PCT 1 Patient Assessment - Intro to asses Flashcards
What do you do for every call?
AEMCA A – Apply PPE E – Environment M – Mechanism of Injury/Illness C – Casualties (#) A – Additional Resources
EMCA -PIE Environment Mechanism of Injury Casualties (Number of) Assistance Required Personnel Protective Equipment Interview Events Prior
What is environment in EMCA - PIE? what do you look for at the scene every time?
Are there dangers to yourself or the patient?
No Fire, Wire, Gas, or Glass
No needles or weapons
No Violence - domestic dispute or aggressive patient
Know your exits and plan a strategy for leaving as you enter
What is Mechanism of Injury/Illness?
What caused the injury/illness?
Motor Vehicle Collision (MVC) Exposure (weather, bee sting) Chest Pain Trauma (fall, assault) Psychiatric Drug overdose
What do you do for casualties? Who can go in the same ambulance?
What are the number of casualties on scene?
If more than one you may need a second ambulance
If one or both are ambulatory (and are friends/family of each other), both can be transported in one vehicle
Some ambulances have double stretchers – able to transport two patients who require a stretcher at the same time
Helpful for isolated areas where another crew is far away
What are additional resources you may need?
What assistance do you need? Resources Police Fire More Ambulances ACP crew Supervisor Air Ambulance Hydro Animal rescue CAS
What is PPE and what do you need? Why is it required for every call?
Protect yourself and others:
Helmet (MVC, fallen structures, etc)
Goggles (i.e. Risk of spray of body substances and/or droplets)
Mask (i.e. Risk of spray of body substances, and/or droplets)
Gloves (to be worn on every call)
Gown/Isolation Suits (exposure to contagious diseases)
How do you approach a patient? what do you say to them?
Always approach from the front of the patient if possible
Introduce yourself:
“Hello my name is ___ and I’m a paramedic.”
“Can you tell me what happened?”
“What’s going on today?”
“If you can hear me please do not move.”
Obtain Consent
Avoid using demeaning terms such as “hun”, “dear”, or “sweetie”
-WRITE DOWN EVERYTHING
Inquire about the patient’s feelings
Be sensitive to the patient’s feelings and experience(s)
Avoid entering the patient’s personal space (if possible)
Use language that is appropriate and easily understood
-Note level of consciousness
Drowsy (tired, not necessarily confused)
Stupor – unaware of surroundings
Obtunded – unresponsive to stimuli
Coma – patient cannot be aroused, no eye movements (unresponsive)
Note posture, gait(walking), and motor activity
Ataxia (uncoordinated movements – the inability to control muscle movement)
Note dress, grooming, hygiene and breath or body odours
Is it appropriate for the environment?
Medic alert bracelets
Facial expressions
Mood
Speech
Thoughts and perceptions
Memory and attention
what is controlling c-spine?
Ensure that your partner (or a trained resource) controls c-spine until you have ruled out any potential spinal injuries.
This is important only for those patients who may have sustained a traumatic M.O.I
Not necessary for medical patients with no traumatic mechanism
What are the different levels of contentiousness? (LOC)?
- Alert
- Verbal- have to talk to them for them to open their eyes
- Pain/Physical- have to touch or move them for them to open their eyes
- Unresponsive
What do you do if you think your patient has an acute altered level of consciousness?
if unprotected airway, determine airway is clear and insert an oro/naso airway
if patient is apneic or respirations are inadequate, assist ventilations
attempt to determine a specific cause for the altered level of consciousness (AEIOU TIPS) and provide further assessment and management
perform a secondary survey to assess the patient from head-to-toe
perform trauma assessments if trauma is obvious, suspected or cannot be ruled out
what is the chief complaint?
The main reason an ambulance was called
whatever the patient is complaining of
What is the definition of primary problem?
PRIMARY PROBLEM- actual reason why they have the complaint, could be the same reason
How do you figure out what the patient was doing proior to the event?
O.P.Q.R.S.T – questioning about pain (only if they are in pain)
S.A.M.P.L.E – questioning about medical history and current medical events (use on EVERY SINGLE PATIENT)
When does physical examination begin?
Although patient assessment formally starts with the history, the physical examination actually begins when you first set eyes on your patient.
whats the purpose of the physical exam?
The purpose of the physical exam is to investigate areas that you suspect are involved in your patient’s primary problem.
What is the foundation of physical assessment based upon?
- Inspection- look at person/body
- Palpation- press into quadrants for discomfort
- Auscultation- listening to heart sounds and blood pressure sounds
- Percussion- determine if area is full of air or water
What do you always check on every patient first for their physical assessment?
ABC (airways, breathing, circulation
How do you assess the airway?
- Is the airway patent (clear of obstruction)?
