Patient Assessment - Scene Size-Up & Primary Assessment Flashcards
Five main parts of the assessment process
- Scene size-up
- Primary assessment
- History taking
- Secondary assessment
- Reassessment
The key to effective patient assessment
Remain organized
Subjective condition that the patient feels and tells you about
Symptom
Objective condition that you can observe or measure
Sign
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 ___
Field impression
Conclusion about the cause of the patient’s condition after considering the situation, history, and examination findings
Field impression
A field impression will help you determine your ___
Priorities of care
The treatment you will provide for most patients is based on ___, not ___
- Symptoms
- An exact diagnosis
Your evaluation of the conditions in which you will be operating
Scene size-up
Paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose
Situational awareness
When working on a roadway, wear a ___
High-visibility Class 2 or 3 safety vest
The result of physical forces applied to the outside of the body
Traumatic injuries
Traumatic injuries are generally classified according to ___
- Type or amount of force
- How long it was applied
- Where it was applied to the body
The forces, or energy transmission, applied to the body that cause injury
Mechanism of injury
MOI
Mechanism of injury
The ___ can be used as a guide to help you focus your assessment
MOI
The force of injury occurs over a broad area, and the skin is sometimes not broken
Blunt trauma
The force of the injury occurs at the specific point of contact between the kin and the object.
Penetrating trauma
The object pierces the skin and creates an open wound that carries a higher potential risk for infection
Penetrating trauma
The tissues and organs underneath the area of impact may be damaged
Blunt trauma
The general type of illness the patient is experiencing
Nature of illness
NOI
Nature of illness
The most serious thing the patient is concerned about and the reason EMS was called
Chief complaint
How to quickly determine the NOI
- Talk with the patient, family or bystanders about the problem
- Use your senses to check the scene for clues
When there are multiple patients ___
Use the incident command system, establish command, identify the number of patients, and then begin triage
The process of sorting patients based on the severity of their condition
Triage
Once all the patients have been triaged, ___ can begin
Treatment and transport of the patients
Usually the ___ EMT is assigned to perform triage
Most experienced
When many patients are present or there are more patients than your responding unit can effectively handle, ___
Put your mass-casualty plan into action, utilizing the ICS and your local protocols
Steps in scene size-up
- Ensure scene safety
- Determine MOI/NOI
- Take standard precautions
- Determine number of patients
- Consider additional/specialized resources
Primary assessment steps
- Form a general impression
- Assess LOC
- Assess the airway: ID and treat life threats
- Assess breathing: ID and treat life threats
- Assess Circulation: ID and treat life threats
- Perform primary assessment
- Determine priority of patient care and transport
The heart of patient assessment begins when ___
You first greet the patient and begin the primary assessment
The goal of the primary assessment
ID and begin treatment of immediate or imminent life threats
LOC
Level of consciousness
Checking the ABCs is not ___
An in depth exam or assessment of vital signs
The focus of the general impression
Rapid ID of potential life-threatening problems
First part of the primary assessment
Form a general impression
Formed to determine the priority of care
General impression
The general impression notes things like ___
The person’s age, sex, race, level of distress, and overall appearance
The patient’s response to your greeting can give insight into ___
LOC, airway potency, respiratory status, and overall circulatory status before you begin your examination
You will define your patient’s condition as ___
- Stable
- Potentially unstable
- Unstable
___ takes priority over other assessments
Uncontrolled external bleeding
The patient’s ___ can tell you a great deal about their neurologic and physiologic status
LOC
In the primary assessment, you need to ascertain only the ___ LOC
Gross
Used to assess a patient’s LOC
AVPU
AVPU
- Awake and alert
- Responsive to verbal stimuli
- Responsive to pain
- Unresponsive
If you are in doubt about whether a patient is truly unresponsive, ___
Assume the worst and treat appropriately
To determine whether a patient who does not respond to verbal stimuli will respond to painful stimuli, ___
Gently but firmly apply pressure or pinch the patient’s tissue
When using the AVPU scale with a patient who is hard of hearing, ___
Tap with your fingers repeatedly, if they respond, not that the patient is hard of hearing but responds to being tapped
Areas where the technique to apply painful stimuli works best
- Sternum
- Posterior edge of the mandible
- Trapezius area
When using painful stimuli, be sure to note ___
The type and location of the stimulus and how the patient responded
Sign that the patient is responsive to painful stimuli
Patient moans or withdraws
For a patient who is alert or responsive to verbal stimuli, next evaluate ___
