Patient Assessment Flashcards
As an EMT, do we diagnose patients?
- No, we do not, that is for the doctor to do. We just determine whether the patient is critical or not.
What are the five parts of the patient assessment process? Note the difference between a sign and symptom again.
The five parts of the patient assessment process are…
- Scene size-up
- Initial assessment (called “primary assessment” in book)
- Focused history and physical exam (“History taking” in book)
- Vital signs
- History
- Detailed physical exam (called “secondary assessment” in book)
- Ongoing assessment (called “reassessment” in book)
A symptom is a subjective condition the patient feels or tells you about.
A sign is an objective condition you can observe about the patient
What is Scene Size Up? What are the components of scene size up?
Scene size up is how you prepare for a specific situation from the moment you are called into action until you finally reach your patient. Book stuff in ()
- Body Substance Isolation; BSI (Take Standard Precautions)
- Safety, Safety, Safety, Safety… (Ensure scene safety)
- Mechanism of injury or nature of illness (Determine Mechanism of injury; MOI /nature of illness; NOI)
- # of patients (Determine number of Patients)
- Need for additional resources (Consider additional/specialized resources)
- Need for extrication / spinal precautions
What is BSI (define it too)? What is PPE (include examples of what we use)? What are standard precautions?
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BSI is Body Substance Isolation, it is the practice of isolating all body substances of individuals undergoing medical treatment.
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PPE is Personal Protective Equipment, which is specialized equipment that provides protection to the wearer.
- Latex/Vinyl gloves (which should always be worn)
- Eye protection
- Mask
- Gown
- Turnout gear
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PPE is Personal Protective Equipment, which is specialized equipment that provides protection to the wearer.
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Standard precautions are protective measures that are developed by Centers for Disease Control (CDC) and Prevention for use in dealing with objects, blood, body fluids, exposure risks of cummunicable diseases; basically it assumes that anything (wet) relating to the patient can be infectious.
- Includes what type of PPE to use before going to patient
- Additional measures such as handwashing
What is Scene Safety? What should you note?
Ensuring that the scene is safe
- Look for danger
- Park in a safe area
- Speak with law enforcement first if present
- The safety of you and your partner comes first
- Safety of patient and bystanders comes second
- Request additional resources
What is a Chief Complaint?
- The most serious problem voiced by the patient but it may not be the most signficant problem present. (Like if the patient was complaining about a headache but their head is split open wide)
What is MOI (define it too)? How do you evaluate the potential for a serious injury using MOI as a guide? What is NOI (Define too)? How do you evaluate the illness using NOI? What are MOI and NOI used alongside to determine?
- MOI means Mechanism of Injury: force or energy body has been exposed to (i.e. blunt/penetrating) that resulted in traumatic injury. Look here if chief complaint.
- Using MOI as a guide, Evaluate seriousness of injury by determining…
- Amount of force applied to body; force
- Length of time the force was applied; time
- Areas of body that are involved; area
- NOI means Natural of Illness: illnesses and injuries not caused by an outside force.
- Using NOI as a guide, Evaluate what it is and seriousness by…
- Searching for clues how incident occured
- Note patient’s chief complaint to determine general type of illness
- To find NOI more easily, gather information from patient and bystanders about problem.
- Observe the scene (noting environment, odors, sounds, medications)
- MOI and NOI are used to determine whether the patient is a trauma patient or medical patient but remember, they can overlap with one causing the other such as seizure (medical) causing head trauma from falling down (trauma)
Just for your information
-Blunt trauma is a force of injury that occurs over a broad area, skin usually isn’t broken but tissues or organs underneath area of impact are possibly damaged.
-Penetrating trauma is a force of injury that pierces the skin and creates an open would that carries a high risk of infection
What should you do when you are determining the number of patients (part of scene size-up?
- Note the number of patients and conditions
- Note if additional resources are needed (such as if there are multiple patients, you need to use the incident command system and call for additional units)
- Finally, use field triage (process of sorting patients based on severity of each patient’s conditions; prioritizing)
Remember to be familar with your incident command system and base your mass casualty plan based on your local protocals.
What are the types additional/specialized resources you may consider? When do you consider these resources?
- Medical resources
- Request additional units (whether BLS or ALS units)
- Request ALS help (w/ AEMTs or paramedics) units for patients with severe injuries or complex medical problems according to your protocol.
