VSS & Adjuncts

Question 1

VSS & Adjuncts

Answer 1

Vital Signs Survey (VSS):
- RSA
- PSA
- GCS

Adjuncts:
- Temp
- ECG
- BGL
- SP02
- EtCO2 (only during ventilation)

Question 2

Perfusion Status Assessment (PSA)

Answer 2

4 THINGS:

1. BP (manual & via machine)
2. HR (and pulse rate –> compare)
3. Skin (look & feel pt’s skin)
4. Conscious State (AVPU or GCS results)

Question 3

Respiratory Status Assessment (RSA)

Answer 3

9 THINGS:

1. Appearance (distressed / calm)
2. Speech (# of words / breath)
3. Sound (auscultate)
4. Rate (# breaths / min)
5. Rhythm (regular/irregular)
6. Effort (accessory muscles?)
7. Pulse
8. Skin
9. Conscious state

Question 4

Glasgow Coma Scale (GCS)

Answer 4

SCORE 3 - 15

EYES - MAX. 4 POINTS (think AVPU)
- Alert (4)
- to Voice (3)
- to Pain (2)
- None / Unconscious (1)

VOICE - MAX. 5 POINTS
5. Orientated to date, time, place
4. Can communicate well but confused /disorientated
3. Inappropriate words
2. Moans/groans
1. None / Unconscious

MOTOR - MAX. 6 POINTS
6. Obeys commands
5. Localizes pain stimuli
4. Withdraws from pain stimuli
3. Flexion (abnormal) to pain stimuli
2. Extension to painful stimuli
1. None / Unconscious

Question 5

Adjunct: Temp

Answer 5

Using tympanic probe to assess core temperature
- Normal: 36-37.3 degrees

Question 6

Adjunct: ECG

Answer 6

Using monitor + 4 leads
5 point analysis:
- rate
- rhythm
- P waves
- PR intervals
- QRS complex duration

Question 7

Adjunct: BGL

Answer 7

Blood Glucose Levels
- Use a lancet to draw a small amount of blood from patient
- Apply blood to the test strip and obtain a BGL reading

Question 8

Adjunct: SpO2

Answer 8

Oxygen Saturation
- Use a pulse Oximeter (finger thingy) to measure SP02

Question 9

Adjunct: EtCO2

Answer 9

End Tidal CO2
- only used at ALS level
- Can only measure with a closed circuit (i.e. ventilation)