Patient Assessment System

Question 1

Scene Size-Up

Answer 1

A step within the Patient Assessment System that involves a quick assessment of the scene and the surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care. This regularly needs to be reassessed in a dynamic wilderness environment.

Question 2

List each of the 3 components of the Primary Assessment and what a rescuer should look for under each.

Answer 2

Circulatory System:

• Pulse – is it present?
• Bleeding – are there any life-threatening bleeds in shorty wetsuit area?

Respiratory System

• Airway – is it open?
• Breathing – are they breathing adequately?

Nervous System

• AVPU – what is their level of consciousness?
• Spine – is there a MOI for spine injury?

Question 3

What is the goal of a Primary Assessment?

Answer 3

Identify life threatening problems and fix them fast. “Find it, fix it, fast!”

Question 4

Mental Status

Answer 4

Describes the level of brain function.

Question 5

Level of Consciousness

Answer 5

Describes the level of brain function in terms of responsiveness to specific stimuli (AVPU scale): A = awake, V = responds to verbal stimuli, P = responds to painful stimuli, U = unresponsive to any stimuli.

Question 6

List items you can use to protect yourself from bodily fluid exposure to the eyes, nose, mouth, and breaks in the skin on your hands.

Answer 6

Gloves – medical grade, Gore-Tex
Eyewear (i.e., sunglasses)
Face Covering – Buff, Bandana
Breathing Barrier – pocket mask, other barriers

Question 7

Describe how to perform a detailed head to toe exam. Describe as if coaching someone through performing this on a patient.

Answer 7

Develop a flow that works for you and do it the same way each time! If you do it differently each time you will forget something.

Example Flow:
Head/Face/Ears/Neck to chest to abdomen to pelvis to back to shoulder area/upper arm/lower arm to comparing wrists/hands to upper leg/lower leg to comparing ankles/feet.

Palpate and observe for any abnormalities (deformities, bruises, scrapes, cuts, fluid, crunching, tenderness, softness when it should be hard, hardness when it should be soft, instability).

Look for other clues (medical alert tags, stuff in pockets/bags, etc.).

Question 8

Shock

Answer 8

Inadequate perfusion pressure in the circulatory system, resulting in inadequate tissue oxygenation.

Question 9

What does “Risk” mean? Give examples of things that would pose a risk to those at the scene.

Answer 9

Answer varies. Risk = things that would make the scene unsafe to anyone involved.

Examples: Rock fall, swift water, crevasses, active lightning, other people, etc.

Question 10

List who you are looking out for in order of priority re: “Risk”.

Answer 10

1. Personal (yourself)
2. Public (includes your rescue partner)
3. Patient

Question 11

Secondary Assessment

Answer 11

The Secondary Assessment takes place after immediate life threats have been treated or ruled out. The secondary Assessment is a thorough assessment to identify more subtle, yet still important, injuries or illnesses.

Question 12

Respiratory Arrest

Answer 12

Absence of breathing; a.k.a. apnea.

Question 13

Before touching an awake patient, what should rescuers ask?

Answer 13

Get consent. Identify yourself, ask if they would like help, explain what you are observing, explain what you would like to do (assessment/treatment), and ask permission to do it.

Question 14

List the three parts of the Patient Assessment System.

Answer 14

Scene Size Up
Primary Assessment
Secondary Assessment

Question 15

Cardiac Arrest

Answer 15

Loss of effective heart function, which results in cessation of functional circulation.

Question 16

What types of questions should be asked when asking about medications in a SAMPLE history?

Answer 16

• *Medications**
• What medications are regularly taking? Prescriptions? Over the counter? Vitamins? Herbal Supplements? Recreational drugs? Alcohol?
• When did you start taking the medication?
• How much?
• When are you supposed to take medication?
• When was the last time you took medication?
• Have you missed any doses in the last few days?
• Any recent changes to medication?

Question 17

When evaluating resources, what are you taking into account?

Answer 17

Ratio of # patients to rescuers.

Amount of resources available to treat patient problems/multiple patients; materials to improvise.

Ability to spend the night out/# of nights; access to food, water, shelter, stove, ability to stay warm, etc.

Question 18

List the 3 components of the Secondary Assessment.

Answer 18

Patient History (SAMPLE)

Detailed Physical Exam

Vital Signs

Question 19

Primary Assessment

Answer 19

A step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats.

Question 20

When should 9-1-1 be called in a delayed care setting where communication devices are limited to SAT phones, In-Reach devices, and/or radios? How is this different from a front country setting? Hint: Think about the limitations of SAT phones and other communication devices.

Answer 20

9-1-1 should be called after an entire patient assessment, problems list, and treatment plan has been completed. Reason = incoming rescuer teams need a full understanding of the problem and location specifics (i.e., terrain, weather) to provide the best available resources/extrication plan. In the frontcountry we have the luxury of fully equipped ambulances, hospitals nearby, and most often we are in areas that are easily accessible. Calling 9-1-1 at the primary assessment level is best practice in a front country setting.

