Study Guide Flashcards
Components of the primary survey
ASSESSING THE SCENE, OBTAINING PT’S CHEIF COMPLAINTS, SAMPLE/OPQRST, SECONDARY ASSESSMENT, TRANSPORT DECISION
MOST IMPORTANT DETERMINATION MADE BY MEDICS
IDENTIFY THE PT’S PROBLEM, SET CARE PRIORITIES, DEVELOP A PT CARE PLAN, QUICKLY AND EFFICIENTLY EXECUTE IT
How to determine that MOI or NOI at an emergency medical scene. Why is it important to differentiate medical and trauma patients
MOI: How the injury occurred
NOI: General type of illness a patient is experiencing
To decide the need for manual stabilization of c-spine.
Minimum standard precautions should follow and the PPE that should be worn at a scene.
Assume everyone you come in contact with has a infectious disease. Diseases do not discriminate.
Minimum PPE: properly fitting gloves
When would additional PPE be appropriate
When blood or other bodily fluids can splash or spray: eye protection.
Inhaled particles: properly sized respirator sometimes a gown
And other things that could pose as a health/safety risk.
Principal goals of the primary survey process
Rapidly Determine and treat life threats, in a pt by prioritizing assessment and interventions on critical areas such as airway breathing circulation. Goal is to quickly stabilize the pt in an emergency.
How is a general impression formed as part of the primary survey? Why is it crucial to patient management?
General impression is formed by the Patients surrounding, the MOI, Signs and symptoms, chief complaint and inspection.
Crucial for the Patients overall outcome.
How to identify life threats by inspecting and palpating
Inspection looks for swelling, deformities, or discoloration
Palpation finds where the patient has pain or tenderness
POSSIBLE HAZARDS THAT MAY BE PRESENT AT AN EMERGENCY MEDICAL SCENE
INFECTIONS, INHALED PARTICLES, BLOOD/ BODY FLUIDS, HAZMAT, DANGEROUS PERSONNEL
How do you recognize hazards on scene
Situational awareness
How to assess the airway status in responsive and unresponsive patients
Responsive: talking and crying
Unresponsive: Sounds of breathing, chest rise and fall
What are some possible signs and causes of airway obstructions and appropriate response by the Medic
Snoring respirations: position problem, Readjust
Gurgling or bubbling respiration: Most likely fluids in the mouth or in the pharynx. Suction
Universal choking sign(food), abdominal thrusts.
TYPES OF BSI
HEPA/ N95, STEEL TOE BOOTS, LEATHER GLOVES, NITRILE GLOVES, HELMETS, HEAT RESISTANCE OUTERWEAR, SCBA
How to assess a patients breathing status
Look and listen
What care is required for adequate and inadequate breathing
Adequate: reassess
Inadequate: rate, effort, chest rise and fall, depth and rhythm
Flail chest: ensure adequate ventilations
Sucking chest would: occlusive dressing, oxygenate and ventilate as needed
Diminished: possible tension pneumothorax, needle decompression
HOW TO ASSESS A PT CIRCULATORY STATUS
Obtaining Pulse, cap refill, skin temp/ color/ condition, looking for obvious bleeds
How to obtain a pulse
2-3 fingers in places where arteries cross over bones. Radial, carotid, pedal, etc
Responsive:
Unresponsive:
Infant (unresponsive or responsive)
- Radial
- Carotid
- Brachial
(In unresponsive pt’s peripheral pulses can be faint or nonexistent, check central d/t lack of profusion)
How to assess a patients skin based on color, temp, and condition.
Color- reflects the circulation status beneath the skin
Temp- rises when peripheral blood vessels dilate and lowers when vessels constrict
Condition- when the sympathetic NS is stimulated.
Can tell a lot about a patient overall condition
Normal and abnormal findings in skin color and what it means
Normal- Warm, dry and pink. In darker skin, using mucous membranes
Red- fever, HTN, superficial burns, allergic reaction, alcohol intake, carbon monoxide poisoning.
White- excessive blood loss, anaphylaxis, hypoglycemia, anxiety
Blue- hypoxemia, o2 desat
Mottled- cardiovascular shock, disseminated intravascular coagulopathy
Jaundice-Liver dysfunction.
Determine priority of pt care and transport: give examples
Stable Pts: not typically deemed high priority tx
Unstable Pt’s: high priority tx
Ex: Cardiac arrest, in need of life sustaining ventilatory/circulatory support, poor general impression, unresponsive, AMS, difficulty breathing, hypoxia that does not correct its self after 1-2 minutes of treatment, hypoperfusion/ shock, shest pain w/ systolic less than 100mm/hg, suspected AMI/STEMI, CVA, severe pain anywhere, multiple injuries, ABD injuries, severe HTN, can’t move, ALTE
(When treating do only what is necessary on scene, and begin transporting)
Skin conditions and possible causes
Hot and dry- excessive body heat, possible heat stroke
Hot and wet- Increased internal or external temperatures
Warm and dry- fever
Cool and dry- exposure to cold
Cool and wet- shock
MOIs that most likely produce Life threatening injuries
Fall 3x the pt’s height(15 ft for adult or 10ft or 2X the height for peds) high risk MVC, Intrusion, ejection, Motorcycle/atv crash higher than 20mph, vehicle v. Pedestrian, death in the same passenger compartment, penetrating wounds to head, neck, torso, or extremities.
