PCT 1 - Rapid Patient Assesment Flashcards
REVIEW TEXT -
General Measures Standard –
Section 1 – pg. 9
Patient Assessment Standard – Section 1 – pg. 10
Spinal Motion Restriction (SMR) Standard – Section 1 – pg. 30
Load and Go Patient Standard – Section 1 – pg. 51
Patient Management Standards – Section 1 – pg. 12
review textbls
what is patient assessment?
Patient assessment
- A problem-oriented evaluation establishing priorities of care
- Based on existing and potential threats
Rule in and out assessments
If assessment does not reveal patient problems the consequences can be dire
what are the roles of the patient care provider?
Provide scene control
- Gather scene information
- Talk to relatives/ bystanders- involve people, ask questions, it will help keep bystanders calm
- Obtain vital signs
- Perform interventions
- Act as triage group leader
What are the components of patient assessment?
- Primary assessment (AEMCA)
- Apply PPE, Environment, Mechanism of Injury/Illness, Casualties, Additional Resources
- Focused history and secondary assessment
- Ongoing assessment
- Detailed secondary assessment- usually when person is unconscious
what are the parts of a scene assessment?
- Medical or trauma
- Body substance isolation
- Scene safety
- Location of all patients
- Mechanism of injury
- Nature of the illness
- Determine possible number of casualties
- Scene hazards
- Best access and egress routes
- Begin triage as soon as possible
what are the priorities of scene safety?
You Your crew Other responding personnel Patient Bystanders
why do you need the right equipment?
If you do not have the right equipment readily available, you have compromised patient care. Infection control Airway control Respiratory/breathing Circulation Disability Dysrhythmia Exposure and protection
The best defense against blood-borne, body-fluid-borne, and air-borne agents is to take appropriate body substance isolation precautions.
what situations do you typically need help/need to call for additional resources?
Situations in which you typically need help:
multiple-casualty incidents
-You cannot effectively and safely treat them all
hazmat emergencies
those involving violence or the potential for violence
fire and downed wires
special rescue situations.
what are potential signs of danger at an emergency scene?
- violence or any indication that violence may have taken or may take place
- signs of intoxication or illegal drug use
- weapons of any kind
- any unusual sounds
how do you identify a patient who may become violent?
- if there are any weapons or objects that can be used as weapons near the patient
- if the patient’s family members, friends, or bystanders tell you the patient has a history of being aggressive or combative
- if the patient is standing or sitting in a way that threatens anyone
- if the patient is yelling, cursing, arguing, or verbally threatening to hurt him or herself or others
- if the patient is moving toward you, carrying a heavy or threatening object, making quick or irregular movements, or has muscle tension
how can you help calm a patient with a behavioral emergency?
- maintaining a comfortable distance between you and the patient
- informing the patient of exactly who you are and what you are going to do to help
- asking questions in a calm, reassuring voice, and speak directly to the patient
- encouraging the patient to tell you what is troubling him or her
- acknowledging the patient’s feelings; responding honestly to the patient’s questions and always telling the truth to the patient.
- do not make any quick movements
- act quietly and slowly
- never threaten, challenge, belittle, or argue with disturbed patients
- do not “play along” with a patient’s visual or auditory disturbances
- involve the patient’s family members or friends, if the patient wants them
- maintain eye contact with the patient
how do you preserve evidence at a crime scene?
- At a crime scene, the PCP should observe and document anything unusual at the scene
- Touch only what needs to be touched and move only what needs to be moved
- Avoid using a telephone
- Avoid cutting through holes in the patient’s clothing or through any knot in a rope or tie
- If the crime is a sexual assault, the PCP should keep the patient from washing, changing clothing, using the bathroom, or taking anything by mouth
- if they would like to change, make sure to bring all clothes in a sealed bag
do you assume a vehicle is stable or unstable?
- Always suspect that a vehicle is unstable until you have made it stable.
- Assume the vehicle is not stable if:
- if it is on a tilted surface, such as a hill
- if part of it is stacked on top of another vehicle
- if it is on a slippery surface, such as ice, snow, or spilled oil
- and if it is overturned or resting on its side
Hazards involved in rescues of patients with confined-space emergencies include low oxygen levels and poisonous or explosive atmospheres
what to do for a cold environment extrication?
