Patient Assessment in detail

Question 1

What are the steps to patient assessment?

Answer 1

1. Scene size-up
2. Primary assessment
3. Secondary assessment/focused history
4. Reassessment

Question 2

What are the parts for scene size up?

Answer 2

• BSI
• Safety, aka, is the scene safe? If not, how can I make it safe?
• Mechanism of injury (MOI) for trauma or nature of illness (NOI) for medical
• Number of patients
• Additional help (Fire, PD, additional ambulances)
• C-Spine

Question 3

If there is any possibility of a C-spine injury, how do you open the airway?

Answer 3

Jaw-thrust maneuver

Question 4

If there is NO possibility of C-spine injury, how do you open the airway?

Answer 4

Head-tilt/chin-lift maneuver

Question 5

What are the parts of primary assessment?

Answer 5

• General impression
• AVPU
• Cheif complaint & life threats
• ABC’s
• Priority (severity of the condition)

Question 6

What do you use AVPU for?

Answer 6

Assessing level of consciousness

Question 7

What does AVPU stand for?

Answer 7

A- Alert
V- Responds to verbal stimuli
P- Responds to physical stimuli
U- Unresponsive

Question 8

What is an example of someone being A in AVPU?

Answer 8

Pt is alert and oriented x4 (oriented to person/self, place, time, and event)

Question 9

What is an example of someone being V in AVPU?

Answer 9

EMT: “Sir can you open your eyes for me?”
Pt: opens eyes

Question 10

What is an example of someone being P in AVPU?

Answer 10

Pt responding to sternal rub

Question 11

What is an example of someone being U in AVPU?

Answer 11

Pt is nonresponsive to verbal or physical stimuli

Question 12

What is a chief complaint?

Answer 12

What is the patient most concerned about. Usually, but not always, the reason they call 911.

Question 13

When do you do CPR on someone with a pulse?

Answer 13

1. A child with a heart rate less than 60 bpm
2. An unconcious/disoriented person who is unable to follow simple commands who has a weak, thready, and bradycardic (<60 bpm) pulse

Question 14

When does a MOI become a serious MOI?

Answer 14

If the MOI is life threatening

Question 15

Where do you take severe trauma patients?

Answer 15

A trauma center (ex: THFW or JPS in Tarrant county/Parkland or Baylor Dallas in Dallas county)

Question 16

When do you take a severe trauma patient to the closest ER?

Answer 16

If you cannot manage their airway

Question 17

Where do you take burn patients?

Answer 17

Burn center (Ex: Parkland in Dallas county)

Question 18

What are the parts to the secondary assessment/focused history?

Answer 18

• If it’s trauma, is it a serious MOI or an isolated injury. If it’s medical, is the person concious or unconscious?
• PEx
• Transport decision
• Vitals
• SAMPLE/OPQRST
• Diagnostics
• Diagnosis
• Interventions
• Detailed PEx
• Patient transfer report

Question 19

If the patient is conscious in a medical call, what do you focus on?

Answer 19

The chief complaint

Question 20

What must you keep in mind when making a transport decision?

Answer 20

Factor in geographical area, time of day, and traffic conditions

Question 21

What is considered a “full” set of vitals?

Answer 21

• Pulse
• Respirations
• Blood pressure
• Temperature
• Pulse oximetry

Question 22

What must you do regarding vitals?

Answer 22

Compare them to patient’s normal, if known

Question 23

What must you keep in mind about pulse oximetry?

Answer 23

It does not tell you the oxygen saturation, just the saturation of the RBC

Question 24

What is the SAMPLE history?

Answer 24

S - signs/symptoms
A - allergies (especially drug)
M - medications/recreational drug use/medication compliance
P- past medical history
L - last oral intake
E - events leading up

Question 25

What is medication compliance?

Answer 25

Does the patient take their medications as directed?

Question 26

OPQRST is generally used for pain complaints, what does it stand for?

Answer 26

O - onset (what was the pt doing when the pain started? was it a gradual onset or a sudden one?)
P - provocation/palliation (what makes the pain better or worse, if anything?)
Q - quality (sharp, dull, throbbing, achy)
R - radiation (does the pain spread anywhere? if so, where?
S - severity (0-10 in adults, Wong-Baker scale in children)
T - time (how long since the pain started)

Question 27

When using the 0-10 pain scale, what is a 10?

Answer 27

The worst pain the patient has ever experienced

Question 28

What are some diagnostics?

Answer 28

• Pulse oximetry
• Breath sounds
• Auscultation with a stethoscope
• Glucometer
• ETCO2

Question 29

What is ETCO2 and what is the normal range?

Answer 29

End tidal CO2 is the amount of CO2 in an exhaled breath. The normal range is 35-45 mmHg (5-6%)

Question 30

What is a part of reassessment?

Answer 30

• Repeat vital signs
• Repeat primary assessment
• Repeat focused history/PEx
• Check interventions and their effects, if any

Question 31

How often do you reassess an unstable patient?

Answer 31

Every 5 minutes

Question 32

How often do you reassess a stable patient?

Answer 32

Every 15 minutes

Question 33

What should you note about temperature rechecks?

Answer 33

If the temperature was originally normal, no reassessment of temperature is needed. If it was abnormal (high or low), recheck the temperature with vital signs

Question 34

When do you hand off your patient?

Answer 34

When you give oral report to the nurse at the ED

Question 35

What is included in your oral report via radio?

Answer 35

Age, sex, signs/symptoms, ETA, vitals, GCS

Question 36

What are the ABC’s?

Answer 36

A - airway
B - breathing
C - circulation