Systematic Approach Flashcards
Sit-Rep
Windscreen Situation Report - occurs before arriving on scene
Primary Survey
DRABCc Danger Response - AVPU Airway Breathing Circulation cervical spine
Vital Signs - base line observations
Heart rate Pulse rate Respiratory rate Glascow coma score Blood pressure Temperature SpO2 Oxygen saturation ECG Skin colour Pain level
Taken every 10-15 min
always take before administering a drug/treatment
If deteriorating reassess in 5 min intervals
History
SAMPLE Signs and Symptoms Allergies Medications Past medical history Last meal/doctor visit Events prior
Injury details/Pain assessment
OPQRST Origin/onset Provoke/palliation - better/worse Quality - describe the pain Radiation/Region Severity - pain scale Time
Summary Survey
DRABCcDEFGH Danger Response Airway Breathing Circulation Cervical spine Disability Expose Family and Friends Get meds and Go History and Handover
Handover
AMIST Age, Name, Sex Mechanism of Injury Injury/Illness Signs and Symptoms Time of event and treatment (SAMPLE)
Danger
To yourself, partner, bystanders, patient Consider safety and hazards - Mechanism of injury - How many patients - Evidence of cause - General impressions - Other resources available
Response
consider c spine
Alert, verbal stimuli, painful stimuli, unconscious
Airway
Clear airway
Scoop out
Breathing
Look, Listen and Feel (listen hard in loud environment - use stethoscope)
Circulation
Patient pulse
Blood Pressure
The force per unit area exerted on a vessel wall by the contained blood - refers to systemic arterial blood pressure
Systolic/Diastolic
Normal Blood Pressure readings
Abnormal BP
Adult = 120/80mmHg Newborn = 80/40 10yr = 100/60 Hypertension - 140/90 Hypotension - systolic below 100 Normotensive - normal BP
Pulse Rate
The alternating expansion and recoil of arteries during each cardiac cycle
Measurement = times pulse felt over 60 sec (at least 15 sec measured)
Look at quality and strength
Pulse Point Locations
Carotid Subclavian Brachial Aorta Ulna Femoral Popliteal Dorsalis Pedis
Normal Pulse Rates
Abnormal PR
Adult = 60-100 bpm Newborn = 120-160 bpm 10yr = 70-115 bpm
Range due to varying amount of influencing factors
Tachycardia - too high
Bradycardia - too low
Cardiac Output - Pulse
CO = HR x SV
The volume of blood ejected by each ventricle per minute
Respiration Rate
The number of times per minute that a person breaths
Measured by counting breaths per minute
Look at rhythm and depth
Normal Respiration rate values
Abnormal RR
Adult = 12-20 Newborn = 40-60 10yr = 15-20
Eupnea = Normal respiration Tachypnoea = high RR Bradypnoea = low RR
Respiration depth
Normal values
Volume of air inhaled and exhaled
Adult = 500mls
Temperature methods
Normal Values
Abnormal Temp
Tympanic thermometer recommended
Other methods = oral, rectal, forehead
Normal = 36-37.5 degrees celsius
Afebrile/normothermic = normal temp Febrile/fever = high temp Hypothermia = low temp
Skin colour
Skin Turgor
Skin Moist/dry
Colour of skin - blue, yellow, burn, dark
Gently raise skin - does it return to normal shape or stay pinched (affected by age of patient)
Capillary refill - push down nail bed and does blood refill in less or more than 2 sec - skin return pink from white
Glucometry - Blood Sugar Level
How is it measured
Regulation of BSL - production of insulin and glucagon by pancreas
Measured by glucometer to detect millimoles per liter of glucose in blood
Normal BSL
Abnormal BSL
BSL = 4-7mmol/L
Hypoglycemia = below 4 mmol/L Hyperglycemia = above 7mmol/L
Focused Assessments (3)
Neurological status assessment
Respiratory status assessment
Perfusion status assessment
Perfusion status assessment
Pulse BP Skin Consciousness * If the lips are blue the brain is too
Neurological status assessment
Level of consciousness (AVPU) Pupillary activity Motor Function Sensory Function VSS
Respiratory status assessment
Conscious state (AVPU) General appearance Speech Ventilatory rate Ventilatory rhythm Ventilatory effort Skin Pulse Chest Auscultations
Physical Assessment - Head to Toe
Systematic Superior to inferior, Proximal to Distal Expose, Palpate and Auscultate Sensory and motor function Pain
Trauma Assessment - what to look for
DCAP-BTLS Deformities Contusions Abrasions Punctures/Penetrations Burns (electrical, chemical, flame) Tenderness Lacerations Swelling
Paediatric patient assessment
Remain calm and confident
Do not separate child and parent
Good rapport with parents
Honesty
Chief complaint
Primary complaint - reason they called
consider mechanism of injury
Clinical Reasoning
Growing Understanding from patient input, environment, knowledge, clinical problems, meta-cognition, cognition
Clinical Reasoning Models (3)
Hypothetico-deductive reasoning
Pattern recognition
Intuition
Hypothetico-deductive reasoning
*Backward reasoning
Problems
4 stages
Hypothesis generation, evaluation, refinement, verification
Backward reasoning - hypothesis is generated and clinical information is gathered to prove or disprove the theory
Faulty hypothesis
Premature closure
Verification stage
Pattern Recognition
*Forward reasoning
Problems
Process of making a judgement of basis of few critical pieces of info
Direct autonomic retrieval of info from well structured knowledge base
Forward reasoning - best used when timely decisions must be made
Anchoring bias
Confirmation bias
Intuition
Gut feeling - individual opinion based on experience
Critical Thinking Process
Concept formation Data interpretation Application of principle Evaluate - continual reassessment Reflection on actions - possible improvement/different approach
