to grab and pull them in

170
Q

“Reach throw row go tow”

What is throw

A

Throw flotation device to pt so have more time to make rescue

171
Q

“Reach throw row go tow”

What is row

A

Use boat to get pt

172
Q

“Reach throw row go tow”

What is go

A

Swimming to pt

173
Q

“Reach throw row go tow”

What is tow

A

Tow them to safety

174
Q

Do EMS do water rescue

A

No wait for pt to be out of water then do what is needed
Ventilations
Suction
Conserve body heat of pt - remove wet clothing

175
Q

7 step protocol for trapped pt

A
  1. Be sure scene safe vehicle stable
  2. Appropriate PPE
  3. When gain access provide regular trauma care ( stabilize head and neck - do primary assessment- provide critical interventions)
  4. Protect self and pt from glass & debris
  5. Remain with pt during extraction
  6. Continually monitor pt condition, advise extraction crew if it deteriorates
  7. Try to keep pt calm during extraction
176
Q

7 steps of primary assessment

A
  1. Form general impression
  2. Stabilize c spine as needed
  3. Asses baseline LOA LOC
  4. Asses Airway
  5. Asses breathing
  6. Asses circulation
  7. Asses priority
177
Q

What is general impression

A

Intial, intuitive evaluation of pt to determine general clinical status and priority of transport

178
Q

When in particular should you suspect a spinal injury

A
  • MVC
  • pedestrian car crash
  • falls
  • hangings
  • diving accidents
  • blunt trauma
  • penetrating trauma to head, neck or torso
  • GSW
  • speed sport accident ( roller bladding, biking, skiing, sledding,)
  • any unconscious trauma pt
179
Q

What is AVPU

A

Alert
Verbal
Painful stimuli
Unresponsive

180
Q

When can you assume airway is patent

A

If pt is responsive and can speak cleary

181
Q

How are pediatric air passage different

A

Smaller
Less reserve air capacity
Can be compromised by less trauma or infection

182
Q

How are pediatric airway structures different

A

Not as long or as large
Can close off if neck flexed or extended too far
Best position is neutral or slight extension

183
Q

What to watch when doing pediatric jaw thrust

A

Hand must be on bony part of chin so as not to let tongue block airway

184
Q

How do children typically breath

A

Threw nose with abundant secretions

185
Q

What to do if child wont tolerate O2 mask

A

Hold it slightly away from face and let O2 blow bu

186
Q

If child’s signs and symptoms subside what is next step

A

Always try to bring child to hospital as there vitals can change quickly

187
Q

A Airway how to.secure airaway

A
  • Is airway patent
  • Reposition (if possible) to ensure airway patency
  • If there is foreign body obstruction, roll pt and remove obstruction
  • if decreased LOC or unresponsive, with no gag reflex or mandible trauma, insert oropharyngeal to maintain patency
188
Q

Pts to consider the possibility of airway obstruction

A

Smoke inhalation, anaphylaxis, epiglottitis, foreign body aspiration or oropharyngeal malignancy

189
Q

If pt has decreasing LOC with intact gag reflex or mandible trauma how do you secure airway patency

A

Use nasopharyngeal airway

190
Q

Who cannot get nasopharyngeal airway

A

Pts with head trauma

191
Q

What to do after airway is patent

A

Can move on with rest of primary survey I.e Breathing (ABC)

- if cant secure airway, initiate rapid transport

192
Q

What are you assessing for whither breathing

A 
Altered mental status
SOB
Retractions
Asymmetric chest wall movement 
Accessory muscles use
Cyanosis 
Audible sounds
Abnormal rate or pattern
Nasal flaring
193
Q

How to get best results during breathing auscultation

A
  • Ask pt to breath slowly and deeply through their mouth

- compare breath sounds of both lungs by comparing spices of each lung and the bases of each lung

194
Q

What is circulation assessment

A

C in ABC

Consists of evaluating the pulse and skin and controlling hemorrhage

195
Q

Too priority ABC pts

A
  • Poor general impression
  • unresponsive
  • responsive but cannot follow commands
  • difficulty breathing
  • hypoperfusion
  • complicated child birth
  • CP & BP < 100 Systolic
  • uncontrolled bleeding
  • severe pain
  • multiple injuries
196
Q

4 types of pts

A
  • trauma pts with significant MOI
  • trauma pt with isolated injury
  • responsive medical pt
  • unresponsive medical pt
197
Q