- If not, reposition (if possible) the patient or the patient’s head/jaw to ensure airway patency
- If the patient has a foreign body obstruction, remove the foreign body to clear the airway
- If patient has a decreased LOC or is unresponsive with no gag reflex or mandible trauma insert an oropharyngeal airway to maintain airway patency
- head tilt, chin lift to see if airway is clear
- oral airway best bet for unconscious patient
- If the patient does not accept an oropharyngeal airway due to an intact gag reflex, or trismus (locked jaw), and has decreasing LOC or mandible trauma, insert a nasopharyngeal airway
- Nasopharyngeal airways should NOT be inserted into patients with head trauma
- Once you have secured a patent airway you may proceed with the remainder of the Primary Survey
How do you assess breathing?
-Look for chest rise and fall
-Listen for air movement in and out of the patient’s mouth and nose
-Determine if the patient’s breathing seems regular, laboured, shallow, deep, etc
-Feel air movement on your ear/cheek while you are looking for chest rise and fall
-You do not check an actual respiratory rate at this stage
-Observe if any accessory muscles are being used
(LOOK, LISTEN, FEEL, OBSERVE)
What do you do for feeling? (in breathing assessment)
-Feel the patient’s chest movement to ensure symmetry. (chest trauma)
-Chest moving as one segment
-This assessment is important in ruling out flail chest and/or a pneumothorax
-Fractured ribs or collapsed/punctured lung
-Note any in-drawing of the intercostal muscles (accessory muscle use) using other muscles to breathe
-Muscles between ribs, around base of neck, abdomen, etc
-Flail chest
-Two or more ribs fractured in two or more places
-The chest wall moves upon inspiration, but the
fractured segments will not move with the rest of the
rib cage upon inspirations
-Pneumothorax
-Punctured/collapsed lung
-Can be spontaneous or traumatic in nature
-The chest wall will not move symmetrically as the lung
is not filling up with air due to rupture within the lung.
What are you trying to determine while listening? (breathing asses)
Auscultate upper and lower lobes for breath sounds:
- Clear
- Crackles – loose fluid or congestion
- Pneumonia, CHF
- Wheezes – bronchoconstriction
- Asthma, Anaphylaxis
- Rhonchi – low pitched rattle
- Cystic Fibrosis, COPD
- Rub – harsh, grating noise
- Infection, Pulmonary Embolism
- Stridor – high-pitched wheeze
- Croup, Airway Obstruction
- Silent chest – inability to hear any lung sounds – uni/bilaterally
- Pneumothorax , Asthma Exacerbation
what is crackles (rales)?
A fine bubbling sound produced by air entering the distal airways and the alveoli that contain serous secretions (fluid) – can be considered “fine” or “coarse”
The most typical cause of crackles is pulmonary edema
-Congestive Heart Failure (CHF)
-Pneumonia
-Chest congestion
Whats wheezes?
High pitched musical noises that are usually louder during expiration
Wheezes are caused by high-velocity air traveling through narrowed airways
Wheezes may occur because of (most commonly):
Asthma
Anaphylaxis
COPD
whats rhonci?
Low –pitch rumbling sounds usually heard on expiration
Similar to wheezes but doesn’t involve small airways
Ronchi are less discrete than crackles and are easily auscultated
Ronchi are caused by the passage of air through thick secretions, muscular spasm, new tissue growth or external pressure collapsing the airway lumen
May result by any condition that increases secretion
Pneumonia
Aspiration
Cystic Fibrosis
COPD
whats stridor?
Stridor Indicates a life threatening problem Usually heard upon inspiration and sounds like a crowing type sound. That can be heard without a stethoscope Caused by significant narrowing (~90%) or obstruction of the larynx or trachea May be caused by: Epiglottitis Croup Aspiration/Airway obstruction
whats a silent chest?
When no breath sounds can be heard but the patient is attempting to breathe Indicates a life threatening problem May occur with: Severe asthma Anaphylaxis Pulmonary trauma Pneumothorax
what do the following mean:
- badypnea
- tachypnea
- eupnea
- hypo/hypernea
- hypo/hyperventilation
- orthopnea
- dyspnea
- paroxysmal noctural dyspnea
- apnea
Bradypnea - <12 breaths/min (slow)
Tachypnea - >28 breaths/min for treatment (fast)
Eupnea – normal for the patient’s age (12-20 breaths/min for adults)
Hypo/Hyperpnea – decreased/increased depth
Hypo/Hyperventilation – decreased/increased rate and depth
Orthopnea – SOB when patient lies down
Dyspnea – difficulty/laboured breathing
Paroxysmal nocturnal dyspnea – sudden onset of SOB while sleeping
Apnea – absence of breathing
what vital signs do you measure?
*obtain, at minimum, x2 sets of vital signs on each patient, whether they are transported to ER or not
- Heart Rate (pulse)
- Respiratory Rate
- Blood pressure
- Body temperature
- SpO2
- Skin
- Pupils
- Level of Awareness (GCS)
Additionally:
Cardiac Monitor
Blood Glucose
H R B T O S P L C B
what do you measure for heart rate?
Rate
The number of pulses felt in one minute
Rhythm
The pattern and regularity of the intervals between beats
Quality
The strength, which can be weak, thready, strong, or bounding