- Oxygen delivery devices lose their malleability and therefore become less effective
- Aluminum stretchers and cylinders quickly cool and can cause frostbite on contact
- Nitrile gloves become stiff in cold weather – the use of extrication gloves is encouraged
- Blankets should be kept available for patients during long periods of cold exposure – especially due to shock
what are hazzards in water rescue?
Hazards a water emergency may pose for the rescuer:
- Underwater holes, sharp drop-offs, and entanglements such as fallen trees or wire fences that may not be visible from shore
- Fast-moving water also can push a rescuer over and hold him or her down
- Hazardous materials can include oil, gas, or other substances that float on the surface of the water, causing a respiratory risk
- Floods can cause sewage to be released in normally safe waters
- Risk of electrocution exists in flooded buildings or grounds
- Severe bleeding of the patient also can pose the risk of infection to other patients and rescuers
hazards with fast moving water?
The hazards commonly associated with fast-moving water are:
- the force of moving water, which can push a person down and hold him or her there
- strainers, which are obstructions that allow water to pass through but catch people and other objects
- obstructions that a person can get pinned against, such as a bridge abutment
- holes, or recirculating currents that can trap a swimmer in its backwash
- low-head dams, which form recirculating currents that are very large and forceful
- extremity entrapment, which can occur when a person tries to stand up in fast-moving water above his or her knees.
what is reach-throw-row-go-tow?
“Reach” refers to holding out an object to the patient, which he or she can grab and on which he or she can be pulled in
“Throw” refers to throwing an object that floats to the patient.
It is meant to give the patient support and the rescuer more time to make the rescue
“Row” refers to using a boat to get to the patient
“Go” refers to swimming to the patient
“Tow” them to safety
what do you do for management of a drowned patient?
EMS IS NOT TRAINED FOR WATER RESCUE
Provide ventilations, if needed
Be prepared to suction
Conserve the patient’s body heat by removing wet clothing and wrapping him or her in blankets
Immersion in water will cool you down 25x faster than air alone so dry and blanket them ASAP.
what is the protocol for trapped patients?
- Be sure the scene is safe, the vehicle is stable
- You are wearing the appropriate personal protective equipment before you try to reach the patient
- After gaining access, provide the same care you would provide to any trauma patient. That is, stabilize the head and neck, complete a primary assessment, and provide critical interventions
- Protect yourself and the patient from the glass and flying debris
- Remain with the patient during a complex extrication.
6, Continually monitor his or her condition and, if it deteriorates, advise the rescue crew - Try to keep the patient calm during rescue
what is the mechanism of injury?
-strength, direction, nature of forces
how do you determine the nature of illness?
To determine the nature of illness:
Use bystanders, family members, or the patient
Use the scene to give clues to the patient’s condition
Remember that the patient’s illness may be very different from the chief complaint
Ask direct questions
WHAT DO YOU DO FOR PRIMARY ASSESSMENT?
Form a general impression
The general impression is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport
Stabilize cervical spine as needed
Assess baseline level of response
Assess airway- can’t assess breathing if airway isn’t clear
Assess breathing- can’t assess circulation if person isn’t breating
Assess circulation- pulse
Assess priority
when should your suspicion for a spinal cord injury be very high?
motor-vehicle or motorcycle crashes pedestrian-car crashes falls diving accidents hangings blunt trauma penetrating trauma to the head, neck, or torso gunshot wounds any speed-sport accident, such as roller blading, bicycling, skiing, surfing, or sledding any unconscious trauma patient.
what is the first step in determining the presence of a life-threatening condition?
The first step in determining the presence of a life-threatening condition is to assess the patient's level of consciousness (mental status) Alert Verbal Painful stimuli Unresponsive
how do you do an airway assessment?
- If the patient is responsive and can speak clearly, assume the airway is patent
- If the patient is unconscious, the airway may be obstructed (tongue is biggest choking hazard)
- If the child only responds to verbal then apply O2
- If the child only responds to pain or not at all then assisted ventilations may be required
- Is the airway patent (clear of obstruction)?
- If not, reposition (if possible) the patient to ensure airway patency
- If the patients 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
Guideline
-Consider the possibility of airway obstruction for patients who have smoke inhalation, anaphylaxis, epiglottitis, foreign body aspiration, or oropharyngeal malignancy.
- If the patient does not accept an oropharyngeal airway due to an intact gag reflex and has decreasing LOC or mandible trauma insert an nasopharyngeal airway.
- **Nasopharyngeal airways SHOULD NOT be inserted into patents with head trauma unless an oropharyngeal airway cannot be inserted due to facial (mandible) trauma.
- Once you have secured a patent airway you may proceed with the remainder of the Primary Survey.
what are the differences of the airway in a pediatric patient? What do you look for and do for assessment of a pediatric airway?
- Smaller air passages
less reserve air capacity
can be compromised by less trauma or infection
ensure a clear and open airway - Airway structures are not as long or as large
can close off if the neck is flexed or extended too far
the best position is a neutral or slightly extended position
may need to place a thin pad under the shoulders
-When performing a jaw-thrust manoeuvre, make sure your hand is placed on the bony part of the chin. If it falls below the chin, the tongue could be pushed back to block the airway.
-Infants and children tend to breathe through their noses and have abundant secretions
-When administering oxygen, if a child will not tolerate a mask, hold the mask slightly away from the patient’s face and let the oxygen “blow by.”
-Generally, allow the child to stay in a position of comfort, either propped up or on a parent’s lap.
-If an infant or child is having a respiratory emergency
-Even if the signs and symptoms of a respiratory emergency subside, it is still important for the child to be transported to a hospital.
what do you look for in a breathing assessment?
- Altered mentalstatus
- Shortness ofbreath
- Retractions
- Asymmetric chest wall movement
- Accessory muscle use
- Cyanosis
- Audible sounds
- Abnormal rate or pattern
- Nasal flaring
- Look for chest rise and fall
- Listen for air movement in and out of the patient’s mouth and nose
- For best results during auscultation, you should:
- Encourage patient to breathe slowly and deeply through mouth
- Compare the breath sounds of both sides by listening from side to side
- Feel air movement while you are looking for chest rise and fall
what do you do for a circulation assessment?
The circulation assessment consists of evaluating the pulse and skin and controlling hemorrhage
- Normal skin condition is pink, warm and dry
- Abnormal findings:
- Pale - shock, dehydration, fright
- Cyanosis - cardiorespiratory compromise, cold environment
- Jaundice - liver disease, hemolysis
- Redness - fever, inflammation, carbon monoxide poisoning
- Wet - hypovolemia, cardiovascular emergencies, increased sweat gland activity
- Hot - fever or heat related illness or injury
- Cold - ↓tissue perfusion or cold related injury
what is the load and go patient standard?
Once the initial assessment is completed, determine the patient’s priority
-Patients with serious illness or injury should be transported immediately to get patients to a facility that can deliver definitive care
-The following types of patients may require interventions prior to initiation of rapid transport:
-vital signs absent patients experiencing cardiac arrest in which a TOR is not indicated
-patients with conditions which require immediate, life-saving interventions, which the paramedic can perform;
obstetrical patients in which delivery appears imminent.
The following patients will require immediate rapid transport:
-CTAS 1
-patients who meet bypass protocols as per the
Standards (e.g. Field Trauma Triage, Stroke)
-obstetrical patients, with:
eclampsia/pre-eclampsia
limb presentation
multiple births expected
premature labour, orumbilical cord prolapse
what are top priority patients (the abcs) ?
- Poor generalimpression
- Unresponsive
- Responsive butcannot followcommands
- Difficultybreathing
- Hypoperfusion
- Complicatedchildbirth
- Chest pain and BP below 100 systolic
- Uncontrolledbleeding
- Severe pain
- Multiple injuries
what are the types of patients?
- Trauma patient with significantmechanism of injury
- Trauma patient with isolatedinjury
- Responsive medical patient
- Unresponsive medical patient
what is major trauma and what does the severity of the injury depend upon?
- Significant mechanism of injury
- Patient may exhibit altered mental status from the incident
- The severity of injury depends on:
- the distance of the fall
- anything that interrupted the fall
- the body part that impacted first
- the surface on which the patient landed
what are predictors of serious internal injury?
- Ejection fromvehicle
- Death in samepassengercompartment (load and go the patient that is alive)
- Fall from higherthan 6 m
- Rollover of vehicle
- High-speed motorvehicle collision
- Vehicle-passengercollision
- Motorcycle crash
- Penetration of thehead, chest, orabdomen
what are predictors of serious injury for infants/children?
- Fall from higher than 3 m
- Bicycle collision
- Medium-speed vehicle collision with severe vehicle deformity
what is a rapid trauma assessment?
- Not a detailed physical exam
- Fast, systematic assessment forother life-threatening injuries
- Special emphasis should be placed on areas suggested by the chief complaint during your detailed physical exam
- Most trauma patients can only receive definitive care when properly stabilized and transported to the appropriate facility
when do patients need a surgical theatre right away? what do you do?
- Patients with internal bleeding, major fractures, head injuries, and multisystem trauma NEED a surgical theatre right away
- These patients need to be packaged within 10 minutes of EMS arrival
- Start IVs enroute
- Limit field management to
- A/w control and ventilatory support
- Spinal immobilization (maintain C spine important)
- Major # stabilization
how do you do a trauma assessment?
- Contusions [bruises] (size, shape, changing?)
- Lacerations (length, depth, shape, type?)
- Abrasions [“road rash”] (oozing/bleeding, made by ?,
impregnated with?) - Penetrations (angle, depth, made by?) /Pulsating Masses (abdominal aneurysm) /Paradoxical Motion (unequal movement due to flail chest)
- Symmetry (one side v.s. the other)
- Deformity (broken bones) /Distention (abdominal bleed)
how do you inspect the neck?
look for:
- Contusions
- Lacerations
- Abrasions
- Penetrations
- Swelling
- Jugular Vein Distention
Palpate for:
- Subcutaneous emphysema (due to a tear in the tracheo-bronchial tree)
- Tenderness
- Instability
- Crepitus
- Deformity
- Tracheal Deviation
when you expose the chest, what do you look for?
look for:
- Contusions
- Lacerations
- Abrasions
- Penetrations
- Paradoxical Motion
- Symmetry
palpate for:
- Subcutaneous emphysema (due to pneumothorax)
- Tenderness
- Instability
- Crepitus
- Deformity
when you expose the abdomen, what do you look for?
look for:
- Contusions
- Lacerations
- Abrasions
- Penetrations
- Pulsatile Mass
feel for:
- Pulsatile Mass
- Distension
- Asymmetry
- Rigidity
- Tenderness
what do you assess for sudden onset of abdominal pain?
-Odors in the patient’s mouth
Sweet smell may indicate diabetes
-Fecal odour may indicate bowel obstruction
-Acid smell usually indicates recent vomiting
-Coffee ground emesis (vomit) indicates an upper GI bleed
-Fresh blood indicates a very recent upper GI bleed
- Guarding of the abdominal wall (physical muscles are tense to protect what’s inside)
- Sudden diaphoresis and pallor
- Incontinence
what do you look for when assessing the pelvis?
Assess the pelvis for:
- Asymmetry
- Crepitus
- Instability
- Deformity
- Squeeze only once – avoid quick movements of the pelvis, especially when unstable, to prevent severing of the large blood vessels running to legs
- Unequal leg lengths or rotation may indicate pelvic/hip fracture or dislocation
what do you look for when assessing the extremities?
-Compare R/L extremities to each other
-For all injuries, assess distal pulses whenever the extremity is moved or the patient’s complaint changes/intensifies
Assess 5 P’s:
-Paralysis
-Paresthesia (pins and needles feeling)
-Pulse (no pulse, transport right away)
-Pallor
-Pain
5 P’s should be assessed before and after splinting
what do you look for when checking the back?
look for:
- Contusions
- Lacerations
- Abrasions
- Penetrations
- Paradoxical Motion
Spine/back assessment can be done at time of log roll onto backboard
palpate spine for:
- Subcutaneous emphysema
- Tenderness
- Instability
- Crepitus
- Deformity
Assess Cervical, Thoracic, Lumbar, Sacrum, and Coccyx for step deformities
what is SAMPLE history?
- Symptoms
- Allergies
- Medications
- Past medical history (relevant)
- Last oral intake
- Events preceding the incident
what is the isolated injury trauma patient?
