Patient Assessment Flashcards by Alyssa Whim

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

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

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What is the purpose of the primary survey?

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

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

hypoxia
shock
head injury
CVA
overdose
 behavioral disorder

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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.

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Define opisthatonos and give a few possible causes.

neck bridging

meningitis, HI, tetanus, PCP, phenothiazines

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

unilateral sternocleidomastoid muscle spasm

phenothiazines and PCP

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

clawing of hands and/or toes

hyperventilation

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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

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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

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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

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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?

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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

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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

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Expansion Questions: Drowning

Length of submersion
Fresh/salt water
Water temperature
Trauma

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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

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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

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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

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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

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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

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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

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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

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Expansion Questions: Poisoning

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

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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

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Expansion Questions: CVA

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

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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

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

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

Describe apneustic respirations.

long inspiration, short- sharp exhalation

What is the normal range for systolic blood pressure?

139-90mmHg

What would cause a SBP >140mmHg?

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

What would cause a SBP <90mmHg?

decreased fluid, decrease PVR, pump failure

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

HTN, renal disease, eclampsia

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

SHOCK- early stages of vascular collapse

What is being noted when assessing the skin?

Color Temp Moisture Hydration

What are causes of cold skin? 3

shock hypothermia barb OD

What are causes of hot skin? 4

fever heat emergency stimulant overdose DKA

What are 2 causes of moist skin?

shock, sympathetic stimulation

What are two causes of dry skin?

dehydration, DKA

What are you assess when noting tugor?

hydration

What are 2 causes of pallor skin?

low O2, shock

At what PaO2/SpO2 will cyanosis be present?

PaO2 <50, SpO2 80%

What are two causes of flushed skin?

vasodilation- anaphylaxis, heat emergency

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

``` Jaundice Liver failure(hepatitis), kidney failure ```

When will you start seeing dependent lividity set in?

30 minutes

What are 4 ways to get a core temp?

Esophageal probe Rectal Tympanic Temporal artery

At what temperature are we concerned about brain cells cooking?

>104

What are three causes of hypothermia?

Cold exposure, alcohol intoxication, barbituate OD

Define AEIOU TIPS

``` 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 ```

What are 4 causes of dilated pupils?

hypoxia, barb OD, atropinie, cocaine(SNS)

What are 3 causes of constricted pupils?

narcotic OD, cholinergic OD, brain injury

What is a conjugate gaze?

track objects; eyes move together

What is nystagmus and what are 3 potential causes?

twitching; can be lateral or verticle alcohol, valium, PCP

What two brain injuries lead to Dolls eyes?

brain stem injury | herniation of brain

What are you assessing in the general impression?

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

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

Clear, patent

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

adequate vs. inadequate Ausculate breath sounds chest wall patency supplemental O2 and PPV

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

Pulses Skin Fluid sweep

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

presence and quality- check central and peripheral

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

blood, urine, feces, or any other body fluids

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

color, temperature, moisture

What is the final step of the initial assessment?

Triage/ transport priority

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

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

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

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

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?

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

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

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

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

roll patient and inspect posterior for exit wounds

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

Evisceration, punctures, rigidity, distention and bruising

What are you looking for when assessing the pelvis?

stability- compress for tenderness/motion

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

femur fractures, arterial hemorrhage, PMS

What are the 5 steps of reassessment?

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

What are the 8 requirements for critical thinking?

``` 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 ```

What are the 5 components of mental checklist?

``` Scan situation stop and think decide and act maintain control reevaluate ```

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

``` Concept development Interpret data Principle application HALF WAY Evaluate Reflect ```

How is clinical decision making developed in EMS education?

Case studies Scenario training Hospital clinicals Field internship

What are disadvantages to protocol use?

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

Protocol vs. standing order

Protocol- standarized treatment plan for specific patient presentation Standing orders- protocols carried out without online physician direction

Define differential diagnosis

preliminary list of possible etiologies for patients presenting condition

Define field impression

condition identified for treatment

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

Think Lead Do

Briefly summarize Think, Lead, Do. | What acronyms are used with each?

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

What does TEAMLEADS acronym stand for?

``` Talk Establish Assessment Management Laps Equipment Adapt Direct Scope ```

``` Student/preceptor communication: within 1 min within 1 min within 2-3 min within 5 min within 5 min within 6-7 min ```

``` 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 ```

What are strategies for working through a brain freeze?

Simple ABC's | 6R's- read scene, read pt, react, reevaluate, revise, review

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

Divergent- taking in information Convergent- narrowing possibilities When you are making selecting your field impression, you should be using convergent thinking

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

Core- TEAM | General- LEADS

Patient Assessment Flashcards

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