WEEK6- Patient observations Flashcards
what does the abcde approach stand for
airway and oxygen
breathing and ventilations
circulation
disability due to neurological impairment
Exposure and examination
what do clinical observations allow paramedics to measure
measure the stability of the patients conditions
measures patients’ vital signs which allows us to detect physiological deterioration of a condition
what are the 14 clinical observations
- respiratory rate 2. oxygen saturations 3. peak flow 4. pulse rate 5. blood measure 6. capillary refill 7. 3 lead ecg 8. 12 lead ecg 9. blood glucose measurement 10. temperature 11. gcs 12. pupillary response 13. fast test 14. avvv test
(2) what are normal oxygen saturations (spo2) for a normal patient
94-100%= normal
less than 94%= hypoxia
(2) what re the normal oxygen saturations (spo2) for a copd patient
88-92%= normal for copd
less than 88%= hypoxia for copd
(2) what does spo2 measure
oxygen sats= ratio of oxyhaemoglobin to the total concentration of haemoglobin
the pulse oximeter measures the saturation of haemoglobin in arterial blood. Through use of 2 light sources (red and infrared) and a sensor, light absorbed is measured
(2) how do you perform spo2
select appropriate probe
place probe on finger (adults) on toe (small children)
not recommended to be put on ear because can give up to 50% variance on the reading
(3) whats a peak flow
treats asthmatic patients that present with breathing difficulties
measures the air-flow through the bronchi/ can indicate the degree of obstruction
what is airway resistance
airway resistance= narrowing of the airway, muscle constriction, inflamed airway walls and mucus deposit.
(3) how do you conduct peak flow
ask if the patient knows their normal range
attach disposable tube to peak flow meter
explain procedure
take deep breath (maximal inhalation)
place mouthpiece between teeth, the take short sharp huff (maximal exhalation)
record and complete for 3 times
(3) what does peak flow meaurenments depend on
age
height
gender
(3) what is peak flow measured in and what a normal measurement
litres per minute
normal= 400 and 700 litres per minute
what does haemodynamic instability mean
perfusion failure represented by clinical features of circulatory shock, advanced heart failure, or simply one or more measurements which may indicate an out-of-range pathological value
(5) what is blood pressure
pressure exerted upon the vessels that carry oxygenated blood around the body
what is blood pressure measured in
mmHg (millimetres of mercury)
whats the measurement instrument uses for blood pressure
sphygmomanometer
what causes systolic pressure
when the heart contracts (highest pressure)
what causes diastolic pressure
when the heart is at rest (lowest pressure)
which number in 120/80 systolic/diastolic
120= systolic
80=diastolic
how do you perfom blood pressure
upper arm must be exposed, supported and at heart level
select correct sized cuff (covers 80% of circumferences of the arm and width is 40% of the arm circumference)
apply cuff firmly around upper arm with the indicator line/centre of the bladder of the brachial artery
place measurement scale where can easily be seen
what is Korotkoff’s sound
cuff is inflated= blood not getting through brachial artery
pressure released= blood can flow which makes a sound which ca be heard.
pressure decrease= different phrase noises
what are the 5 Korotkoff sound phases
phase I= clear tapping
phase II= softening of the tapping and swishing
phase III= like phase I but with distinct sharpening
phase IV= abrupt muffling
phase V= cessation of all sounds
How do you conduct blood pressure
place stethoscope over brachial artery just below cuff
deflate cuff slowly (2 mmHg per second/ per heartbeat)
systolic value= taken when phase 1 begins (clear tapping)
when all sounds disappear, the diastolic value is recorded (phase 5) remember the auscultatory gap
whats the normal values for blood pressure
100/60 to 140/90= normal
less than 90 systolic= hypotension
140/90 to 160/100= stage 1 hypertension
160/100 to 180/120= stage 2 hypertension
+180 systolic OR +120 diastolic
what complications can occur within hypotension
acute coronary syndrome
internal blood loss
seizure
blood clot in lung (PE)
life threatening asthma
what complications can occur within hypertension
pregnancy
chronic hypertension
cocaine, cannabis etc
intracerebral haemorrhage
what does capillary refill measure
assess’ the adequacy of tissue perfusion
measures the time taken for the cpoliy bed to regain coloir afyer pressure has been applied.