- No significant mechanism of injury
- Shows no signs of systemicinvolvement
- Does not require an extensive history
- Does not require a comprehensivephysical exam
what do you do if you have a medical patient that is responsive?
- History takes precedence over FULL physical exam
- Focus physical EXAM SURROUNDING COMPLAINTS
what is a patients history? what do you ask?
- Chief complaint- what they’re complaining about
- History of the present illness- recent meds or hospital visits
- Past history- full history of issues
- Current health status
- SAMPLE
what is the chief complaint? what do you ask the patient?
- The pain, discomfort, or dysfunction causing patient to call for help
- “What seems to be the problem?”
- “What is bothering you the most today?”
- “What made you call the ambulance today?”
-*REMEMBER – Chief Complaint may just be a sign/symptom of the real Primary Problem
what do you ask to figure out the history of the present illness?
- Onset
- Provocation/Palliation
- Quality- what it actually feels like
- Region/Radiation- isolated to one spot?
- Severity- scale of 1-10 how painful
- Time- when did it occur?
OPQRST***
what do you ask about past medical history?
- General state of health
- Childhood and adult diseases
- Psychiatric illnesses
- Accidents and injuries
- Surgeries and hospitalizations
what do you ask about current health status?
- Currentmedications
- Allergies
- Tobacco use
- Alcohol andsubstance abuse
- Diet
- Screening exams
- Immunizations
- Sleep patterns
- Exercise andleisure activities
- Environmentalhazards
- Use of safetymeasures
- Family history
- Social history
what is a focused physical exam?
HEENT (head, eyes, ears, nose, throat) Lip and oral mucosa color Sputum and color Swelling, hives, redness Symmetry
Neck Accessory muscle use and retractions Carotid arteries JVD - SITTING at 45°, not supine Trachea position
Chest Respiratory rate and pattern (listen to lungs) Symmetry of chest wall Surgical scars Lung sounds Percussion Cardiovascular (heart and/or vessels) Signs of arterial insufficiency Peripheral pulses Heart sounds
Abdomen Surgical scars, bruising Abdominal muscle use Distension, pulsatile masses Edema Pulsation of descending aorta Palpate the quadrants, guarding, rigidity
Pelvis
Incontinence, rectal bleeding
Ruptured membranes
Extremities
Pulses, sensation, movement
Edema/pitting edema, digital clubbing, needle marks, medic alert
Spine
Obvious deformity
Discomfort with movement
what are the baseline vital signs?
- Blood pressure
- Pulse
- Respiration
- SpO2
- Temperature
- Pupils
- Orthostatic vitals
- Move patient from supine to standing then in 30-60 seconds take HR and BP. If HR↑ 10-20 bpm or systolic ↓ 10-20 mmHg then suspect hypovolemia
what are additional assessments to do?
- Cardiac monitoring
- Blood glucose determination
- 12-Lead assessment
- Neuro assessment
- Auscultation
what are reasons for unresponsiveness?
Alcohol Epilepsy Insulin Overdose Uremia/metabolic Hypoxia Obstetrics Temperature Trauma Infection Psychiatric Syncope/stroke
what do you do for a detailed secondary assessment? is it important? when do you do it?
Never forget the importance of a physical exam
move patient from the environment and into ambulance before assessment
Assessment based on the patient falling in to one of the following categories:
- Trauma patient with significant mechanism of injury or altered mental status
- Trauma patient with isolated injury
- Medical patient who is responsive
- Medical patient who is unresponsive
what are the areas of a nervous system exam?
Mental status and speech Cranial nerves Motor system Reflexes Sensory system
what do you do reflex tests on?
Biceps Triceps Brachioradialis Quadriceps Achilles Abdominal plantar
what are sensory systems tests?
Pain Light touch Temperature (is the person hot or cold? Is the area in pain hot or cold?) Position Vibration Discriminative
what is an ongoing assessment? what do you do for it?
- Detects trends
- Determines changes to patient presentation
- Assess the effects of treatment provided
- Observe changes to vital signs
- Listen to changes – positive or negative – from patient about chief complaint
- Mental status (reassess ABCs if a negative change in mental status)
- Airway patency
- Breathing rateand quality
- Pulse rate andquality
- Skin condition
- Transport priorities
- Vital signs
- Focused assessment
- Effects of interventions
- Management plans
