Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Trauma and Trauma Systems > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

patient assessment

A
  • focus now on the patient as an individual
  • golden hour is critical
  • prioritizes patient and their critical functions
  • create a method that is systematic:
  • scene assessment
  • general impression
  • primary survey
  • secondary survey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

golden hour

A
  • trauma patients are time critical
  • R Adams Cowely, MD
  • found that if bleeding is not controlled and tissue oxygenation is not restored within 1 hour of the injury the patients survival rate plummets
  • THE CLOCK WHEN THE EVENT OCCURS
  • 90% of trauma patients are simple injuries
  • for those 10%, definitive care is the ultimate goal for the patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

primary concern

A
  • prioritize patients in the following order
  • conditions that may result in loss of life
  • conditions that may result in loss of limb
  • all others that do not fall into the above two categories
  • this will maximize the golden hour for the patients that are more time sensitive!
  • systems are prioritized when assessing the patient in order to get the most people treated the fastest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

handling primary concerns

A
  • hemorrhage control perfusion- stopping arterial bleeding
  • airway
  • ventilation
  • oxygenation
  • neurologic function
  • following this path of assessment will protect the patients ability to oxygenate and deliver RBC to the bodies tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

scene assessment

A
  • safety- fire, contamination, combat
  • pre-arrival information
  • arrival on scene
  • mechanism of injury
  • patients
  • taught individually
  • wind shield survey -> what can you see/information from outside the scene
  • performed simultaneously
  • personal and personnel safety is paramount
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

safety: pre-incident

A
  • prophylaxis (recommended vaccinations)

- training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

safety: incident: situational awareness

A
  • do not enter scene unless it is safe
  • crime scene
  • bad guys still in the area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

safety measures

A
  • PPE
  • incident specific
  • patient specific
  • blood, body fluids, sharps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

safety: post-incident

A

-exposures (TB, body substances, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pre-arrival information

A
  • dispatch information
  • location of incident
  • nature of incident
  • reported situational issues
  • safety
  • number of patients
  • co-responders
  • weather conditions
  • traffic conditions
  • time of day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

arrival on scene

A
  • global view- before you get out of the vehicle
  • what do you see, feel, hear, smell?
  • is the scene safe?
  • what happened?
  • who, what, and how many are involved?
  • are there any access issues?
  • what additional resources may be needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

general impression

A
  • part of the primary survey
  • occurs as a bridge between scene and patients assessment
  • it is a quick global observation of the patients respiratory, circulatory, and neurologic systems
  • it identifies obvious, significant external problems with primary functions
  • flow directly into the primary survey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

primary survey

A
  • dont be distracted by visually dramatic, non-life threatening injuries
  • primary survey and management take precedence over the secondary survey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

XABCDE: primary survey

A
  • X- identify severe external bleeding
  • A- identify airway compromise or potential for this to develop
  • B- identify breathing inadequacy or potential for this to develop
  • C- identify hypoperfusion; control mild to moderate bleeding
  • D- identify neurologic dysfunction
  • E- identify significant injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

airway and cervical spine

A
  • stabilize the cervical spine
  • trauma patients with significant mechanism for injury are suspected to have a spinal injury until it is conclusively ruled out
  • ensure the patients neck is manually maintained in the neutral position during the opening of the airway and the administration of necessary ventilation
  • airway patency- open and clear
  • remove and assess for obstruction
  • consider advanced techniques to secure airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

breathing

A
  • make sure patient is breathing
  • look, listen, feel for 5-10 sec
  • assess rate in value of breaths per minute
  • ventilate the patient if they are not breathing
  • ensure a patient airway and compliance with ventilation
  • ensure oxygen delivered is 85% or greater
  • make sure you are having mechanical compliance -> chest rise
  • depth is just as important
  • if the patients is breathing you must think about the quality/efficacy of that patients efforts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

I PASS O2

A
  • I- inspection
  • P- palpation
  • A- auscultation - 4 places- aortic, pulmonic, tricuspid, and mitral valves
  • S- seal holes
  • S- stabilize flail segments- two or more ribs broken in two or more places
  • O- oxygen/ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

apnea

A

-not breathing, no effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

bradypnea

A
  • guppy breathing

- less than 10 RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

eupnea

A
  • between 12-20 RR

- healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tachypnea

A
  • between 20-30 RR

- closely monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

severe tachypnea

A
  • greater than 30 RR
  • indication of hypoxia
  • anaerobic metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ronchi

