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Emergency Medical Technician > Patient Assessment - Scene Size-Up & Primary Assessment > Flashcards

Patient Assessment - Scene Size-Up & Primary Assessment Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Five main parts of the assessment process

A
  1. Scene size-up
  2. Primary assessment
  3. History taking
  4. Secondary assessment
  5. Reassessment
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2
Q

The key to effective patient assessment

A

Remain organized

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3
Q

Subjective condition that the patient feels and tells you about

A

Symptom

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4
Q

Objective condition that you can observe or measure

A

Sign

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5
Q

It is essential to have a basic understanding of the causes and presentations of commonly encountered emergencies, as this info can help to formulate a ___

A

Field impression

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6
Q

Conclusion about the cause of the patient’s condition after considering the situation, history, and examination findings

A

Field impression

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7
Q

A field impression will help you determine your ___

A

Priorities of care

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8
Q

The treatment you will provide for most patients is based on ___, not ___

A
  1. Symptoms
  2. An exact diagnosis
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9
Q

Your evaluation of the conditions in which you will be operating

A

Scene size-up

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10
Q

Paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose

A

Situational awareness

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11
Q

When working on a roadway, wear a ___

A

High-visibility Class 2 or 3 safety vest

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12
Q

The result of physical forces applied to the outside of the body

A

Traumatic injuries

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13
Q

Traumatic injuries are generally classified according to ___

A
  1. Type or amount of force
  2. How long it was applied
  3. Where it was applied to the body
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14
Q

The forces, or energy transmission, applied to the body that cause injury

A

Mechanism of injury

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15
Q

MOI

A

Mechanism of injury

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16
Q

The ___ can be used as a guide to help you focus your assessment

A

MOI

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17
Q

The force of injury occurs over a broad area, and the skin is sometimes not broken

A

Blunt trauma

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18
Q

The force of the injury occurs at the specific point of contact between the kin and the object.

A

Penetrating trauma

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19
Q

The object pierces the skin and creates an open wound that carries a higher potential risk for infection

A

Penetrating trauma

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20
Q

The tissues and organs underneath the area of impact may be damaged

A

Blunt trauma

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21
Q

The general type of illness the patient is experiencing

A

Nature of illness

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22
Q

NOI

A

Nature of illness

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23
Q

The most serious thing the patient is concerned about and the reason EMS was called

A

Chief complaint

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24
Q

How to quickly determine the NOI

A
  1. Talk with the patient, family or bystanders about the problem
  2. Use your senses to check the scene for clues
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25
Q

When there are multiple patients ___

A

Use the incident command system, establish command, identify the number of patients, and then begin triage

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26
Q

The process of sorting patients based on the severity of their condition

A

Triage

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27
Q

Once all the patients have been triaged, ___ can begin

A

Treatment and transport of the patients

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28
Q

Usually the ___ EMT is assigned to perform triage

A

Most experienced

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29
Q

When many patients are present or there are more patients than your responding unit can effectively handle, ___

A

Put your mass-casualty plan into action, utilizing the ICS and your local protocols

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30
Q

Steps in scene size-up

A
  1. Ensure scene safety
  2. Determine MOI/NOI
  3. Take standard precautions
  4. Determine number of patients
  5. Consider additional/specialized resources
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31
Q

Primary assessment steps

A
  1. Form a general impression
  2. Assess LOC
  3. Assess the airway: ID and treat life threats
  4. Assess breathing: ID and treat life threats
  5. Assess Circulation: ID and treat life threats
  6. Perform primary assessment
  7. Determine priority of patient care and transport
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32
Q

The heart of patient assessment begins when ___

A

You first greet the patient and begin the primary assessment

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33
Q

The goal of the primary assessment

A

ID and begin treatment of immediate or imminent life threats

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34
Q

LOC

A

Level of consciousness

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35
Q

Checking the ABCs is not ___

A

An in depth exam or assessment of vital signs

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36
Q

The focus of the general impression

A

Rapid ID of potential life-threatening problems

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37
Q

First part of the primary assessment

A

Form a general impression

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38
Q

Formed to determine the priority of care

A

General impression

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39
Q

The general impression notes things like ___

A

The person’s age, sex, race, level of distress, and overall appearance

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40
Q

The patient’s response to your greeting can give insight into ___

A

LOC, airway potency, respiratory status, and overall circulatory status before you begin your examination

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41
Q

You will define your patient’s condition as ___

A
  1. Stable
  2. Potentially unstable
  3. Unstable
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42
Q