Orientation
Tests a patient’s mental status by checking their memory and thinking ability
Orientation
Test for orientation
- Person
- Place
- Time
- Event
Any deviation from alert and oriented x 4 or from a patient’s normal baseline
Altered mental status
If it is not possible to both manually stabilize the patient’s cervical spine and continue your assessment to identify and correct life threats ____
Do your best to ensure the patient’s spine remains in a stable position while you continue your primary assessment
You should complete your primary assessment ___ applying a cervical collar
Prior to
All patient’s with ___ warrant spinal immobilization
A ling bone fracture and a significant MOI
Indications for spinal immobilization
- 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 - Blunt trauma with any of the following:
- Altered mental status
- Intoxication
- Difficulty or inability to communicate
Any injury that distracts the patient’s attention from other injuries they may have, even severe injuries
Distracting injury
The general conditions that cause sudden death
- Airway obstruction
- Respiratory failure
- Respiratory arrest
- Shock
- Severe bleeding
- Cardiac arrest
___ has priority of the ABCs
Uncontrolled bleeding
If you ID an air problem, ___
Stop the assessment process and work to clear the patient’s airway
With an unresponsive patient or a patient with a decreased LOC, immediately ___
Assess the latency of the airway
If there is a potential for trauma, use the ___ to open the airway
Jaw-thrust maneuver
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 ___
The head tilt-chin lift maneuver
To address the tongue blocking the airway ___
First position the airway, then place an oral or nasal airway
To address objects block the airway ___
Clear using manual techniques and suctioning
Once the airway is clear, you can ___
Continue your assessment
Signs of airway obstruction in an unconscious patient
- Obvious trauma, blood, or other obstruction
- Noisy breathing
- Extremely shallow or absent breathing
If any airway conditions exist, the airway is considered inadequate, and you should open it using ___
The head tilt-chin lift maneuver, suction as necessary, and use an airway adjust as necessary
Once the airway is confirmed to be open, confirm ___
The patient’s breathing is present and adequate
A patient who is breathing without assistance is said to have ___
Spontaneous respirations
Questions to ask as breathing is assessed
- Is the patient breathing
- Is the patient breathing adequately
- Is the patient hypoxic
___ should be performed for patients who are not breathing or whose breathing is too slow or too shallow
Postitive-pressure ventilations
If the patient is breathing adequately but remains hypoxic, ___
Administer oxygen
The goal for oxygenation for most patients is an oxygen saturation of greater than ___
94%
If a patient seems to develop difficulty breathing after your primary assessment, ___
Immediately reevaluate the airway
When respirations exceed ___ or are fewer than ___, consider providing positive-pressure ventilations with an airway adjunct
- 28 breaths/min with signs of distress
- 8 breaths/min, or are too shallow to provide adequate air exchange
Remember that ___ is the critical issue, not the number of breaths
Air exchange
Shallow respirations can be identified by ___
Little movement of the chest wall or poor chest excursion
Indentation above the clavicles and in the spaces between the ribs during breathing
Retractions
What to observe when evaluating the effort required to breath
The presence of retractions or the use of accessory muscles of respiration
Accessory muscles of respiration include
- Neck muscles (sternocleidomastoid)
- Chest pectorals major muscles
- The abdominal muscles
___ indicates inadequate breathing in a pediatric patient
Nasal flaring and seesaw breathing
Two- to three-word dyspnea
A patient can speak only two or three words without pausing to take a breath
Two common postures that indicate that a patient is trying to increase air flow
- Tripod position
- Sniffing position
The posture most commonly seen in children when trying to increase airflow
Sniffing position
Sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward, significant effort is required for breathing
Tripod position
Sits upright with the head and chin thrust slightly forward, and the patient appears to be sniffing
Sniffing position
Breathing that requires effort
Labored breathing
Progression of labored breathing
- Initially characterized by the patient’s position, concentration on breathing, and the increased effort and depth of each breath
- Progresses with accessory muscles in the chest and neck are used, and may make grunting noises
In infants and children, cardiac arrest is usually caused by ___
Respiratory arrest
Respiratory failure occurs when ___
The blood is inadequately oxygenated or ventilation is inadequate to meet the oxygen demands of the body
___ is the ultimate result of respiratory failure if it is now corrected
Respiratory arrest
Circulation is evaluated by assessing the patient’s ___
Mental status, pulse, and skin condition
The first step in evaluating any patient
Rapidly scan for, identify, and control severe external bleeding
The first consideration when taking a pulse
To determine whether the patient has one