A

-course bubbling sound indicating sever fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

rales

A
  • fine crackling

- indicating fluid build up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

wheezing

A
  • high pitch sounds

- indication bronchi constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

stridor

A
  • high pitch wheeze

- indicates obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

absent breathing

A
  • due to trapped air
  • pneumothorax
  • hemothorax (blood in chest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

circulation

A

assess for circulatory compromise or failure

  • check radial, femoral, or carotid pulse for 10 secs
  • control hemorrhages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

types of hemorrhages

A
  • BLOOD SWEEP
  • capillary- from abrasion or mild laceration that have open capillaries just below skin; usually stops on own
  • venous- from deeper areas, usually controlled with direct pressure, blood is dark, blueish
  • arterial- cause by compromised artery, most important and difficult to control, bright red in color and usually spurting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

controlling hemorrhage

A
  • direct pressure with dressing
  • redressing if saturation occurs
  • tourniquet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

perfusion

A
  • assessed by:
  • pulse- palpable, strength, regularity
  • skin- color, temperature, moisture, capillary refill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

disability

A
  • assessment of cerebral function
  • primary concern is the patients level of consciousness
  • glasgow coma scale is a tool use to measure consciousness/mental status
  • patient can have other causes that can cause decrease neurological function
  • medical issues can cause trauma
  • pupillary response is also a good indication of internal head injury
  • extremity function, sensation will also be good indicators of injury
  • measures GSC, pupil response, extremity function
  • factors that can contribute to decreased LOC:
  • CNS injury
  • decreased oxygenations
  • metabolic
  • drug/alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

causes of decrease LOC

A
  • A- alcohol/drugs
  • E- epilepsy
  • I- insulin/diabetes
  • O- opiates
  • U- uremia
  • T- trauma
  • I- infection
  • P- psychosis
  • S- stroke/seizure/shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

expose/environment

A
  • although not in the mnemonic, exposure is a critical part of assessment for LOC
  • expose anything that you think could possibly be injured
  • address any factors environmentally that could contribute to patient deterioration
  • prevent loss of body heat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

rapid assessment

A
  • rapid regional exam of the body
  • quickly sweep from head to toe looking for injuries
  • focuses on outward signs of trauma
  • looking for signs of DCAP-BTLS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

DCAP-BTLS

A
  • D- deformities
  • C- contusion
  • A- abrasions
  • P- punctures
  • B- burns
  • T- tenderness- pain only when you touch it
  • L- lacerations
  • S- Swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

trauma is time critical

A
  • only critical life threatening injuries/airway complications should be addressed on scene
  • all other treatments should be done enroute to the receiving facility
38
Q

scene size up

A

-what scene safety concerns or consideration are present

39
Q

capillary bleeding

A
  • caused by abrasions that have scraped open the tiny capillaries beneath the skin
  • controlled with direct pressure
40
Q

venous bleeding

A
  • trauma to a vein
  • originates from deeper in the tissue
  • usually controlled with direct pressure
41
Q

arterial bleeding

A
  • trauma to an artery
  • difficult to control
  • characterized by spurting blood
  • can quickly result in life threatening hypovolemia
42
Q

secondary assessment

A

-After the General Impression, and Primary Survey are Done,
The Secondary Survey is completed
-It is a head to toe evaluation of the patient
-SAMPLE and OPQRST History
-Signs and Symptoms, Allergies, Medicines, Pertinent
Medical History, Last oral intake, Events leading to Event.
-Onset, Provocation, quality, radiation, severity, Time
-Detailed Physical Exam
-Primary survey finds life threatening conditions
-Secondary survey finds all other injuries,
-A regional Investigation looking for any sign of injury

43
Q

secondary assessment by region

A

-Head: Search Through Hair, Check Pupil, Palpate bones
-Neck: Anatomical placement, SQ (subcutaneous) Emphysema, tracheal
Alignment (is it midline?)
-Thoracic: Pain, Paradoxical movement, symmetry
-Back: Log Roll, Expose!, Palpate, Step offs, Subluxation
-Abdomen: Guarding, Tenderness, Distention, Pulsing mass
-Pelvic Girdle: Palpate Pubis, Iliac Crests, Crepitus.
-THIS IS DONE ONLY ONCE!
-Extremities: Palpate Girdle Through Fingers or toes

