Patient Assessment Flashcards
Patient assessment, skills criteria, expansion questions, critical decision making and team leadership
What are the 5 steps of the scene size-up?
BSI Scene safe MOI/NOI Number of patients Add'l resources needed?
What is the purpose of the primary survey?
to find an correct all life threat; to prioritize the patient for treatment and transport
What are possible causes for a patient who appears restless, anxious, or combative as you approach?
hypoxia shock head injury CVA overdose behavioral disorder
Describe decorticate and decerebrate posturing, what they indicate and which one is more serious.
Decorticate: arms flexed, fists clenched, legs extended. Indicated increased ICP and cerebral cortex and midbrain injury.
Decerebrate has arms and legs rigidly extended. This also indicated increased ICP but with extension of injury to brain stem. This is more serious.
Define opisthatonos and give a few possible causes.
neck bridging
meningitis, HI, tetanus, PCP, phenothiazines
Define torticollis/wry neck and give a few possible causes.
unilateral sternocleidomastoid muscle spasm
phenothiazines and PCP
Define carpal/pedal spasms and give a few possible causes.
clawing of hands and/or toes
hyperventilation
10 signs or symptoms which indicate a “sick” patient in need of immediate resuscitation
audible noise assoc with breathing one words sentences decreased or absent breath sounds weak, irregular or absent peripheral pulses pale, wet, cyanotic skin altered mental status chest pain visible GI bleeding active seizures a look of anxiety or horror
Triage colors and what pts fall into each
Red: high priority patients, immediate life threat is present or will develop in minutes
Yellow: intermediate category requiring urgent care. Deterioriation is unlikely if care is delayed 45-60 mins. Anyone alive who is not clearly red or green.
Green: minor injuries/illness. Walking wounded
Black: dead
Expansion Questions: Acute Abdomen
Type of pain- steady or intermittent
Vomitting- frequency, appearance, odor
Alcohol history
GYN history- LMP, unusual discharge, pregnancy
Dietary habits- dyspepsia, fatty food intolerance
Bowel habits- frequency, color, odor
Expansion Questions: Asthma
Severity/frequency of past attacks
Asthma medications- inhalers, frequency of use
Hospitalized for this in the past
Intubated for this in the past
Changed or stopped your medications recently
What meds/treatments have worked for you before?
Expansion Questions: Behavioral
Current chief complain/situation- per pt, per bystander
Thoughts, threats, previous destructive behavior
History or active ETOH or drug abuse
Bizarre or abrupt behavior or sudden change in behavior
Recent crisis
Hallucinations/delusions- their severity
Interaction with family and friends
Onset, previous history, previous disorders, family history
Suicidal- plan, detailed
Expansion Questions: Diabetes
Insulin dependant- type, dose, amount Compliant with medications Normal diet Normal exercise Recent illness, infection Family history Blood glucose monitored daily Normal blood glucose
Expansion Questions: Drowning
Length of submersion
Fresh/salt water
Water temperature
Trauma
Expansion Questions: Head-Neck-Spinal Trauma
Loss of consciousness
Current LOC
Symptoms- dizziness, vertigo, HA, N/V
MOI- restrained, hemlet
Previous evert
Aggravating factores- alcohol, drugs, etc.
Regionalized tingling, numbness, weakness, paralysis
HA- where and how the pain presents
Changes in vision, hearing, sensations and/or motor function
Expansion Questions: Body Cavity and Abdominal Trauma
Location of pain/tenderness
Is respiratory effort easier or more difficult
Nature of incident causing injury
Projectile- range, size, entrance/ exit
Puncture- knife size, object diameter, clean
Safety precautions in place- seatbelt, airbag, body armor
Special physical- breath sounds, neck veins, SQ air, trachea midline
Expansion Questions: OB/ GYN
LMP- normal duration, average flow
Is pregnancy a possibility
Contraceptives used
Has there been a traumatic event to reproductive system
Current blood loss or other vaginal discharge
Previous OB history- gravida/para, abortion, c-sections, miscarriage, previous infections
Expansion Questions: Pulmonary Embolus
History of recent surgery
Personal or genetic history of varicose veins
Recent history of prolonged bed rest
Recent fractures
Cardiac irregularities- Afib, valve problems
History of pregnancy, postpartum bleeding
Special physical- breath sounds, neck veins
See questions for respiratory distress
Expansion Questions: Respiratory
History of present event
Do positional changes make better or worse- orthopnea
Coughing- productive, hemoptysis, color
Pain- location, onset, duration/radiation/ increase with respiration
Body temperature
Special physical- breath sounds, neck veins, accessory muscle use
Expansion Questions: Seizures
History of seizures
Medications and compliance- dilantin, phenobarbital, mysoline, tegretol, depakene, reglin
Describe seizure activity- post/current, full body/Jacksonial
Frequency of seizures. Can they be controlled. Warning/aura
PMH ETOH abuse, head trauma, diabetes, infections, fever, CVA, HTN
Length of seizure- normal
Length of post-ictal- normal
Special physical- breath sounds, core temp, blood glucose, complete trauma exam
Expansion Questions: Syncope
Patient position prior to event Duration of event Symptoms prior to arrival of EMS Associated symptoms PMH including past syncopal episodes Medications and compliance Rule out other medical emergencies- CVA, seizures, AMI, etc. EKG
Expansion Questions: Poisoning
PMH What was taken When was it taken Anything else taken Interventions (dilution, ipecac) Last meal
Expansion Questions: Chest Pain
Dyspnea Breath sounds N/V History of syncope Previous AMI Change in pain with respiratory cycle Tenderness on palpation of chest wall EKG
Expansion Questions: CVA
Previous TIA
Onset and change of symptoms (stuttering vs. maximal)
History of Afib
Onset <3hr
Standard 6 vital signs
LOC Pulse Respirations Blood pressure Skin Pupils
What would cause tachycardia? (7)
Shock, hypoxia, dysrhythmias, fear/anxiety, fever, pain, stimulants
What would cause bradycardia? (4)
Dysrhythmias, increased ICP (CVA, TBI/ HI), drug OD(beta or Ca++ blocker)
What would cause an irregular pulse? (2)
dysrhythmias, pulse deficit
What would cause a weak/absent peripheral pulses? (3)
shock, poor perfusion, hypothermia
What is pulse deficit?
electrical stimuli of heart that is not creating a beat
What is pulsus paradoxus? What are three examples of when you would see it?
Difference in SBP >10mmHg; breath stacking
See in tamponade, asthma and tension pneumothorax
A positive tilt test is significant for what percent volume loss?
20%
What is a normal cap refill?
<2 seconds
What is the normal tidal volume to give chest rise? (average and cc/kg)
500cc or 5-7cc/kg
What would cause tachypnea? (4)
shoch, hypoxia(all respiratory emergencies), DKA, ASA poisoning
What would cause bradypnea? (3)
sedative OD, hypothermia, imminent respiratory arrest
What would cause an increased WOB? (4)
bronchospasm
lung disease
pulmonary edema
FBO
What are kussmaul respirations
fast, deep respirations. Compensatory mechanism for metabolic acidosis
What are biot’s respirations and what injury are these associated with?
irregular respirations with periods of apnea. Direct trauma to brain stem