Major trauma severity of injury depends on: (4)

A
  • distance of fall
  • anything that interrupt the fall
  • the body part that interrupted the fall
  • the surface the pt landed on
198
Q

What could wet skin indicate

A

Diaphoresis (sweating)
Hypovolemia
Cardiovascular emergency
Increased sweat gland activity

199
Q

What could hot skin indicate

A

Fever or heat related illness or injury

200
Q

What could cold skin indicate

A

Decreased tissue perfusion or cold related injury

201
Q

MOI that could = serious internal injury

A 
Ejection from vehicle 
Death in same passenger compartment 
Fall from higher than 6m 
Rollover of vehicle 
High speed motor vehicle collision 
Vehicle passenger collision 
Motorcycle crash
Penetration of the head, chest, abdo
202
Q

Severe trauma predictors for infants / children

A
  • fall from higher than 3m
  • bicycle collision
  • medium speed vehicle collision with severe vehicle deformity
203
Q

What is a Rapid trauma assessment

A
  • not a detailed exam

- fast, systematic assessment for other life threatening injuries

204
Q

When should you put a special emphasis on ares suggested by c/c

A

During detailed physical exam

205
Q

Which pts can you assume NEED a surgical theater

A

Internal bleeding
Major Fx
Head injuries
Multisystem trauma

206
Q

How fast should pts who likely need sx be packaged in

A

Within 10 mins of EMS arrival

207
Q

In Rapid transport trauma pts what can you do on scene and in transport

A 
Start IV enroute
Limit field management to:
- A/w control and ventilation support
- Spinal immobilization 
- Major # stabilization
208
Q

General trauma assessment

CLAPSD

A

C - contusions (size,shape, changing bruises)
L - lacerations (length, depth, shape, type)
A - abraisions (oozing, bleeding, made by, impregnated with)
P - penetrations ( angle, depth, maee by) / Pulsating masses (abdominal aneurysm) / Paradoxical Motion ( unequal movement flail chest)
S - Symmetry (and side vs other)
D - Deformity (broken bones) / Distention (abdominal bleed)

209
Q

When inspecting Neck LOOK FOR:

A 
Contusions
Lacerations
Abraisions
Penetrations
Swelling

Jugular Vein Distention

210
Q

When inspecting the Neck PALPATE FOR:

A 
○Subcutaneous emphysema ( tear in         tracheo-bronchial tree)
○Tenderness 
○Instability 
○Crepitus
○Deformity

○Tracheal Deviation

211
Q

Asses the chest LOOK FOR:

A 
Contusions
Lacerations 
Abraisions 
Penetrations
Paradoxical Motion
Symmetry
212
Q

Assess the Chest PALPATE FOR:

A 
Subcutaneous emphysema(from pneumothorax)
Tenderness
Instability 
Crepitus
Deformity
213
Q

Asses the abdo LOOK FOR:

A 
Contusions
Lacerations
Abraisions
Penetrations
Pulsatile Mass
214
Q

Asses the Abdo PALPATE FOR:

A 
Pulsatile Mass
Distention
Asymmetry 
Rigidity
Tenderness
215
Q

What is acute vs chronic

A

Sudden onset vs ongoing issue

216
Q

Acute abdo odors from pt mouth: (5)

A 
Sweet smell may = DM
Fecal odor may = bowel obstruction 
Acid smell usually = recent vomitting 
Coffee ground nemesis = upper GI bleed
Fresh blood = very recent upper GI bleed
217
Q

For acute abdo asses for (4)

A

1 odors in pts mouth

  1. Guarding abdominal wall
  2. Sudden diaphoresis and pallor
  3. Incontinence
218
Q

Asses pelvis FEEL FOR:

A

Asymmetry
Crepitus
Instability
Deformity

219
Q

How to asses pelvis and why

A

Squeeze only once and push down
Avoid quick movements
Risk of severing large blood vessels

220
Q

What is a possible indication of hip or pelvic fx or dislocation

A

Unequal leg lengths or rotation

221
Q

How to asses extremities

A
  • Compare R and L to each other
  • For all injuries, asses distal pulses every time limb is moved or complaint changes
  • asses 5 p’s before and after splinting
222
Q

What to asses extremities for :

A 
5 P's
Paralysis 
Paresthesia 
Pulse
Pallor
Pain
223
Q

Asses the Back LOOK FOR:

A 
Contusions
Lacerations 
Abraisions 
Penetrations
Paradoxical Motion
224
Q

Asses the Back PALPATE FOR:

A 
Subcutaneous emphysema 
Tenderness 
Instability 
Crepitus 
Deformity (C-T-L-S and coccyx for step deformities)
225
Q

When are good times to asses Back

A

If pt Supine when arrive then check quickly right away

- at time of log roll onto backboard

226
Q

Differences with isolated injury trauma pt

A

No significant MOI
Shows no sign of systemic involvement
Does not require extensive Hx
Does not require a comprehensive physical exam

227
Q

2 important tasks in responsive medical pt

A
  1. Hx takes president over full physical exam

2. Focus physical exam surrounding complaints

228
Q

What to look for with past medical hx

A 
General state of health
Childhood and adult diseases 
Psychiatric illness
Accidents and injuries 
Sx's and hospitalizations
229
Q

Things to look for with current health status

A 
Current meds
Allergies
Tobacco use
Alcohol and substance abuse
Diet
Screening exams
Immunizations
Sleep patterns
Excercise and leisure activities 
Environmental hazards 
Use of safety measures
Family hx
Social hx
230
Q

Focused physical exam HEENT

A
  • lip and oral mucosa color
  • sputum and color
  • swelling, hives, redness
  • symmetry
231
Q

Focused physical exam Neck

A
  • accessory muscle use and retractions
  • Carotid arteries
  • JVD - SITTING at 45°, not supine
  • Trachea position
232
Q

Focused physical exam Chest

A
  • Respiratory rate and pattern
  • Symmetry of chest wall
  • Surgical scars
  • Lung sounds
  • Percussion
233
Q

Focused physical exam Cardiovascular

A
  • Signs of arterial insufficiency
  • Peripheral pulses
  • Heart sounds
234
Q

Focused physical exam abdomen

A
  • surgical scars, bruising
  • Abdominal muscle use
  • Distention, pulsatile masses
  • Edema
  • Pulsation of descending aorta
  • Palpate the quadrants, guarding, rigidity
235
Q

Focused physical exam Pelvis

A
  • Incontinence, rectal bleeding

- Ruptured membranes

236
Q

Focused physical exam Extremities

A
  • Pulses, sensation, movement

- Edema/ pitting edema, digital clubbing, needle Mark’s, medic alert

237
Q

Focused physical exam Spine

A
  • obvious deformity

- discomfort with movement

238
Q

What is Orthostatic vitals

A

Move pt from supine to standing then in 30- 60 seconds take HR and BP, if HR up 10-20 bpm or systolic down 10-20 mmHg suspect hypovolemia

239
Q

Baseline vitals

A 
BP
Pulse
Respiration 
SpO2
Temperature 
Pupils
Orthostatic vitals
240
Q

Additional assessments (like vitals)

A 
Cardiac monitoring
BG determination
12 Lead assessment 
Neuro assessment 
Auscultation
241
Q

Reasons for unresponsiveness

A 
AEIOU HOTTIPS
Alcohol
Epilepsy 
Insulin
Overdose 
Uremia/ metabolic
Hypoxia 
Obstetrics 
Temperature 
Trauma 
Infection 
Psychiatric 
Syncope/ stroke
242
Q

2 key points about detailed secondary assessment

A
  1. Never forget importance of a physical exam

2. Move pt from environment into ambulance before assessment

243
Q

Detailed secondary assessment will be based on

A 
Which of 4 categories pt falls into 
Trauma w/ significant MOI
Trauma w/ isolated injury
Medical responsive
Medical unresponsive
244
Q

5 areas of nervous system exam in secondary assess

A 
Mental status and speech
Cranial nerves
Motor system 
Reflexes 
Sensory system
245
Q

6 reflex tests of secondary assessment

A 
Biceps
Triceps
Brachioradialis
Quadriceps
Achilles
Abdominal plantar
246
Q

6 sensory system tests in secondary assessment

A 
Pain
Light touch
Temperature 
Position 
Vibration
Discriminative
247
Q

Why are ongoing assessments important

A 
Detect trends
Determines changes to pt presentation 
Asses effects of tx
Observe changes to vitals
Listen to changes about c/c
248
Q

What to check during ongoing assessments

A 
Mental status
Airway patency 
Breathing rate and quality
Pulse rate and quality 
Skin condition 
Transport priorities 
Vital signs
Focused assessment 
Effects of interventions
Management plans

PCT (9 decks)

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