- Nonmedical resources
- Fire department
- Fire suppression
- High-angle rescue
- Hazardous materials management
- Complex extrication from motor vehicle crashes
- (swift) Water rescue
- Rescue; search and rescue teams
- Finding, packaging, transporting patients over long distances or unusual terrain
- Law enforcement personnel
- Control traffic
- Control violence
- Trained as first responders
- Fire department
You consider these resources by asking yourself these questions…
- How many patients are there?
- What is the nature of their conditions?
- Who contacted EMS?
- Does the scene pose a threat to you, your patient, or others?
What should you do regarding Spinal Immobilization?
- Consider it early during assessment
- Do not move without immobilization
- Err on side of caution
What is the goal of initial (primary) assessment? What determines the extent of treatment on the scene? What are all the components of an initial assessment?
The goal of initial (primary) assessment to identify and initiate treatment of immediate and potential life threats. The extent of treatment on the scene is determined by the patient’s vital signs (level of consciousness, airway, breathing, circulation; ABC’s) (
The components of initial assessment are…(Bolded ones outlined in ppt list)
- Develop a general impression
- Assessing Level of Consciousness
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Assess Mental Status and LOC
- Check Orientation
- Alert/oriented X4 test
- Check Responsiveness
- Use AVPU critera
- Additional information: Glasgow Coma Scale (GCS) test
- Check Orientation
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Assess Mental Status and LOC
- Assessing ABC’s
- Assess the airway
- Assess the adequecy of breathing
- Assess circulation
- Perform rapid scan (should be done while Assessing ABC’s)
- Establish Patient Rapport
- Identify patient priority care and transport
How do you develop a general impression during initial assessment?
- As you approach the scene…
- Assess (gather) information of the environment as you approach patient.
- Introduce yourself to the patient (note any difficulty in responding), and ask the patient about their chief complaint.
- Assess signs and symptoms of patient
- No vitals yet, look at patient’s skin signs/capiliary refill
NOTE!!: If life threatening problem is found during this process, treat it immediately! Also, determine whether your patient is stable, stable but potentially unstable, or unstable during this process.
What does assessing level of consciousness (mental status) help us find? What are the ways we test it (3 ways)?
LOC, a vital sign can help determine a patient’s neurologic and physiologic status thus we can see which category our patient fits in to…
- Conscious with unaltered LOC
- Conscious with altered LOC
- Can indicate a chemical or neurologic problem adversely affecting the brain’s functioning
- Can indicate inadequate perfusion and oxygenation
- Can indicate problems caused by medications, drugs, alcohol, or poisoning.
- Unconscious
- Focus on ABC’s for this, and other emergency care needed
We can test Mental Status and LOC by testing for…
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Responsiveness
- Using AVPU method
- A - Alert: Patient’s eyes open spontaneously as you approach, patient appears to be aware of you, responsive to environment, appears to follow commands, and eyes visually track people and objects.
- V - Verbal: Patient’s eyes do not open spontaneously but opens to verbal stimuli, able to respond in some meaningful while when spoken to.
- P - Pain: Patient does not respond to questions but responds to painful stimulus. (Be aware that some methods may not give an accurate assessment if spinal cord injury is present)
- U - Unresponsive: Patient does not respond spontaneously, or to verbal, or to painful stimuli. (usually have no cough or gag reflex and cannot protect airway)
- Check for Orientation x 4(for patient is is at least responsive to verbal stimuli) by asking these four questions…
- Person: able to remember their name
- Place: able to identify their current location
- Time: able to identify current year, month, or approximate date
- Event: able to describe what happened
- Using Glasgow Coma Scale; GCS (more advanced LOC indicator) tests for the following on a point scale of 15 to 3… (Don’t worry about the subdivisions for eye, verbal, motor skills, you are given the info on the ambulance cheat sheet)
- Eye (opening) skills
- Spontaneous = 4
- To voice = 3
- To pain = 2
- none = 1
- Verbal skills
- Oriented = 5
- Confused = 4
- Inappropriate words (doesn’t make sense) = 3
- Incomprehensible sounds = 2
- None = 1
- Motor skills
- Obeys command = 6
- Localizes pain = 5
- Withdraws (puling away; pain) = 4
- Flexion (pain) = 3
- Extension (pain) = 2
- None = 1
- Eye (opening) skills
- Using AVPU method
What are pupils? How do they work? What can their diameter and reactivity to light indicate? When must you assume the patient has depressed brain function based on pupils? What can depressed brain function be caused by? What does PEARRL mean?