What is the purpose of obtaining the Patient HX
To gain information about the patient and learn about the events surrounding the incident
What is the initial approach to a patient
Establishing a professional relationship the patient, good hygiene, gaining trust, be aware of demeanor.
What are different techniques that medics may use to obtain information from patients during history taking?
Taking notes, eye contact, introduce yourself, asking the patient their name, cultural intelligence, ask about feelings, communicate empathy, offer reassure, reading nonverbal cues, avoid medical terminology
Unique challenges in HX taking for Peds
History of present illness can be difficult d/t child not being able to give detail and/or the guardian not able to give accurate info.
Beware of pt’s guardian concerns
Unique challenges that arise when getting a hex from geriatrics
Geriatrics—decreased sensorium, more medical and traumatic conditions not seen in other pt’s, blood thinners can cause deadly outcomes, difficulty seeing and hearing, medication compliance, difficulty distinguishing acute or chronic, polypharmacy(causing iatrogenic conditions.) iatrogenic- caused by medications or other medical treatment and can mask other illnesses that may need immediate attention, accidental OD.
What challenges may a medic face when obtained sensitive information?
Non reliable/inaccurate information
Elements of Pt HX to be obtained from responsive pts, or from family or bystanders from unresponsive pts
Chief Complaint- why they called for EMS
History of Present Illness- what happened and when (OPQRST) (SAMPLER)
UNRESPONSIVE- majority of your information comes from your head to toe physical assessment.
TRAUMA- majority of your info either comes from your pt, from your assessment of the scene ect..
What are strategies that can be used to obtain sensitive information
Facilitation- encourage your pt to feel open to give you any info
Reflection- pause to consider something significant your pt has told you
Clarification- ask more info when some aspect of the pt hx is vague or unclear to you
Confrontation- make your pt aware that you perceive an inconsistency between their behavior( or info) and the actual scene or your exam
Interpretation- infer the cause of the pt’s distress, then asking the pt if you are right
How do you use clinical reason from the primary survey and pt hx to form a differential diagnosis
Clinical reasoning combines your knowledge of A&P and patho with information from the patient to form differential DX
Rule in or Rule out.
Consider all possibilities until proven otherwise.
What is the purpose of performing a secondary assessment?
The secondary assessment is used to obtain a field impression & differential diagnosis, and an overall full assessment of the pts condition and health, consists of vitals, and full body/ focused exam.
What aspects of the body systems should be covered during HX taking process
All of them. Skin/nails, head/ neck, endocrine, chest and lungs, hematology, GI, GU, Neuro, psych.
(Ask questions based off of your pts c/c. Learn more about what is going on w/ your pt)
What are some techniques and equipment used in the secondary assessment
Inspection- Looking at the pt, either in general, or at a specific area
Auscultation- listening to the body sounds w/ a stethoscope
percussion- gently striking the surface of the body, typically where it overlies body cavities
palpation- touching to obtain info, such as tenderness, and DCAP-BTLS
Equipment: stethoscope, sphygmomanometer(bp cuff), pulse ox, capnogography, CBG, reflex hammer, light/pen light, gloves, sheet or blanket
What is the importance of assessing a patients mental status
Importance of assessing mental status is assessing a pt’s cognitive ability. Recognizing if the AMS can be fixed.
Devices used to monitor a pt’s medical condition, during primary and secondary ax
Vital Signs and repeat vital signs (bp, hr, pupils, skin, rr)
Cardiac monitoring- 12 lead ecg/ekg
CO2 monitoring- (capnometry { co2 output}& capnography {co2 output w/ waveform})
Basic blood chemistry- CBG
I- STAT- dx tests for cardiac markers, lactate, coagulation, blood gasses, chemistries, electrolytes, CMP, BMP, liver function, renal function
What are different methods to assess mental status
AVPU, LOC, CBG
A&O, person place, time and event.
General appearance, posture, facial expressions, ability to relax speech and language, hallucinations, insight and judgment.
What are general conditions to be considered during the secondary assessment?
Skin, Hair, nails, head, Eyes, ears, nose, throat, c-spine, chest, cardiovascular, abdomen, female and male genitalia, anus, musculoskeletal system, peripheral vascular system, spine and nervous system.