___ takes priority over other assessments

A

Uncontrolled external bleeding

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43
Q

The patient’s ___ can tell you a great deal about their neurologic and physiologic status

A

LOC

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44
Q

In the primary assessment, you need to ascertain only the ___ LOC

A

Gross

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45
Q

Used to assess a patient’s LOC

A

AVPU

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46
Q

AVPU

A
  1. Awake and alert
  2. Responsive to verbal stimuli
  3. Responsive to pain
  4. Unresponsive
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47
Q

If you are in doubt about whether a patient is truly unresponsive, ___

A

Assume the worst and treat appropriately

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48
Q

To determine whether a patient who does not respond to verbal stimuli will respond to painful stimuli, ___

A

Gently but firmly apply pressure or pinch the patient’s tissue

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49
Q

When using the AVPU scale with a patient who is hard of hearing, ___

A

Tap with your fingers repeatedly, if they respond, not that the patient is hard of hearing but responds to being tapped

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50
Q

Areas where the technique to apply painful stimuli works best

A
  1. Sternum
  2. Posterior edge of the mandible
  3. Trapezius area
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51
Q

When using painful stimuli, be sure to note ___

A

The type and location of the stimulus and how the patient responded

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52
Q

Sign that the patient is responsive to painful stimuli

A

Patient moans or withdraws

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53
Q

For a patient who is alert or responsive to verbal stimuli, next evaluate ___

A

Orientation

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54
Q

Tests a patient’s mental status by checking their memory and thinking ability

A

Orientation

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55
Q

Test for orientation

A
  1. Person
  2. Place
  3. Time
  4. Event
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56
Q

Any deviation from alert and oriented x 4 or from a patient’s normal baseline

A

Altered mental status

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57
Q

If it is not possible to both manually stabilize the patient’s cervical spine and continue your assessment to identify and correct life threats ____

A

Do your best to ensure the patient’s spine remains in a stable position while you continue your primary assessment

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58
Q

You should complete your primary assessment ___ applying a cervical collar

A

Prior to

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59
Q

All patient’s with ___ warrant spinal immobilization

A

A ling bone fracture and a significant MOI

60
Q

Indications for spinal immobilization

A
  1. Either blunt or penetrating trauma with any of the following
    - Pain or tenderness on palpation of the neck or spine
    - Patient report of pain in neck or back
    - Paralysis or neurologic complaint
  2. Blunt trauma with any of the following:
    - Altered mental status
    - Intoxication
    - Difficulty or inability to communicate
61
Q

Any injury that distracts the patient’s attention from other injuries they may have, even severe injuries

A

Distracting injury

62
Q

The general conditions that cause sudden death

A
  1. Airway obstruction
  2. Respiratory failure
  3. Respiratory arrest
  4. Shock
  5. Severe bleeding
  6. Cardiac arrest
63
Q

___ has priority of the ABCs

A

Uncontrolled bleeding

64
Q

If you ID an air problem, ___

A

Stop the assessment process and work to clear the patient’s airway

65
Q

With an unresponsive patient or a patient with a decreased LOC, immediately ___

A

Assess the latency of the airway

66
Q

If there is a potential for trauma, use the ___ to open the airway

A

Jaw-thrust maneuver

67
Q

If you cannot obtain a patent airway using the jaw-thrust maneuver or if it can be confirmed that the patient did not experience a traumatic event, use ___

A

The head tilt-chin lift maneuver

68
Q

To address the tongue blocking the airway ___

A

First position the airway, then place an oral or nasal airway

69
Q

To address objects block the airway ___

A

Clear using manual techniques and suctioning

70
Q

Once the airway is clear, you can ___

A

Continue your assessment

71
Q

Signs of airway obstruction in an unconscious patient

A
  1. Obvious trauma, blood, or other obstruction
  2. Noisy breathing
  3. Extremely shallow or absent breathing
72
Q

If any airway conditions exist, the airway is considered inadequate, and you should open it using ___

A

The head tilt-chin lift maneuver, suction as necessary, and use an airway adjust as necessary

73
Q

Once the airway is confirmed to be open, confirm ___

A

The patient’s breathing is present and adequate

74
Q

A patient who is breathing without assistance is said to have ___

A

Spontaneous respirations

75
Q

Questions to ask as breathing is assessed

A
  1. Is the patient breathing
  2. Is the patient breathing adequately
  3. Is the patient hypoxic
76
Q

___ should be performed for patients who are not breathing or whose breathing is too slow or too shallow

A

Postitive-pressure ventilations

77
Q

If the patient is breathing adequately but remains hypoxic, ___

A

Administer oxygen

78
Q

The goal for oxygenation for most patients is an oxygen saturation of greater than ___