44
Q

summary

A
  • scene safety of prehospital care providers and the patient is the priority
  • all life threats are to be managed as soon as discovered
  • maintain a high index of suspicion for subtle life threatening injuries
45
Q

who needs a full secondary assessment

A
  • people who cant communicate to you
  • perform a rapid full body scan
  • focused assessment of pain
  • assessment of vital signs
  • techniques of physical examination
  • respiratory system
  • presence of breath sounds
46
Q

5 main parts in an incident

A
  • scene size up
  • primary assessment
  • history taking
  • secondary assessment
  • reassessment
47
Q

symptoms and signs

A
  • rarely does one sign or symptom show you the patients status or underlying problem
  • symptom- subjective condition the patient feels and tell you about
  • sign- objective condition you can observe about the patient
48
Q

secondary assessment

A
  • may be performed on scene in the back of the ambulance en route to the hospital or not at all
  • purpose is to perform a systematic physical exam on the pt
  • may be a systematic head to toe survey or an assessment that focuses on a certain area or system of the body
  • compare one side of the body to the other
  • goal is to identify hidden injuries or identify causes missed during 60-90 sec exam during primary assessment
49
Q

how and what to assess in a secondary assessment

A
  • inspection- look at the patient for abnormalities
  • palpation- touch or feel the pt for abnormalities
  • auscultation- listen to the sounds a body makes by using a stethoscope
50
Q

focused assessment

A
  • performed on patients who have sustained nonsignificant MOIs or on responsive medical pts
  • typically based on the CC
  • goal is to focus your attention on the body part or systems affected by the priority problems
51
Q

respiratory system

A
  • expose the pts chest
  • look for signs of airway obstruction
  • inspect symmetry
  • listen to breath sounds
  • measure RR
  • look for retraction and increased work of breathing
52
Q

respiratory rate

A
  • normal is 12-20 breaths/min for adults
  • children breathe at even faster rates
  • count the number of breaths in a 30 sec period and multiply by 2
53
Q

respiratory rhythm

A
  • regular- the time from one peak chest rise to the next is fairly consistent
  • irregular- respirations vary or the rate changes frequently
54
Q

quality of breathing

A
  • normal breathing is silent

- breathing accompanied by other sounds may indicate a significant respiratory problem

55
Q

upper air sounds

A

-usually inspiration

56
Q

lower airway sounds

A

-usually expiration

57
Q

depth of breathing

A

-amount of air the pt exchanges depends on the rate and tidal volume

58
Q

breath sounds

A

-you can almost always hear breath sounds better from the pts back

59
Q

what are you listening for?

A
  • normal breath sounds
  • snoring breath sounds
  • wheezing breath sounds
  • crackles
  • rhonchi
  • stridor
60
Q

cardiovascular system

A
  • look from trauma to the chest and listen for breath sounds
  • consider the pulse, respiratory rate, and BP
  • pay attention to rate, quality, and rhythm
  • consider your finding when assessing skin
  • check and compare distal pulses
  • consider auscultation for abnormal heart sounds
61
Q

pulse rate

A
  • normal resting for an adult is 60-100 beats/min

- the younger the pt the faster the pulse

62
Q

pulse quality

A
  • describe a stronger than normal pulse as bounding

- a pulse that is weak and difficult to feel is described as weak or thready

63
Q

pulse rhythm

A
  • regular- interval between each contraction should be the same; the pulse should occur at a constant regular rhythm
  • irregular- heart perdiocally has an early or late beat; if a pulse beat is missed
64
Q

blood pressure

A
  • pressure of circulating blood against the walls of the arteries
  • a drop in BP may indicate:
  • loss of blood or fluid components
  • a loss of vascular tone and sufficient arterial constriction
  • cardiac pumping problem
  • decreased blood pressure is a late sign of shock
  • abnormally high blood pressure may result in a rupture or other critical damage in the arterial system
65
Q

blood pressure cuff

A
  • blood pressure cuff with gauge contains:
  • wide outer cuff
  • inflatable wide bladder
  • ball pump with one way valve
  • pressure gauge
66
Q