Note!!: May not be on test, might come later in assessing the eyes.
- A pupil is a circular opening of the pigmented iris of the eye. The iris constricts the pupils according to how much light there is (bigger pupil = less light, smaller pupil = more light).
- It can reflect the status of the brain’s perfusion, oxygenation, and condition (occulamotor nerve).
You must assume depressed brain function when the patient’s pupils…
- Become fixed with no reaction to light
- Dilate with introduction of a bright light and constrict when light is removed
- React sluggishly instead of briskly
- Become unequal in size when bright light is introduced into or removed from one eye.
The causes of depressed brain function are…
- Injury of brain or brain stem
- Trauma or stroke
- Brain tumor
- Inadequate oxygenation or perfusion
- Drugs or toxins (CNS depressants)
PEARRL is a useful guide in assessing the pupils which means…
- P: pupils
- E: Equal
- A: And
- R: Round
- R: Regular in size
- L: React to light
What are the ABC’s? What does A mean and look for in conscious and unconscious patients? What should you do if you see an airway problem?
The ABCs are part of the initial assessment of the patient’s condition.
A means airway, to check if airway is open for the following patient types…
- Unconscious
- We already know this, head-tilt chin lift and listen for breath and look for chest rise.
- Conscious
- Is patient speaking to you in full sentences or 2-3 words (helps indicate A and B)? Talking, crying, etc indicates an open airway.
Stop the assessment and clear the airway immediately (remove obstruction!)
What does B meaning in the ABC’s? What should you obtain when looking for breathing?
B means breathing, assess the following (again, note full sentences or 2-3 word sentences)…
- Respiratory rate
- Assess for 30 seconds and multiply by 2
- Rhythm, regular or irregular
- If chest rises are consistent; regular. If they change in vary; irregular.
- Quality/character of breathing
- Auscultate with stethoscope to check breathing (more info and different sounds/patterns heard on respiratory section)
- Depth of breathing (Tidal volume: amont of air moved in/out of lungs in mL)
- Note if increased TV, adequate TV, or decreased TV (types of depths of breathing discussed in resporatory section)
What does the C stand for in ABC? How do you check for C in conscious and unconscious patients? What do you check for in C?
C stands for circulation. What to check for in circulation involves…
- Assessing the Pulse (Present or not)
- Conscious: palpate radial pulse (older than 1 yr)
- Unconscious: palpate carotid pulse (older than 1 yr)
- Check pulse rate (generally, the younger the patient the faster the pulse, check pg 271 for values)
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Pulse quality (strength)
- Bounding, strong, weak; thready
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Pulse Rhythm (regularity)
- consistant or skips around? regular/irregular
- Check for skin signs: indicates perfusion
- Skin color: pink, cyanosis, jaundice, flushed, pale, gray, sclera?
- Skin temperature: (feel forehead) Hot, warm, or cool (poor perfusion)?
- Skin Moisture: Dry, wet, moist?
- Capillary refill
Perform a rapid scan (similar to head-to-toe) with your partner and explain what you’re looking for.
- Note DCAP-BTLS for every part you are checking!
- Pages 276-277)
What is patient rapport? What should you do?
Establishing a personal connection to your patient. You should…
- Have people skills or develop them!
- Make patient comfortable
- Listen to patient
- Make eye contact with patient
- Base question’s on patient’s complaint
- Mentally summarize information before starting treatment
- Obtain consent
What are two questions you must as yourself as your decision point to identify and prioritize which patient needs care and rapid transport? Who counts as your priority patients?
Regardless whether the patient is trauma or medical, ask yourself if the patient is critical and if they need rapid transport.
Priority patients include (includes problems with ABC’s)…
- Poor general impression
- Unresponsive with no gag or cough or gag reflexes
- Responsive but unable to follow commands
- Difficulty breathing
- Pale skin or other signs of poor perfusion
- Complicated child birth
- Uncontrolled bleeding
- Severe pain in any part of the body
- Severe chest pain
- Inability to move any part of body.
What is the Golden Hour/Period? What is our time in the Golden Hour?
- The Golden Hour/Period refers to the time from injury to definitive care, best chance of survivial is within the hour.
- We have 20 minutes of EMS intervention in the golden hour
- The golden (platinum reduces both these two steps to ten minutes) ten minutes
- initial assessment and intervention
- EMS packaging and transport 10 minutes
- The golden (platinum reduces both these two steps to ten minutes) ten minutes