A

94%

79
Q

If a patient seems to develop difficulty breathing after your primary assessment, ___

A

Immediately reevaluate the airway

80
Q

When respirations exceed ___ or are fewer than ___, consider providing positive-pressure ventilations with an airway adjunct

A
  1. 28 breaths/min with signs of distress
  2. 8 breaths/min, or are too shallow to provide adequate air exchange
81
Q

Remember that ___ is the critical issue, not the number of breaths

A

Air exchange

82
Q

Shallow respirations can be identified by ___

A

Little movement of the chest wall or poor chest excursion

83
Q

Indentation above the clavicles and in the spaces between the ribs during breathing

A

Retractions

84
Q

What to observe when evaluating the effort required to breath

A

The presence of retractions or the use of accessory muscles of respiration

85
Q

Accessory muscles of respiration include

A
  1. Neck muscles (sternocleidomastoid)
  2. Chest pectorals major muscles
  3. The abdominal muscles
86
Q

___ indicates inadequate breathing in a pediatric patient

A

Nasal flaring and seesaw breathing

87
Q

Two- to three-word dyspnea

A

A patient can speak only two or three words without pausing to take a breath

88
Q

Two common postures that indicate that a patient is trying to increase air flow

A
  1. Tripod position
  2. Sniffing position
89
Q

The posture most commonly seen in children when trying to increase airflow

A

Sniffing position

90
Q

Sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward, significant effort is required for breathing

A

Tripod position

91
Q

Sits upright with the head and chin thrust slightly forward, and the patient appears to be sniffing

A

Sniffing position

92
Q

Breathing that requires effort

A

Labored breathing

93
Q

Progression of labored breathing

A
  1. Initially characterized by the patient’s position, concentration on breathing, and the increased effort and depth of each breath
  2. Progresses with accessory muscles in the chest and neck are used, and may make grunting noises
94
Q

In infants and children, cardiac arrest is usually caused by ___

A

Respiratory arrest

95
Q

Respiratory failure occurs when ___

A

The blood is inadequately oxygenated or ventilation is inadequate to meet the oxygen demands of the body

96
Q

___ is the ultimate result of respiratory failure if it is now corrected

A

Respiratory arrest

97
Q

Circulation is evaluated by assessing the patient’s ___

A

Mental status, pulse, and skin condition

98
Q

The first step in evaluating any patient

A

Rapidly scan for, identify, and control severe external bleeding

99
Q

The first consideration when taking a pulse

A

To determine whether the patient has one

100
Q

In responsive patients who are older than one year, palpate the pulse at ___

A

Radial at the wrist

101
Q

In unresponsive patients who are older than one year, palpate the pulse at ___

A

Carotid in the neck

102
Q

Palpating the carotid artery too hard can ___

A

Occlude blood flow, especially in a patient who has poor perfusion or is hypotensive

103
Q

When palpating a pulse, do not use ___

A

Your thumb

104
Q

In children younger than one year, palpate the pulse at ___

A

Brachial medial area of the upper arm

105
Q

To feel the brachial pulse in an infant ___

A

Elevate the arm over the head, and press all fingers into it

106
Q

If a patient has a pulse but is not breathing, ___

A

Provide ventilations at a rate of 10 to 12 breaths/min for adults and 12 to 20 breaths/min for an infant or child

107
Q

When providing ventilations, continue to monitor the pulse every ___

A

Two minutes

108
Q

Assessing the skin is one of the most important and most readily accessible ways of evaluating ___

A

Circulation and perfusion, blood oxygen level, and body temperature

109
Q

Perfusion is assessed by evaluating ___

A

A patient’s skin color, temperature, moisture, and capillary refill

110
Q

The skin’s color is determined by ___

A

The blood circulating near the surface of the skin and the amount and type of pigment in the skin

111
Q

Delicate membrane lining the eyelids, and covers the exposed surface of the eye

A

Conjunctiva

112
Q

Where changes in skin color will be apparent in patient’s with deeply pigmented skin

A

Fingernail beds, mucous membranes in the mouth, the lips, underside of the arm and palm, and the conductive of the eyes

113
Q

Poor peripheral circulation will cause the skin to appear ___

A

Pale, white, ashen, or gray, possibly with a way translucent appearance similar to a white candle

114
Q

Where to assess skin in infants and children

A

Palms of the hands and soles of the feet

115
Q

Abnormally cold or frozen skin will appear ___

A

Pale, white, ashen, or gray, possibly with a way translucent appearance similar to a white candle