auscultation: BP

A

-most common means of measuring blood pressure

67
Q

palpation

A

-does not depend on the ability to hear sounds

68
Q

normal blood pressure

A
  • hypotension- blood pressure is lower than normal

- hypertension- blood pressure is higher than normal

69
Q

neurologic assessment

A
  • should be performed with any pt who has:
  • changes in mental status
  • possible head injury
  • stupor
  • dizziness/drowsiness
  • syncope
  • evaluate the LOC and orientation
  • use the AVPU scale if appropriate
  • glasgow coma scale (GCS) can be helpful in providing additional info
70
Q

pupils

A
  • the black center portion of the eye
  • pupils are normally round and of approx equal size
  • in the absence of any light the pupils will become fully relaxed and dilated
71
Q

anisocoria

A
  • unequal pupils

- small number of population exhibit this

72
Q

causes of depressed brain function

A
  • injury of the brain or brain stem
  • trauma or stroke
  • brain tumor
  • inadequate oxygenation or perfusion
  • drugs or toxins
73
Q

PEARRL: pupil

A
  • pupils
  • equal
  • and
  • round
  • regular in size
  • react to light
74
Q

neurovascular status

A
  • check for bilateral muscle strength and weakness
  • complete a thorough sensory assessment
  • test for pain, sensations, and position
  • compare distal and proximal sensory and motor responses and one side with the other
75
Q

head, neck, and cervical spine

A
  • palpate the scalp and skull
  • check the pts eyes
  • check the color of the sclera
  • assess the pts cheekbones
  • check the pts ears and nose for fluid
  • check the upper (maxillae) and lower (mandible) jaw
  • open the pts mouth and look for any broken or missing teeth
  • note any unusual odors in the mouth
76
Q

chest

A
  • inspect, visualize, and palpate
  • watch for both sides of the chest to rise and fall together with normal breathing
  • observe for abnormal breathing signs
77
Q

abdomen

A
  • palpate for tenderness, rigidity, and pt gaurding
  • start palpating away from the pain and work your may closer
  • four quadrants:
  • left upper quadrant (LUQ)
  • left lower quadrant (LLQ)
  • right upper quadrant (RUG)
  • right lower quadrant (RLQ)
78
Q

pelvis

A

-inspect for symmetry and any obvious signs of injury, bleeding and deformity

79
Q

extremities

A
  • inspect for symmetry, cuts, bruises, swelling, obvious injuries, and bleeding
  • palpate for deformities
  • check for pulses and motor and sensory functions
80
Q

posterior body

A
  • inspect the back for DCAP-BTLDS, symmetry and open wounds

- palpate the spine from the neck to the pelvic for tenderness and deformity

81
Q

pulse oximetry

A
  • used to evaluate oxygenations effectiveness
  • measures the oxygen saturation of hemoglobin in the capillary beds
  • patients with difficulty breathing should receive oxygen regardless of their pulse oximetry value
82
Q

monitoring devices

A

-never replace you comprehensive assessment of the pt

83
Q

capnography

A

-can quickly provide information on a pts ventilation, circulation, and metabolism

84
Q

blood glucometry

A

-measures the level of glucose in the bloodstream

85
Q

sphygmomanometer

A

-blood pressure cuff

86
Q

reassessment

A
  • perform at regular intervals during the assessment process
  • repeat the primary assessment
  • reassess vital signs
  • compare with the baseline vital signs obtained during the primary assessment
  • look for trends
87
Q

reassess the chief complaint

A
  • ask and answer the following questions
  • is the current treatment improving the pts condition
  • has an already identified problem gotten better
  • has an already identified problem gotten worse
  • what is the nature of any newly identified problems
88
Q

recheck interventions

A
  • check all interventions
  • most important are the pts ABCs
  • ensure management of bleeding
  • ensure adequacy of other interventions, and consider the need for new interventions
89
Q

identify and treat changes in the pts condition

A

-document any changes, whether positive or negative

90
Q

reassess the patient

A
  • unstable pts- approx every 5 minutes

- stable patients- approx every 15 minutes

91
Q

stabilization of spine is the first step of assessing disability

A
  • false

- LOC and cerebral function is the first step

Trauma and Trauma Systems (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions