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EMS Protocols 2015 > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

4 Things included in BSI

A
  1. Gloves
  2. Eye protection if necessary
  3. Gown if necessary
  4. Mask if necessary
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2
Q

Definition of Scene Safety

A

An assessment to assure the well being of the EMS providers

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3
Q

3 Considerations for Scene Safety

A
  1. Personal Protection
  2. Protection of the pt
  3. Protection of bystanders
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4
Q

2 Things to size up at a medical incident

A
  1. Nature of illness

2. Total number of pts

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5
Q

Define Nature of Illness

A

Why EMS was activated

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6
Q

If more pts are present then the responding unit can effectively handle what should occur

A

Initiate Mass Casualty Plan

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7
Q

2 Things to size up at a trauma incident

A
  1. Mechanism of Injury

2. Total number of pts

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8
Q

If the responding crew can handle the trauma incident what should then immediately occur?

A

Consider spinal precautions and continue care

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9
Q

During START triage Deceased are defined as:

A

Dead or mortally wounded, no care required

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10
Q

During START triage Immediate are defined as:

A

Immediate care, life threatening

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11
Q

During START triage Delayed are defined as:

A

Urgent care, can delay for up to one hour

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12
Q

During START triage Minor are defined as:

A

Delayed care, can delay up to three hours

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13
Q

7 Considerations for pt movement

A
  1. Primary and Secondary assessment before pt movement unless grave threat to pt
  2. Monitor airway and C-spine carefully while moving
  3. Roll as a unit
  4. Splint PRIOR to movement if possible
  5. Perform smooth and safe transfer to transport device (board or vehicle)
  6. Use proper body mechanics as rescuer
  7. Minimize pt movement with modification for environmental hazards
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14
Q

During extrication of a pulseless apneic pt what occurs first? Extrication or CPR?

A

Extrication

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15
Q

When should a C-collar and spinal immobilization happen during an extrication?

A

Prior to extrication

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16
Q

When should life threatening problems be address during an extrication?

A

Prior to extraction

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17
Q

Define general impression of the pt

A

Formed to determine the priority of care and is based on the EMS provider’s immediate assessment of the environment and the patients chief complaint

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18
Q

What 4 things should be found during the general impression?

A
  1. Medical or Trauma etiology
  2. Age
  3. Gender
  4. Presence of a life threatening condition
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19
Q

Define the acronym AVPU

A

A- Alert
V- Verbal stimulus pt responds to
P- Painful stimuli pt responds to
U- Unresponsive- no gag or cough

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20
Q

If responsive pt is talking or crying what should you do?

A

Assess for adequacy of breathing

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21
Q

If responsive pt is not talking or crying what should you do?

A

Open airway

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22
Q

If unresponsive medical pt does not have an open airway what should you do?

A

Open airway with head tilt chin lift

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23
Q

If airway of the unresponsive medical pt has been opened with the head tilt chin lift but the airway is not clear what should you do?

A

Clear the airway

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24
Q

If unresponsive trauma pt does not have an open airway what should you do?

A

Stabilize the C spine and open the airway using the jaw thrust maneuver

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25
Q

If airway of the unresponsive trauma pt has been opened with the jaw thrust maneuver while maintaining control of pt c spine but the airway is not clear what should you do?

A

Clear the airway

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26
Q

How may you clear an airway?

A

BLS choking maneuvers or Magill forceps removal if indicated

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27
Q

What level should the pulse ox of an adequately breathing responsive pt be maintained at?

A

> 94%

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28
Q

What level should the pulse ox of an adequately breathing responsive pt with COPD be maintained at?

A

92%

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29
Q

How should all responsive pt with respiratory distress or depression be treated?

A

With oxygen to maintain appropriate pulse ox levels with capnography utilized and nasal airway considered.

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30
Q

How should the unresponsive but breathing pt be treated?

A

Placement of appropriate airway device, maintain appropriate pulse ox levels while utilizing capnography to guide therapy

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31
Q

How should the pt who is not breathing be treated?

A

Placement of appropriate airway device, maintain appropriate pulse ox levels while utilizing capnography to guide therapy

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32
Q

Initial assessment of responsive medical pt should include what 4 things?

A
  1. OPQRST
  2. SAMPLE history
  3. Rapid assessment
  4. Baseline vital signs
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33
Q

Define the acronym OPQRST

A 
Onset
Provocation
Quality
Radiation
Severity
Time
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34
Q

Define the acronym SAMPLE

A 
Signs/Symptoms
Allergies
Medications
Pertinent medical history
Last oral intake
Events leading
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35
Q

Initial assessment of trauma pt should include what 5 things?

A
  1. Consider Mechanism of Injury
  2. Perform rapid trauma assessment on pt to determine life threatening injuries
  3. Continue spinal stabilization
  4. Consider transport decisions
  5. Assess baseline vitals signs
36
Q

For the trauma call what should be considered pertaining to transport decisions?

A

Hospital capabilities

Air vs Ground transport

37
Q

Define the acronym DCAP-BTLS

A 
Deformities
Contusions
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling
38
Q

When assessing the head what are you looking for?

A

Signs of injury:

DCAPBTLS

39
Q

When assessing the face what are you looking for?

A

Signs of injury:

DCAPBTLS

40
Q

When assessing the ears what are you looking for?

A

Signs of injury:
DCAPBTLS
Drainage

41
Q

When assessing the eyes what are you looking for?

A 
Signs of injury:
DCAPBTLS
Discoloration
Unequal pupils
Foreign bodies
Blood in anterior chamber
42
Q

When assessing the nose what are you looking for?

A

Signs of injury:
DCAPBTLS
Drainage
Bleeding

43
Q

When assessing the mouth what are you looking for?

A 
Signs of injury:
DCAPBTLS
Teeth
Obstructions
Swollen or lacerated tongue
Odors
Discoloration
44
Q

When assessing the neck what are you looking for?

A

Signs of injury:
DCAPBTLS
Jugular vein distention
Crepitus

45
Q

When assessing the chest what are you looking for?

A 
Signs of injury:
DCAPBTLS
Crepitus
Paradoxical motion
Breath sounds in the apices, mid-clavicular line, bilaterally and at the bases, mid-axillary line, bilaterally for presence or absence and equality.
46
Q

When assessing the abdomen what are you looking for?

A 
Signs of injury:
DCAPBTLS
Firm
Soft
Distended
47
Q

When assessing the pelvis what are you looking for?

A

Signs of injury:
DCAPBTLS
If the pt does not complain of pain or is unresponsive, gently flex and compress the pelvis to determine stability

48
Q

When assessing all four extremities what should you look for?

A 
Signs of injury:
DCAPBTLS
Distal pulses
Sensation
Motor function
49
Q

How should you assess the posterior aspect of the body and what should you look for?

A

Roll with spinal precautions
Signs of injury:
DCAPBTLS

50
Q

4 ways to assess a pt for injury?

A

Inspect
Palpate
Look
Feel

51
Q

During what part of pt care is pt history commonly obtained?

A

While performing secondary survey

52
Q

Another name for secondary survey

A

Detailed physical exam

53
Q

What should you consider as a possibility when assessing a trauma pt?

A

Possible medical causes for trauma particularly in single-person accidents

54
Q

5 things to observe when assessing a pts neurologic status

A
  1. Vital signs. Particularly for adequacy of ventilation; depth; frequency; and regularity of respirations
  2. Level of Consciousness (GCS)
  3. Eyes. Direction of gaze. Size and reactivity of pupils
  4. Movement. Do all 4 extremities move equally well?
  5. Sensation. Observe for absent, abnormal, or normal sensation at different levels if cord injury suspected.
55
Q

What is assessed in determining pt GCS?

