Unit 4 - Assessment Flashcards
Keys to knowing the MOI
Understand the sport
Know what to look for
Optimal viewpoint
Pay close attention to the field of play
Primary Assessment Steps
- Introduce yourself (gain consent).
- Spinal Motion Restriction (SMR).
- Assess:
○ Chief Complaint (C/C)
○ Level of Responsiveness (LOR)
○ Airway
○ Breathing / Circulation - Pulse oximetry
- Perform Rapid Body Survey
- Reassessment (ABCs)
- EMS & Rapid Transport Decision.
Precautions of a spinal injury
○ Unresponsiveness
○ Unknown MOI
○ Fall > 1 m (3.3 ft) or 5 stairs
○ MVC or ejection from motor vehicle
○ Patient’s helmet is broken
○ Severe blunt force to head or trunk
○ Penetration wound to head or trunk
○ Diving accident
Chief Complaint (C/C)
- Always an injury or condition It is not the MOI!
- Ask the patient “what seems to be the problem?”
- If the patient is unresponsive, the C/C is unresponsive
Level of Responsiveness (LOR)
○ Alert: Eyes are open; patient is able to verbalize
○ Verbal: Patient responds to commands or questions.
○ Painful: Patient exhibits facial grimace; flexion, extension or withdrawal of body part; or moans.
○ Unresponsive: Patient makes no response
Assess Airway (A)
- Responsive Unresponsive
- Ask a question & evaluate if the response is clear & unobstructed.
§ If so, they have a clear airway.
- Ask a question & evaluate if the response is clear & unobstructed.
- Unresponsive
- Open: grasp the tongue & draw the mandible anteriorly or use cross-finger technique.
- Inspect: Look inside for mouth guard, broken or loose teeth, vomit, blood, gum, etc.
- Clean: manually or with suction.
- Secure: HTCL / JT / OPA / NPA
Assess Breathing (B) & Circulation (C)
- Look, Listen & Feel
- Assess (10 sec) the presence of breathing & circulation simultaneously.
- If either are present, include assessment of their quality.
S / S: Abnormal Breathing
- Inadequate rise & fall of the chest.
○ Too quiet breathing - Increased effort on respiration.
○ Loud breathing - Decreased LOR.
- Dyspnea.
○ Labored breathing - Cyanosis.
○ Patient is blue - Bradypnea
○ Slow breathing - Tachypnea.
○ Fast Breathing
Pulse Oximetry (Sp02)
- device that measures the % of hemoglobin saturated with oxygen.
- % of oxygen saturation of blood and pulse
- neurological, respiratory, cardiovasc complaints
- abnormal vital signs
- under effects of respiratory depressants
- multi system trauma patients
Normal SP02 and treatment
95-100%
No treatment
Mild Hypoxia and treatment
91-94%
Oxygen via a nasal cannula or simple mask
Moderate Hypoxia and treatment
86-90%
Oxygen via a NRM or BVM with oxygen reservoir
Severe Hypoxia and treatment
<85%
Oxygen via a NRM or BMV with oxygen reservoir
Rapid Body Servey (RBS)
- Rapid assessment for severe external bleeding, signs of internal bleeding or potential life- threatening fracture. - < 30 sec unless intervention is required.
When should you call EMS?
-Decreased LOR or unresponsive.
- Instability / absence of ABCs
- Severe or multi-system trauma
- Neurological deficits
- Internal or external hemorrhage
- Ongoing seizures
-Chest pain (MI suspected)
- Burns with signs of inhalation injury
- Extensive burns
- Abdominal distension & tenderness
- Unstable pelvic injury
- Femoral # (# = fracture)
- Amputation
- Childbirth complications
- Severe hypothermia
- Electrocution
- Decompression illness
Information to Provide EMS Dispatcher
- Location of the emergency.
- Telephone number from which the call is made.
- Caller’s name.
- What happened.
- Number of casualties.
- Condition of the casualties.
- Care being provided.
Secondary Assessment
- Patient History
○ SAMPLE
○ PQRST - Vital signs
- Physical Assessment
SAMPLE / MAPLES
M: medication (kind, dose, last time, why)
A: allergies (what are they? relevant?)
P: past medical history (anything like this? conditions?)
