Patient Assessment Flashcards

Patient assessment, skills criteria, expansion questions, critical decision making and team leadership

1
Q

What are the 5 steps of the scene size-up?

A
BSI
Scene safe
MOI/NOI
Number of patients
Add'l resources needed?
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2
Q

What is the purpose of the primary survey?

A

to find an correct all life threat; to prioritize the patient for treatment and transport

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3
Q

What are possible causes for a patient who appears restless, anxious, or combative as you approach?

A
hypoxia
shock
head injury
CVA
overdose
 behavioral disorder
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4
Q

Describe decorticate and decerebrate posturing, what they indicate and which one is more serious.

A

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.

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5
Q

Define opisthatonos and give a few possible causes.

A

neck bridging

meningitis, HI, tetanus, PCP, phenothiazines

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6
Q

Define torticollis/wry neck and give a few possible causes.

A

unilateral sternocleidomastoid muscle spasm

phenothiazines and PCP

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7
Q

Define carpal/pedal spasms and give a few possible causes.

A

clawing of hands and/or toes

hyperventilation

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8
Q

10 signs or symptoms which indicate a “sick” patient in need of immediate resuscitation

A
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
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9
Q

Triage colors and what pts fall into each

A

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

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10
Q

Expansion Questions: Acute Abdomen

A

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

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11
Q

Expansion Questions: Asthma

A

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?

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12
Q

Expansion Questions: Behavioral

A

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

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13
Q

Expansion Questions: Diabetes

A
Insulin dependant- type, dose, amount
Compliant with medications
Normal diet
Normal exercise
Recent illness, infection
Family history
Blood glucose monitored daily
Normal blood glucose
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14
Q

Expansion Questions: Drowning

A

Length of submersion
Fresh/salt water
Water temperature
Trauma

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15
Q

Expansion Questions: Head-Neck-Spinal Trauma

A

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

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16
Q

Expansion Questions: Body Cavity and Abdominal Trauma

A

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

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17
Q

Expansion Questions: OB/ GYN

A

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

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18
Q

Expansion Questions: Pulmonary Embolus

A

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

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19
Q

Expansion Questions: Respiratory

A

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

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20
Q

Expansion Questions: Seizures

A

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

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21
Q

Expansion Questions: Syncope

A
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
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22
Q

Expansion Questions: Poisoning

A
PMH
What was taken
When was it taken
Anything else taken
Interventions (dilution, ipecac)
Last meal
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23
Q

Expansion Questions: Chest Pain

A
Dyspnea
Breath sounds
N/V
History of syncope
Previous AMI
Change in pain with respiratory cycle
Tenderness on palpation of chest wall
EKG
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24
Q

Expansion Questions: CVA

A

Previous TIA
Onset and change of symptoms (stuttering vs. maximal)
History of Afib
Onset <3hr

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25
Q

Standard 6 vital signs

A
LOC
Pulse
Respirations
Blood pressure
Skin
Pupils
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26
Q

What would cause tachycardia? (7)

A

Shock, hypoxia, dysrhythmias, fear/anxiety, fever, pain, stimulants

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27
Q

What would cause bradycardia? (4)

A

Dysrhythmias, increased ICP (CVA, TBI/ HI), drug OD(beta or Ca++ blocker)

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28
Q

What would cause an irregular pulse? (2)

A

dysrhythmias, pulse deficit

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29
Q

What would cause a weak/absent peripheral pulses? (3)

A

shock, poor perfusion, hypothermia

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30
Q

What is pulse deficit?

A

electrical stimuli of heart that is not creating a beat

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31
Q

What is pulsus paradoxus? What are three examples of when you would see it?

A

Difference in SBP >10mmHg; breath stacking

See in tamponade, asthma and tension pneumothorax

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32
Q

A positive tilt test is significant for what percent volume loss?

A

20%

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33
Q

What is a normal cap refill?