In responsive patients who are older than one year, palpate the pulse at ___
Radial at the wrist
In unresponsive patients who are older than one year, palpate the pulse at ___
Carotid in the neck
Palpating the carotid artery too hard can ___
Occlude blood flow, especially in a patient who has poor perfusion or is hypotensive
When palpating a pulse, do not use ___
Your thumb
In children younger than one year, palpate the pulse at ___
Brachial medial area of the upper arm
To feel the brachial pulse in an infant ___
Elevate the arm over the head, and press all fingers into it
If a patient has a pulse but is not breathing, ___
Provide ventilations at a rate of 10 to 12 breaths/min for adults and 12 to 20 breaths/min for an infant or child
When providing ventilations, continue to monitor the pulse every ___
Two minutes
Assessing the skin is one of the most important and most readily accessible ways of evaluating ___
Circulation and perfusion, blood oxygen level, and body temperature
Perfusion is assessed by evaluating ___
A patient’s skin color, temperature, moisture, and capillary refill
The skin’s color is determined by ___
The blood circulating near the surface of the skin and the amount and type of pigment in the skin
Delicate membrane lining the eyelids, and covers the exposed surface of the eye
Conjunctiva
Where changes in skin color will be apparent in patient’s with deeply pigmented skin
Fingernail beds, mucous membranes in the mouth, the lips, underside of the arm and palm, and the conductive of the eyes
Poor peripheral circulation will cause the skin to appear ___
Pale, white, ashen, or gray, possibly with a way translucent appearance similar to a white candle
Where to assess skin in infants and children
Palms of the hands and soles of the feet
Abnormally cold or frozen skin will appear ___
Pale, white, ashen, or gray, possibly with a way translucent appearance similar to a white candle
When the blood is not properly saturated with oxygen, it appears ___
Blue
Lips, mucous membranes, nail beds, and skin over the blood vessels appear blue or gray
Cyanosis
High blood pressure may cause skin to be ___
Abnormally flushed and red
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
Red
Liver disease or dysfunction may cause ___ in the skin
Jaundice
Skin and sclera turning yellow
Jaundice
Normally white portion of the eye
Sclera
May show color changes before the skin color change is visible
Sclera
Normal skin temperature will be ___
Warm to the touch
Abnormal skin temperatures are ___
Hot, cool, cold, and clammy
When the patient has a significant fever, sunburn, or hyperthermia, the skin feels ___
Hot to the touch
The skin will feel ___ when the patient is in early shock, has mild hypothermia, or has inadequate perfusion
Cool
With poor perfusion, the body pulls blood away from the surface of the skin and diverts it to ___
The core of the body
How to feel temperature
Feel the patient’s forehead with the back of your gloved hand
When the skin is bathed in sweat, it is described as ___
Diaphoretic
Order to note assessment of skin
- Color
- Temperature
- Moisture
CRT
Capillary refill time
In an adult CRT may be affected by ___
Patient’s position, age, history as a smoker, history of medical problems such as diabetes, medications, and exposure to the cold environment
How to assess CRT in infants
Press on the forehead, chin, or sternum
Normal CRT
2 seconds or less
How to notate delayed CRT
CRT>2
When direct pressure is not quickly successful or whenever you encounter obvious arterial hemorrhage of an extremity ___
Apply a tourniquet
A ___ is performed following the primary assessment
Rapid head-to-toe exam
The rapid head-to-toe exam is used to ___. It is not ___ and should take ___
- Find any additional injuries
- A focused assessment
- No more than 90 seconds
Rapid head-to-toe exam steps
- Assess the head, looking and feeling for DCAP-BTLS. Assess the pupils
- Assess the neck, looking and feeling for DCAP-BTLS, jugular venous distention, deviation of the trachea, and spinal step-off or vertebra not aligned
- 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
- Assess the abdomen, looking and palpating for DCAP-BTLS, rigidity (firm or soft), and distention
- 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
- Assess all four extremities, looking and palpating for DCAP-BTLS. Assess bilaterally for distal pulses and motor and sensory function
- 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
DCAP-BTLS
- Deformity
- Contusions
- Abrasions
- Punctures
- Burns
- Tenderness
- Lacerations
- Swelling
The ___ will assist you in determining transport priority
Primary assessment
Patient conditions that are high priority and should be transported immediately
- Unresponsive
- Difficulty breathing
- Uncontrolled bleeding
- Altered LOC
- Severe chest pain
- Pale skin or other signs of poor perfusion
- Complicated childbirth
- Severe pain in any area of the body
A grating or grinding sensation caused by fractured bone ends or joints rubbing together
Crepitus
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
Golden hour
If the patient’s condition is stable, reassess vital signs every ___ until you reach the ED
15 minutes
If the patient’s condition is unstable, reassess vital signs every ___
5 minutes, or as often as the situation permits