L: last oral intake (when, what, quantity)
E: events leading up
S: signs (objective) and symptoms (subjective)
PQRST
Onset (when, how long)
Provoke (what makes it worse/better)
Quality (describe pain: sharp, dull)
Region/Radiation (centralized, radiate)
Severity (how bad? 0-10)
Timing (constant, come and go)
Anatomical Differences in Children
- Tongue – larger
- Airway – smaller
- Nose & face – flat
- Brain tissue – thinner & softer
- Neck – short
- Respiratory rate – faster
- Ribs – more flexible
- Body surface – larger
- Bones – softer
- Skin – thinner
7 Vitals in secondary assessment
- Level of responsiveness (LOR)
- Respiration
- Pulse
- Sp02
- Skin characteristics
- Blood pressure
- Pupils
LOR in Secondary Assessment
- Reassess LOR: Glasgow Coma Scale (GCS)
- Eye opening.
- Best verbal response.
- Best motor response.
Glasgow Coma Scale (GCS)
Max = 15
Mild = 13-15
Moderate 8-12
Severe = <8 - coma
Respirations
- Assessing rate, rhythm & volume.
- “regular, quiet, effortless” shallow, deep, wheezy, laboured, raspy…
- Rate = 15 sec assessment X4
- Normal is 12-20
Pulse
- Assessing rate, rhythm & quality
- “regular, strong”
- Rate = 15 sec assessment X4
- 1st = carotid, 2nd = brachial
- moderate hypothermia = 45 sec
- severe hypothermia = 60 sec
Skin Characteristics: Colour, Temperature & Moisture
- Assess with dorsal side of your hand
- Temperature: Warm? Cool? Hot? Cold?
- Moisture: Moist? Clammy? Dry?
- Colour: Flush? Pale? Ashen? Blue? Pink?
What Do Abnormal Skin Findings Mean?
- Pale = shock
- Flushed, red = heat illness, anaphylaxis, hypertension, emotional distress
- Clammy or moist = shock
- Hot = heat illness, fever
- Cool = shock
- Cold = prolonged cold exposure
Reassessing ABC
○ q5 min – unstable / life-threat
○ q10 min – stable / no life-threat
Blood Pressure (BP)
force exerted by blood against blood vessels as it travels through the body
- systolic / diastolic (120mmHg/80mmHg)
- sphygmomanometer and stethoscope
palpation method (BP)
- find radial pulse
- inflate 20mmHg past when pulse disappear
- slowly release until pulse returns (2mmHg/sec)
Estimation method (BP)
palpate bilaterally if equipment not accessible (systolic)
- radial 80mmHg
- femoral 70mmHg
- carotid 60 mmHg
Pupils
PEARL (pupils equal and reactive to light)
capillary refill
estimates blood flowing through capillaries
- more than 3 sec means impairment to fingertip
- shock, dehydration, hypothermia, vascular disease
pulse averages
neonate: 120-160
infant: 100-120
child: 80-120
adult: 60-80 bpm
respiration averages
neonate: 40-60
infant: 30-40
child: 16-24
adult: 12-20 breaths per minute
blood pressure averages
neonate: 80/40
infant: 80/40
child: 90/50
adult: 120/80mmHg
temperature average
98.6 F
impact of exercise on vitals
faster and stronger pulse
faster and deeper breaths
elevated SBP
same DBP
flushed (warm) or gray (cold)
cool with sweat or warm
could be significant sweating
physical assessment
detect all injuries life threatening
or focused on c/c
- direct patient remain still
- ask them to inform of pain and discomfort
- compare bilaterally
SHARP assessment
S (swelling)
H (heat)
A (altered function)
R (redness)
P (pain)
head and face (Phys Ass)
- integrity of bony structures
- reassess pupils
- periauricular or periorbital ecchymosis
- reassess airway
- blood, CSF from ears, eyes
- feel skull
- load mandible and maxilla
- grab nose
neck (Phys Ass)
- start at C7 and work way up feeling vertebrae and intervertebral disks
- tracheal deviation
- jugular distension
torso (Phys Ass)
- assess signs of dypsnea
- load clavicle then wait for breath
- load sternum
- assess ribs
- palpate 4 ab quadrants
pelvis (Phys Ass)
assess for pulse, motor, sensory
- remove shoes, socks, gloves, etc
-pulse of each extremity
- motor (tell them to move the phalanges)
- sensory (“which toe/finger am i touching?”)
- reassess ABCs
pulse oximetry factors
hypoperfusion, shock
hypotension
decreased circulation to extremities
cardiac arrest
finger nail polish
CO poisoning
hypothermia
smokers
edema
Eye Opening (Glasgow Coma Scale)
Eye-opening /4
- spontaneous = 4
- to voice = 3
- to pain = 2
- no response = 1
Verbal Response (GCS)
Oriented - 5
Confused conversation - 4
Inappropriate words - 3
Incomprehensible sounds - 2
Nil - 1
Motor response (GCS)