A

<2 seconds

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34
Q

What is the normal tidal volume to give chest rise? (average and cc/kg)

A

500cc or 5-7cc/kg

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35
Q

What would cause tachypnea? (4)

A

shoch, hypoxia(all respiratory emergencies), DKA, ASA poisoning

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36
Q

What would cause bradypnea? (3)

A

sedative OD, hypothermia, imminent respiratory arrest

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37
Q

What would cause an increased WOB? (4)

A

bronchospasm
lung disease
pulmonary edema
FBO

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38
Q

What are kussmaul respirations

A

fast, deep respirations. Compensatory mechanism for metabolic acidosis

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39
Q

What are biot’s respirations and what injury are these associated with?

A

irregular respirations with periods of apnea. Direct trauma to brain stem

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40
Q

What are cheyne-stoke’s respirations and what are some causes?

A

increasingly deeper and then decreasing shallower respirations followed by periods of apnea. Present in CVA, HI, severe CHF, cardiogenic shock

41
Q

Describe apneustic respirations.

A

long inspiration, short- sharp exhalation

42
Q

What is the normal range for systolic blood pressure?

A

139-90mmHg

43
Q

What would cause a SBP >140mmHg?

A

Sympathetic stimulation- cocaina OD, emotion. increased ICP, CVA

44
Q

What would cause a SBP <90mmHg?

A

decreased fluid, decrease PVR, pump failure

45
Q

What would cause a DBP >90mmHg? (3)

A

HTN, renal disease, eclampsia

46
Q

What would cause a DBP <50mmHg? (1)

A

SHOCK- early stages of vascular collapse

47
Q

What is being noted when assessing the skin?

A

Color
Temp
Moisture
Hydration

48
Q

What are causes of cold skin? 3

A

shock
hypothermia
barb OD

49
Q

What are causes of hot skin? 4

A

fever
heat emergency
stimulant overdose
DKA

50
Q

What are 2 causes of moist skin?

A

shock, sympathetic stimulation

51
Q

What are two causes of dry skin?

A

dehydration, DKA

52
Q

What are you assess when noting tugor?

A

hydration

53
Q

What are 2 causes of pallor skin?

A

low O2, shock

54
Q

At what PaO2/SpO2 will cyanosis be present?

A

PaO2 <50, SpO2 80%

55
Q

What are two causes of flushed skin?

A

vasodilation- anaphylaxis, heat emergency

56
Q

What is another term for icterus? What are 2 causes of icterus?

A
Jaundice
Liver failure(hepatitis), kidney failure
57
Q

When will you start seeing dependent lividity set in?

A

30 minutes

58
Q

What are 4 ways to get a core temp?

A

Esophageal probe
Rectal
Tympanic
Temporal artery

59
Q

At what temperature are we concerned about brain cells cooking?

A

> 104

60
Q

What are three causes of hypothermia?

A

Cold exposure, alcohol intoxication, barbituate OD

61
Q

Define AEIOU TIPS

A
A- ammonia, acidosis, alkalosis
E- environment, endocrine, electrolytes
I- increase ICP ( trauma, space occupying lesion)
O- oxygen
U- uremia
T- toxin
I- infection( sepsis, intracranial infection)
P- psychiatric
S- seizure, stroke
62
Q

What are 4 causes of dilated pupils?

A

hypoxia, barb OD, atropinie, cocaine(SNS)

63
Q

What are 3 causes of constricted pupils?

A

narcotic OD, cholinergic OD, brain injury

64
Q

What is a conjugate gaze?

A

track objects; eyes move together

65
Q

What is nystagmus and what are 3 potential causes?

A

twitching; can be lateral or verticle

alcohol, valium, PCP

66
Q

What two brain injuries lead to Dolls eyes?

A

brain stem injury

herniation of brain

67
Q

What are you assessing in the general impression?

A
A- age/ sex
A- audible breath sounds
M- MOI/NOI
B- Bodily fluids
I- imminent life threats
R- responsiveness
P- position
C- color
68
Q

When assessing the airway, what are the two things you are assessing?

A

Clear, patent

69
Q

When assessing breathing, what are the 3 things you are assessing and what interventions would you provide if indicated?

A

adequate vs. inadequate
Ausculate breath sounds
chest wall patency

supplemental O2 and PPV

70
Q

What three assessments are preformed in the initial to determine circulatory status?

A

Pulses
Skin
Fluid sweep

71
Q

Regarding pulses, what is specifically being assessed in the initial?

