Vol.2-Ch.2 "Primary Assessment" Flashcards
What is the goal of the Primary Assessment?
To identify and correct immediate life threatening conditions of the PTs ABC’s
What is the basis of all prehospital emergency medical care?
The Primary Assessment
Immediately following the primary assessment what should you do?
Make your transport decision
What does the Primary Assessment consist of? (5)
- Forming general impression
- Stabilizing C-Spine (if necessary)
- Assessing baseline mental status (AVPU)
- Assessing and Managing ABC
- Determining priorities of care and transport
What is your first intuitive evaluation of your PT.
The general impression (Aka “your view from the door”)
What is the standard CPR ratio of compressions to breaths?
30 comps to 2 breaths
What is one of the first determinations you will make in a general impression?
Do they look dead or not dead
What are some factors about your PT that may effect your index of suspicion?
Age, Sex, Race
Which comes first: C-Spine Stabilization or Check Mental Status?
C-Spine comes first in trauma PTs especially when unconscious, looking around a lot, or after significant mechanism of injury.
What else can be done in a small child trauma PT to stabilize C-Spine apart from collar or manual stabilization?
You can place a towel or pad beneath their shoulders to help maintain alignment
When does pt assessment begin?
As soon as you approach the scene
What questions can you ask an Alert PT to see if they are oriented?
Person, Place, Time, Event
What is Decorticate postering?
Arms flexed, legs extended
What is Decerebrate postering?
Arms and legs extended
What type of movements should you look for in a PT that is responding to painful stimuli?
Is the response Purposeful (ex. they try to swat your hand away at the stimulated area) or Non-Purposeful (decorticate or decerebrate postering which would indicate serious brain injury)
What do you do to test painful stimuli?
Pinch fingernails or “horsebite” (pinch sensitive areas)
If oxygen drops below ____ give them O2 until they reach _____?
below 95; get them to 95-100%
What should you assume about an unconscious PTs airway?
They cannot maintain it and have no gag reflex
What are the 2 maneuvers to open a PTs airway? Which do you use if a C-Spine injury is suspected?
Head-Tilt/Chin-Lift or Jaw-Thrust ; Use Jaw-Thrust for injured C-Spine PTs
How do you assess a PTs airway?
Look for chest rise and fall while listening for quite airflow and free air movement
What is another term for a high pitched inspiratory screech?
Stridor
What is Stridor?
A high pitched INspiratory screech
What is Stridor a sign of?
Upper airway obstruction (foreign body, severe swelling, allergic reaction, or infection)
What should you do it you see poor air flow and suspect a foreign body movement? (3 actions in order)
- Chest thrusts (not abdominal)
- If 1 fails, remove object under direct laryngoscopy with Magill forceps
- If 2 fails, go for endotracheal tube and either go past it (prefered) or push object into right mainstem bronchus so that the left and ventilate
If patients present with Anaphylaxis, what should be administered to decrease upper airway swelling so that proper ventilation can occur?
Vasoconstrictor medication (Epinephrine)
Respiratory Burns can cause ____ and require ____?
Rapid massive swelling of upper airway ; require a quick endotracheal tube before airway completely closes
What is wheezing?
A softer EXpiratory whistle
What is another term for a soft EXpiratory whistle?
Wheezing
What does wheezing indicate?
A lower airway restriction (often with asthma and is treated with albuterol or ipratroprium)
If PT has a pulse (no need for chest compressions) but not moving air what should you do?
Provide ventilation with a bag-valve-mask and O2
How many bag rescue breaths should you give and how should you squeeze the bag/look for when doing so?
You give 2 rescue breaths, each over 1 second per squeeze, with enough volume to make the chest rise
How many ventilations should you give an adult PT per minute? (W/BVM)
10-12
How many ventilations should you give children per minute? (W/ BVM)
12-20
If you cannot ventilate the lungs when trying with the BVM (and with head/tilt/chin/lift) what should you do and if that fails as well what should you assume?
Try to reposition the head and neck and try again, if failure persists assume there is a complete airway obstruction
With an infant, if you cannot make an effective seal over the mouth and nose what should you do?
Try mouth to nose ventilation or mouth to mouth
(whichever path you chose to try to ventilate through, be sure to close the opposite (mouth=close nose ; nose=close mouth))
If PT needs to keep airway open and this requires constant attention you can use what basic airway adjuncts.
Nasopharyngeal or Oropharyngeal
What should you look out for when applying an OPA? What should you look out for when applying an NPA?
OPA - don’t use when gag reflex is present
NPA - don’t use is basal skull fracture is suspected
What advanced airway should not ever be used with children?
Multilumen Airways
When a PT can maintain their own airway but has hypoxia, or O2% lower than 95 what can you use to deliver oxygen?