116
Q

When the blood is not properly saturated with oxygen, it appears ___

A

Blue

117
Q

Lips, mucous membranes, nail beds, and skin over the blood vessels appear blue or gray

A

Cyanosis

118
Q

High blood pressure may cause skin to be ___

A

Abnormally flushed and red

119
Q

A patient with a significant fever, heatstroke, sunburn, mild thermal burns, or other conditions in which the body is unable to properly dissipate heat will appear to have ___ skin

A

Red

120
Q

Liver disease or dysfunction may cause ___ in the skin

A

Jaundice

121
Q

Skin and sclera turning yellow

A

Jaundice

122
Q

Normally white portion of the eye

A

Sclera

123
Q

May show color changes before the skin color change is visible

A

Sclera

124
Q

Normal skin temperature will be ___

A

Warm to the touch

125
Q

Abnormal skin temperatures are ___

A

Hot, cool, cold, and clammy

126
Q

When the patient has a significant fever, sunburn, or hyperthermia, the skin feels ___

A

Hot to the touch

127
Q

The skin will feel ___ when the patient is in early shock, has mild hypothermia, or has inadequate perfusion

A

Cool

128
Q

With poor perfusion, the body pulls blood away from the surface of the skin and diverts it to ___

A

The core of the body

129
Q

How to feel temperature

A

Feel the patient’s forehead with the back of your gloved hand

130
Q

When the skin is bathed in sweat, it is described as ___

A

Diaphoretic

131
Q

Order to note assessment of skin

A
  1. Color
  2. Temperature
  3. Moisture
132
Q

CRT

A

Capillary refill time

133
Q

In an adult CRT may be affected by ___

A

Patient’s position, age, history as a smoker, history of medical problems such as diabetes, medications, and exposure to the cold environment

134
Q

How to assess CRT in infants

A

Press on the forehead, chin, or sternum

135
Q

Normal CRT

A

2 seconds or less

136
Q

How to notate delayed CRT

A

CRT>2

137
Q

When direct pressure is not quickly successful or whenever you encounter obvious arterial hemorrhage of an extremity ___

A

Apply a tourniquet

138
Q

A ___ is performed following the primary assessment

A

Rapid head-to-toe exam

139
Q

The rapid head-to-toe exam is used to ___. It is not ___ and should take ___

A
  1. Find any additional injuries
  2. A focused assessment
  3. No more than 90 seconds
140
Q

Rapid head-to-toe exam steps

A
  1. Assess the head, looking and feeling for DCAP-BTLS. Assess the pupils
  2. Assess the neck, looking and feeling for DCAP-BTLS, jugular venous distention, deviation of the trachea, and spinal step-off or vertebra not aligned
  3. Assess the chest, looking and feeling for DCAP-BTLS, chest wall movement, crepitus, subcutaneous emphysema, and equal rise and fall. Listen to breathing on both sides of the chest
  4. Assess the abdomen, looking and palpating for DCAP-BTLS, rigidity (firm or soft), and distention
  5. Assess the pelvis, looking for DCAP-BTLS. If there is no pain, gently compress the pelvis, placing palms over the iliac crests and pressing downward and inward to look for tenderness and instability
  6. Assess all four extremities, looking and palpating for DCAP-BTLS. Assess bilaterally for distal pulses and motor and sensory function
  7. Assess the back and buttocks, looking and feeling for DCAP-BTLS. In all trauma patients, maintain in-line stabilization of the spine while rolling on their side in one motion
141
Q

DCAP-BTLS

A
  1. Deformity
  2. Contusions
  3. Abrasions
  4. Punctures
  5. Burns
  6. Tenderness
  7. Lacerations
  8. Swelling
142
Q

The ___ will assist you in determining transport priority

A

Primary assessment

143
Q

Patient conditions that are high priority and should be transported immediately

A
  1. Unresponsive
  2. Difficulty breathing
  3. Uncontrolled bleeding
  4. Altered LOC
  5. Severe chest pain
  6. Pale skin or other signs of poor perfusion
  7. Complicated childbirth
  8. Severe pain in any area of the body
144
Q

A grating or grinding sensation caused by fractured bone ends or joints rubbing together

A

Crepitus

145
Q

The time from injury to definitive care, during which treatment of shock and traumatic injuries must occur to maximize the patient’c chance of survival

A

Golden hour

146
Q

If the patient’s condition is stable, reassess vital signs every ___ until you reach the ED

A

15 minutes

147
Q

If the patient’s condition is unstable, reassess vital signs every ___

A

5 minutes, or as often as the situation permits

Emergency Medical Technician (100 decks)

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