A

Eye Response
Verbal Response
Motor Response

56
Q

What is the max possible GCS?

A

15

57
Q

What is the lowest possible GCS?

A

3

58
Q

What is the highest possible score for Eye response?

A

4

59
Q

What are the levels of Eye response?

A

4- Open spontaneously
3- Open to verbal comand
2- Open in response to pain
1- No response

60
Q

What is the highest possible score for Verbal response?

A

5

61
Q

What are the levels of Verbal response?

A 
5- Talking/ Oriented
4- Confused speech/ disoriented
3- Inappropriate words
2- Incomprehensible sounds
1- No response
62
Q

What is the highest possible score for Motor response?

A

6

63
Q

What are the levels of Motor response?

A 
6- Obeys commands
5- Localizes pain
4- Withdraws from pain
3- Abnormal flexion
2- Extension
1- No response
64
Q

Vital signs include what 5 things?

A 
Pulse
Blood Pressure
Respirations
Pulse oximetry
Temperature
65
Q

When should vital signs be assessed?

A

Within 5 minutes of pt contact and reassessed during transport as indicated by protocol and after each pharmacological intervention.
Final set should be documented concerning the pt condition upon arrival at ED.

66
Q

What should occur with all abnormal blood pressures?

A

Confirmation with a manual blood pressure

67
Q

When should capnography be used?

A

All high acuity medical/trauma pts.

68
Q

When should capography be documented?

A

At the same time as the pts vital signs

69
Q

What is the goal range for pCO2?

A

35-45mmHG

70
Q

When should a 12 lead EKG be performed?

A

When indicated within 5 minutes

71
Q

13 situations in which a 12 lead is mandated

A
  1. Paramedic suspects cardiac etiology
  2. Previous cardiac hx and symptoms
  3. Chest pain
  4. Dyspnea
  5. Syncope, dizziness, new onset seizure
  6. Bradycardia
  7. Tachycardia
  8. Non-traumatic abdominal pain Age>35
  9. Nausea and vomiting Age>35
  10. Diaphoresis
  11. Weakness Age>35
  12. Altered Mental Status
  13. Overdose/ ingestion
72
Q

Does a normal EKG rule out cardiac etiology?

A

No

73
Q

How should EKG be reported?

A
  1. Relay significant 12 lead EKG changes to the receiving hospitals ER
  2. Transmit 12 lead EKG to the receiving hospitals ER
  3. Leave a copy of the 12 lead EKG with the receiving hospitals ER
74
Q

For prophylactic IV access and medication delivery what may be placed?

A

Saline lock with 10ml NS flush

75
Q

What fluid is appropriate for volume resuscitation?

A

Normal Saline

76
Q

What dose of Normal Saline is provided for volume resuscitation of an adult?

A

250-1000 cc bolus

77
Q

What dose of Normal Saline is provided for volume resuscitation of a pediatric?

A

20cc/kg bolus

78
Q

In what pts should caution be used in fluid resuscitation?

A

Pt with acute CHF

Pt with renal failure

79
Q

Does a history of renal failure and/or CHF preclude a pt from receiving fluids?

A

No

80
Q

3 times in which Intraosseous access is warranted

A
  1. Critical condition exists
  2. Condition will rapidly worsen without medication and/or fluid administration
  3. IV access unsuccessful after 2 attempts or 90 seconds.
81
Q

Other than intraosseous access what other method of access is acceptable?

A

External Jugular

82
Q

What medications may be given by intraosseous access?

A

All medications that may be given by IV

83
Q

What is the name of the FACES rating scale?

A

Wong-Baker FACES pain rating scale

84
Q

What is the range of the Wong-Baker FACES pain rating scale?

A

0-10

85
Q

What does the range of the Wong-Baker FACES pain rating scale signify?

A

Increasing gradually from 0-10 with 0=No Hurt and 10=Hurts Worst

EMS Protocols 2015 (8 decks)

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