A

presence and quality- check central and peripheral

72
Q

Regarding body fluid sweep, what specifically is bring assessed in the initial?

A

blood, urine, feces, or any other body fluids

73
Q

Regarding skin, what specifically is being assessed in the initial?

A

color, temperature, moisture

74
Q

What is the final step of the initial assessment?

A

Triage/ transport priority

75
Q

What are the past medical histories that should be asked with each assessment?

A

history of heart problems, respiratory disease, seizures, diabetes, and hypertension
diabetes

76
Q

During the assessment of the head, what 3 things are you looking for?

A

deformity, blood/fluid in ears, nose or mouth, and pupils

77
Q

When assessing the neck, what 6 things are you looking for? When that is complete, what is the last step in the assessment of the neck?

A

JVD, SQ air, trach deviation, accessory muscle use, c-spine, medic alert tag.

Apply C-collar

78
Q

When assessing the chest, what 5 things are you looking for?

A

chest wall patency, retractions, SQ air, paradoxical motion, breath sounds

79
Q

If penetrations are observed in the chest, what will you immediately do?

A

roll patient and inspect posterior for exit wounds

80
Q

When assessing the abdomen, what 5 things are you looking for?

A

Evisceration, punctures, rigidity, distention and bruising

81
Q

What are you looking for when assessing the pelvis?

A

stability- compress for tenderness/motion

82
Q

What are the three things you are looking for when assessing the extremities?

A

femur fractures, arterial hemorrhage, PMS

83
Q

What are the 5 steps of reassessment?

A

Reassess primary, vitals, focused assessment, interventions(O2/PPV, hemorrhage management, other interventions), and re-establish priorities

84
Q

What are the 8 requirements for critical thinking?

A
knowledge/ skills base
focus on large amounts of data
organize data
identify and deal with medical ambiguity
separate relevant and irrelevant data
analyze and compare situation
explain and support decisions
courage to lead
85
Q

What are the 5 components of mental checklist?

A
Scan situation
stop and think
decide and act
maintain control
reevaluate
86
Q

What are the 5 steps of clinical decision making? (CIPHER)

A
Concept development
Interpret data
Principle application
HALF WAY
Evaluate
Reflect
87
Q

How is clinical decision making developed in EMS education?

A

Case studies
Scenario training
Hospital clinicals
Field internship

88
Q

What are disadvantages to protocol use?

A

Difficult to apply to atypical or vague complaints, multiple underlying conditions, multiple presenting conditions, and when a field diagnosis cannot be reached.

Protocols also promote “cookbook” medicine

89
Q

Protocol vs. standing order

A

Protocol- standarized treatment plan for specific patient presentation

Standing orders- protocols carried out without online physician direction

90
Q

Define differential diagnosis

A

preliminary list of possible etiologies for patients presenting condition

91
Q

Define field impression

A

condition identified for treatment

92
Q

What are teh three concurrent processes in the essential triad of team leadership? (TLD)

A

Think
Lead
Do

93
Q

Briefly summarize Think, Lead, Do.

What acronyms are used with each?

A

Think- CIPHER
Lead- TEAMLEADS
Do- Assessment, Impression, Treatment, Reassessment

94
Q

What does TEAMLEADS acronym stand for?

A
Talk
Establish
Assessment
Management
Laps
Equipment
Adapt
Direct
Scope
95
Q
Student/preceptor communication:
within 1 min
within 1 min
within 2-3 min
within 5 min
within 5 min
within 6-7 min
A
within 1 min- sick/not sick; triage
within 1 min- resuscitative
within 2-3 min- developing clinical picture
within 5 min- differential diagnosis
within 5 min- field impression
within 6-7 min- treatment plan
96
Q

What are strategies for working through a brain freeze?

A

Simple ABC’s

6R’s- read scene, read pt, react, reevaluate, revise, review

97
Q

What is divergent thinking vs. convergent thinking and when should they be uses during team leadership?

A

Divergent- taking in information
Convergent- narrowing possibilities

When you are making selecting your field impression, you should be using convergent thinking

98
Q

Which are core responsibilities and which are general- TEAM or LEADS?

A

Core- TEAM

General- LEADS