Nonrebreather mask (or nasal cannula but that wasn’t mentioned yet)
What are some signs of inadequate breathing? (9)
- Altered mental status, confusion, apprehension, agitation
- Shortness of breath while speaking
- Retractions
- Asymmetric chest wall movement
- Accessory muscle use (neck, absdominal)
- Cyanosis
- Audible sounds
- Abdnormally rapid, slow, or shallow breathing
- Nasal Flaring
What should you asses about a PTs breathing?
Rate, rythm, quality
If PT has fast or slow respiratory rates (both decrease tidal volume) what should you do and with what?
Provide positive pressure ventilation to ensure full lung expansion and max oxygenation ; this can be done with a BVM and supp O2
What is another term for rapid breathing?
Tachypnia or Tachypnic
What is another term for deep breathing?
Hyperpneic
What is Kussmaul’s respirations? What can it be a sign of when paired with fruity breath odor?
Deep and rapid breathing ; with fruity odor can be a classic sign of diabetic ketoacidosis
What is another term for deep and rapid breathing?
Kussmaul’s respirations
What are Cheyne-Stokes respirations? What can they be a sign of?
A series of increasing then decreasing breaths followed by a period of apnea ; can be a sign of brain stem injury
What is a series of increasing then decreasing breaths followed by a period of apnea?
Cheyne-Stokes Respiration
What is Biot’s Respirations? And what can it be a sign of?
Short, gasping, irregular breaths ; it can be a sign of a serious brain injury
What can short, gasping, irregular breaths be called?
Biot’s Respirations
What does a CPAP machine do and when can it be useful?
It maintains positive pressure in the lungs at all time so that airways can’t collapse on exhale, it can also help pulmonary edema by pushing liquids out, and also helps push O2 accross the alveolar- capillary membrane.
If PTs breathing is inadequate, what else should you inspect before moving on to circulation? (3)
- Check neck and chest
- Palpate ribs for rigidity and wounds
- Auscultate bilaterally high and low for adequate and equal breath sounds
What should you do for a sucking chest wound?
Cover it at the end of exhalation (to prevent trapping air in the pleural space) with an occulsive dressing taped on three sides (allows air out but not in)
How do you recognize a tension pneumothorax? And what should you do for a tension pneumothorax?
Signs include: absent breath sounds on one side, diminished on the other, distended neck veins, unequal chest expansion.
Immediately decompress the affected side with a large IV catheter at the second intercostal space, midclavicular line.
What do you do for a flail chest? what do you do if the flail portion has paradoxical movement?
Perform positive pressure ventilation for a flail chest ; apply large dressing to stabilize paradoxial movement.
What does Pulse Oximetry do?
Quantifies the O2 saturation of RBCs
What are 2 noninvasive devices that can help assess the adequacy of you PTs breathing?
Pulse Oximetry and Continuous Waveform Capnography
Normal Respiratory rates for Newborn?
30-60
Normal Respiratory rates for Infant (less than a year)?
30-60
Normal Respiratory rates for Toddlers (1-2)?
24-40
Normal Respiratory rates for Preschoolers (3-5)?
22-34
Normal Respiratory rates for School Age (6-12)?
18-30
Normal Respiratory rates for Adolescent (13-18)?
12-26
Normal Respiratory rates for Adults (18+)?
12-20
The circulation assessment includes ____?
Evaluating the pulse, skin, and controlling hemorrhage.
If you cannot get a radial pulse where should you palpate next on adult?
Carotid
Where should you palpate a pulse on an infant?
Brachial
What should you assess for in a PTs pulse?
Rate, rhythm, and quality
What is Tachycardia?
Fast heart rate
What is Bradycaria?
Slow heart rate
For bleeding control what steps should you take if bleeding is from an extremity? What if it is on the head, neck, or abdomen?
Apply direct pressure with elevation then apply a tourniquet if required ; if tourniquet can’t be used use a hemostatic agent
Normal Pulse Rates for Newborn?
100-180
Normal Pulse Rates for Infant (less than year)?
100-160
Normal Pulse Rates for Toddler (1-2)?
80-110
Normal Pulse Rates for Preschooler (3-5)?
70-110
Normal Pulse Rates for School Age (6-12)?
65-110
Normal Pulse Rates for Adolescent (13-18)?
60-90
Normal Pulse Rates for Adult (18+)?
60-100
What should you assess the skin for?
Temperature, moisture, color
What are some signs of shock that can be seen from the skin?
Skin may be mottled (blotchy), cyanotic (blue), pale, or ashen. It is usually cold and clammy. (This occurs because blood is being shunted away from skin and extremities and moved to core for vital organs)
What can you use with children and infants to quickly assess their circulatory function?
Capillary Refill
Pg 41 has very detailed 4 step process to determine priority determination.
Pg 41 has very detailed 4 step process to determine priority determination.