Question 21

What is meant by mechanism of injury (MOI)? Give 3 examples.

Answer 21

Trauma = something that hit a patient or something the patient hit (i.e., mountain bike accident)

Medical = internal system glitch (i.e., low blood sugar)

Environmental = weather, flora, fauna (i.e., lightning, poison oak, tick bite)

Question 22

What are the 3 components of Scene Size-Up?

Answer 22

Risk
Mechanism of Injury
Numbers

Question 23

Nervous System

Answer 23

A complex network of nerves and cells that carry messages to and from the brain and spinal cord to various parts of the body.

Question 24

Where should you start in the Primary Assessment?

Answer 24

Start where it makes sense. This is not a linear process. Rescuers can check many at the same time (example – check breathing and pulse simultaneously).

Question 25

What types of questions should be asked when asking about events in a SAMPLE history?

Answer 25

Events
- Please describe what you were going leading up to the event or these symptoms. Having patient give a play by play helps identify TBI.

Question 26

Patient Assessment System

Answer 26

A system of surveys including Scene Size Up, Primary Assessment, and Secondary Assessment designed to gather information about an injured or ill patient and the environment in which the patient is found.

Question 27

Why should rescuers not run into a situation? What should they do instead?

Answer 27

To prevent injury to themselves and to allow time for them to take in information from the surroundings. Rescuers should pause and observe their surroundings.

Question 28

What types of questions should be asked when asking about allergies in a SAMPLE history?

Answer 28

• *Allergies**
• Do you have any allergies to medications (Rx, OTC), food, things in the environment?
• If yes, how do you react?
• When was the last time you had a reaction?
• Do you think you may have been exposed today?

Question 29

Circulatory System

Answer 29

An organ system that circulates blood and lymph through the body, consisting of the heart, blood vessels, blood, lymph, and the lymphatic vessels and glands.

Question 30

What is the minimum number of sets of vital signs needed to establish a pattern?

Answer 30

Three

Question 31

Respiratory Failure

Answer 31

Difficulty breathing where the respiratory system is not able to adequately oxygenate the blood to maintain brain function. The patient will have altered mental status or reduced level of consciousness.

Question 32

Respiratory Distress

Answer 32

Difficulty breathing, but the respiratory system is still able to adequately oxygenate the blood to maintain brain function. The patient remains awake and responsive. Any mental status changes are mild or primarily due to ASR.

Question 33

What types of questions should be asked when asking about symptoms in a SAMPLE history?

Answer 33

• *Symptoms**
• What were you doing when symptoms started?
• What makes it worse? What makes it better?
• What does it feel like?
• Where does it hurt? Can you point with one finger? Does it radiate anywhere? If so, where?
• How badly does it hurt? On a scale of 1-10; 10 = worst pain you have been in. What is the worst pain you have experienced?
• When did the symptoms start? Have you experienced this before?

Question 34

Where should you start in the Secondary Assessment?

Answer 34

Start where it makes sense.

Question 35

What four vital signs will you most often take? Describe how to measure each one.

Answer 35

Pulse – using your index and middle finger gently palpate for pulse on the inside of the wrist thumb side for at least 30 seconds. If counting for 30 seconds multiple # by two to get rate/minute.

Respirations – this is best done with one hand on patient to feel movement in the chest/abdominal area. Count for at least 30 seconds (multiply by 2 to get rate/minute). You should count for a full minute for any patient having trouble breathing.

Skin – note color of skin, temperature (mom touch – cold, warm, hot), and moisture.

AVPU – note where they are on the scale. If awake also add a descriptive word for their mental status (i.e., A + lethargic).

Question 36

What types of questions should be asked when asking about last ins and outs in a SAMPLE history?

Answer 36

• *Last Ins/Outs**
• How much water or other fluid have you drank today? Yesterday? Show me.
• What and how much have you eaten today? Yesterday?
• Have your bowel movements and urination been normal for you? If not, when was your last bowel movement? What did the bowel movement look/feel like (color, texture, amount)? What did urine look/feel like (color, amount, pain)?

Question 37

Respiratory System

Answer 37

A system of organs, functioning in the process of gas exchange between the body and the environment, consisting especially of the nose, nasal passages, nasopharynx, larynx, trachea, bronchi, and lungs.

Question 38

What types of questions should be asked when asking about pertinent history in a SAMPLE history?

Answer 38

• *Pertinent History**
• Have you ever felt this way before?
• Any current medical problems that you are seeing a doctor for?
• Those who menstruate…
• When was your last menstrual cycle?
• Was it normal for you?
• Are you sexually active?
• Could you be pregnant?
• If pregnant…
• How many weeks?
• Due date?
• How many pregnancies? How many live births?
• Have they been seeing a doctor regularly for prenatal care?
• Any pregnancy complications for current and previous ones?