Describe normal breath sounds
Normal breath sounds- clear and quiet
What should the secondary assessment include on the patients chief complaint?
Going into detail with each body system effected.
What is the importance of reassessing a patient?
Reassessment indicates what changes has occurred and which critical conditions have been addressed and corrected.
What are things to include in reassessment of a patient?
Compare LOC with baseline
Reassess ABC’s with baseline and stay alert for ventilatory fatigue.
Ensure all bleeding is controlled.
Upon reassessment should routine TXP be stepped up to Priority. Pt condition worsening? Diverting to closer facility? Can priority be stepped down to routine?
Obtain a complete set of vitals and compare to expected outcomes from interventions.
Reassess chief complaint. Have complaints improved? Have complaints worsened?
Document every reassessment and findings in reassessments.
Abnormal breath sounds
Stridor- brassy crowing sound
Wheezes- high pitched whistling
Crackles (rales)- wet breath sounds/ moist crackles
Rhonchi- congested breath sounds, low pitch & rattling
Pleural Friction Rubs- squeaking grating sounds
Decreased/ Absent- lessened or no breath sounds
Where is PMI found?
Can be palpated at the apex of the heart (apical impulse) the site at which the heartbeat is most strongly felt, usually located on the L anterior part of the chest at the 5th intercostal space, along the midclavicular line.
After the scene size up is finished, what is the best reason to begin a primary assessment?
Determining and Treating for life-threats
Breakfast Question.
Following an assessment of an unresponsive pt, pt is high priority, life threats addressed, what do you do next?
Rapid secondary assessment.
Why wound you find a PMI above and left to the normal position?
Indicates possible L ventricular hypertrophy/ enlarged heart chambers
AVPU
AVPU : Responsiveness scale - Alert, recognizes you are there on their own, Verbal, becomes responsive with noises/when spoken to, Painful, responsive to painful stimuli, Unresponsive, does not respond to any stimuli.
GCS
GCS - Glasgow Coma Scale - normal GCS scale is 15, Unresponsive or deceased GCS is 3. measures LOC by eye opening, verbal responses, and motor function. Know scale.
(Go over motor)
Upon arrival at the scene, the pt is awakened by loud noises, and will respond to you calling their name by mumbling. What is the Most appropriate way to describe loc?
AVPU score is VERBAL, Responsive to verbal stimuli, GCS Verbal-2, incomprehensible sounds
Arrive on scene to an unresponsive pt witnessed seizure, what info is most beneficial to medical providers if available?
Bystanders description of seizure.
What are S/S of fluid overload, Pericardial tamponade, Tension pneumothorax, and CHF?
Fluid Overload: Edema, SOB, elevated BP; could b from R sided heart failure, renal failure, liver cirrhosis
Pericardial Tamponade: heart has so much fluid around it that it can’t pump: Pain, SOB, tachycardia, dizziness, palpations, AMS
Tension Pneuomo: Trapped air in chest, pleural space: JVD, tracheal deviation, SOB, CP, shallow breathing, low O2, increased HR, low BP, decreased or absent lung sounds.
CHF: peripheral edema, SOB, CP, fatigue, palpatations
Breakfast question
Pt ejected from vehicle all other variables are equal which of the following crash types motor vehicle crashes will yield to death?
Roll over
Why would 3 sets of vitals be important
To have a trend, time frame of potential decline, or reassessment of treatments (did they work? What did they do, what did they change?)
What are Typical aspects that you consider when you assess fingernails and toenails?
Color, shape, texture presence/absence of lesions. Normal would be firm/smooth. Aging will change color (yellow tint) & striations, related to reduction of calcium. Thick nails with lines running parallel to finger could be fungal infection. Clubbed fingers, flattening & enlargement of fingertips is assoc w/long term respiratory dz. Beau lines depressions in nails indicate period of growth inhibition, systemic illnesses, infection, or injury. Psoriasis, autoimmune disease. Splinter hemorrhages, red/brown linear streaks in the nail bed, bacterial endocarditis or trichinosis. Terry nails, transverse white bands, cirrhosis.
Ready to recheck vital signs, asked why you need to recheck, what would be a good response?
To monitor pts condition, identify any significant changes, monitor treatments.
Best reason for rescuers to have a delay in completing a secondary assessment?
Unresponsive, significant MOI, perform rapid full-body ax in 60-90 seconds
Acoustic Medus
(Ocustic meat us)
Ear Canal
TRAGUS
Small bump of cartilage on outside of ear
What are the first 12 steps to preform in order?
Scene Safety
MOI/NOI
BSI
# of pts
additional resources
C-Spine
General Impression
LOC
Airway, open, blocked, patent
Breathing, rate, rhythm, sounds
Circulation, bleeding, pulse (rate, rhythm, strength) skin
Transport decision- immediate or “stay and play”