when should capillary refill be conducted
for patients who are in a “shock” like state/ when there haemodynamically unstable
how do you perform capillary refill
apply pressure to nail ned for about 5 seconds
nail bed will return white
release pressure
count how many seocnds it takes for the colour to return
how do you perform capillary refill
apply pressure to nail ned for about 5 seconds
nail bed will return white
release pressure
count how many seocnds it takes for the colour to return
what’s normal cap refill time
2 seconds
capillary refill of +2 seconds may indicate poor perfusion unless extremely cold
what does the 3 lead ecg measure
measures rate and regularity of the cardiac rhythm
shouldn’t be used as a diagnosis tool as not accurate
when should you conduct 3 lead ecg
when investigating an acutely unwell patient
when monitoring a haemodynamically unstable patient
to monitor after giving drugs
if irregular rhythm or abnormal heart rate is found
how do you perform a 3 lead ecg
R (red)- place near right mid-clavicular line, directly below clavicle
L (yellow)- place near left mid-clavicular line, directly below clavicle
F (green)- place between 6th and 7th intercostal space on patients left mid-clavicular line
N (black)- place between 6th and 7th intercostal space on patient’s right mid-clavicular line
what’s the similarities and differences between NSR SB and ST
normal sinus rhythm, sinus bradycardia and sinus tachycardia all have a structured pqrst
nsr, sb and st all differ in rhythm (normal, slow, fast)
how do you measure a 12 lead ecg
provides 12 views of the electrical activity of the heart
like cameras being placed around the heart to build a 3D picture
how do you perform 12 lead ecg
V1- 4th intercostal space @ right sternal margin
V2- 4th intercostal space @ sternal margin
V3- midway between V2 and V4 leads
V4- 5th intercostal space at mid-clavicular line
V5- same transverse level as V4 at lest anterior- axillary line
V6- same transverse level as V4 at left mid-axillary line
whens 12 lead ecg conducted
drug overdose
collapse that’s unknown why
chest pain (to rule out an MI)
if the 3 lead ecg is abnormal
seizure
diagnosed/known cardiac problems
how many limb leads does a 12 lead ecg consist of and what’s their job
6 (I, II, III, aVR, aVL and aVF)
these look at the electrical activity of the heart in a vertical plane
what’s blood glucose levels measured in
millimoles per litre
how does the body regulate blood glucose levels
through the production pf insulin and glycogen by the pancreas
how to conduct blood sugar
explain that the procedure hurts
insert test strip into monitor
clean the site- side of finger for adults’ heel for children
use the lancet to pierce the skin and introduce test strip to take the sample
whilst monitor analyses the sample apply gauze and pressure
normal values for blood sugar
4.0-7.0 mmol/L = normal
less than 4.0 mmol/L = hypoglycaemia
more than 7.0 mmol/L = hyperglycaemia
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
what could change in temperature mean
infection
central nervous system event
hypoglycaemia
how to take a temperature
apply the single use tympanic cover
turn the thermometer on
insert into the ear
press the analysis button to take the reading
normal values for temperature
36.5 to 37.5= normal
less than 35= hypothermia
more than 40 degrees= hyperthermia
above 38 degrees= pyrexia (fever)
what does gcs measure
the Glasgow coma scale records the conscious state of a person for initial and subsequent assessment
evaluates 3 key categories of behaviour
what are the 3 aspects of behaviour
motor responsiveness, verbal performances and eye opening
whats the highest and lowest gcs number that can be given
15= highest
3= lowest
what are the 3 aspects of behaviour marked out of
eye-opening response= 4: spontaneously 3: to speech 2: to pain 1:no response
verbal response= 5: recognizes time, person, place 4: confused 3: inappropriate words 2: incomprehendible sounds 1:no response
motor response= 6: obeys command 5: moves to localised pain 4: flex to withdraw from pain 3: abnormal flexion 2: abnormal extension 1:no response
how do you measure the pupillary response
identifies any abnormality of the pupils and tests the normal reactions of the pupils.
what size in diameter should an adult’s pupil constrict
2-4mm to bright light
4-8mm in the dark
how to conduct a pupil check
observe pupil size, shape, equality, and position of pupils.
shine pen torch in one eye and observe the direct response (constriction)
shine pen torch in the same eye and observe the construction of the opposite pupil
repeat to the other eye
what does anisocoria mean
one pupil is bigger than the other
what does the fast test measure
fast is a stroke recognition tool which can identify a person having an acute stroke
what does fast stand for
face, arms, speech and time
how to conduct fast
ask patient is they have abnormalities normally
face- symmetrical, droop
arm- equal power, does arm drift
speech- slurred speech and speaking normally, ask challenging words like hippopotamus
what percent does fast test identify strokes
70%
how do we measure avvv
another stroke detection tool but measures different symptoms to fast
how to conduct avvv
ask patient to stand, walk
assess co-ordination
ask about eyesight, is it blurry, double vision, black patches
