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EMT > Ch. 9 EMR Book: Patient Assessment > Flashcards

Ch. 9 EMR Book: Patient Assessment Flashcards

1
Q

What are the 5 steps in the patient assessment?

A
  1. Scene size-up
  2. Primary assessment
  3. History Taking
  4. Secondary assessment
  5. Reassessment
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2
Q

What is assessment-based care?

A

Conducting a careful and thorough evaluation of the patient so that you can provide appropriate care

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3
Q

What is a scene size-up?

A

General overview of the incident and its surroundings

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4
Q

What are the 5 parts of the scene size-up?

A
  1. Ensure scene safety
  2. Determine mechanism of injury or nature of illness
  3. Take standard precautions
  4. Determine number of patients
  5. Consider additional resources
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5
Q

When does the scene size-up start?

A

After receiving information from the dispatcher

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6
Q

What information does dispatch give you?

A
  1. Location of incident
  2. Type of incident
  3. Number of people involved
  4. Safety issues at the scene
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7
Q

What other factors should you consider while responding to a call?

A
  1. Time of day
  2. Day of the week
  3. Weather conditions
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8
Q

What are some examples of visible hazards?

A

Downed electrical wires, traffic, spilled gasoline, unstable buildings, a crime scene, weather, crowds, unstable surfaces etc.

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9
Q

What are some examples of invisible hazards?

A

Electricity, biologic hazards, hazardous materials (look for placards on vehicles), poisonous fumes, etc.

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10
Q

What are some additional resources you can call for if hazards are present?

A

Fire department, additional EMS units, law enforcement, heavy-rescue equipment, hazardous materials teams, electric or gas company personnel, other specialized resources

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11
Q

What should you do early on in a scene that seems unsafe?

A
  1. Wait for additional resources
  2. Ensure the patient, bystanders, and rescuers are not exposed to the hazard unnecessarily
  3. Identify potential exit routes from the scene if the hazard becomes life threatening
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12
Q

How do you determine the mechanism of injury (MOI) or nature of illness (NOI)?

A

By looking for clues that may indicate how the incident happened while approaching the scene and asking the patient later on if they’re conscious

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13
Q

What is the knowledge of the MOI or NOI helpful for?

A

Predicting the patient’s injuries and what kind of care they may need
* NOT for ruling out possible injuries or determining the injuries without a secondary assessment on the patient’s entire body

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14
Q

Who else can you ask information from to determine the MOI or NOI?

A

Bystanders or the patient’s family members if present

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15
Q

What are examples of PPE?

A
  1. Gloves (worn all the time)
  2. Eye protection (in case of splashing of bodily fluids)
  3. Gowns (usually for large amounts of blood loss present)
  4. Masks
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16
Q

What should you do with the information of how many patients there are at an incident?

A

Determine if you can handle treating everyone or if you need additional resources

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17
Q

What is a strategy to determine which patients should be treated and transported first?

A

Grouping patients according to the severity of their injuries

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18
Q

What can additional EMS units help with?

A

Treatment and transport

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19
Q

What can law enforcement help with?

A

Securing the scene if unsafe, traffic control, and crowd control

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20
Q

What can fire departments help with?

A

Spilled fuel, fire, or extrication

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21
Q

What can utility company personnel help with?

A

Damaged utility lines

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22
Q

What can wrecker operators help with?

A

Removal of vehicles

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23
Q

When should you request for additional resources?

A

While reporting the number of patients to dispatch, before beginning to treat patients

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24
Q

What are the 4 parts of the primary assessment?

A
  1. Form a general impression (WASPM)
  2. Assess level of responsiveness (AVPU)
  3. Perform a rapid exam to identify life threats (ABC)
  4. Update responding EMS units
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25
Q

What is the purpose of the primary assessment?

A

To identify life threats to the patient

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26
Q

What are life threats to the patient?

A

Problems with the patient’s airway, breathing, and circulation

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27
Q

What does the WASPM acronym stand for in the general impression?

A

W: weight
A: age
S: sex
P: position patient is found in
M: movement

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28
Q

What is the general impression useful for?

A

Determining whether the patient has experienced trauma or illness

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29
Q

What should you do if you do not know if the patient experienced trauma or illness?

A

Treat the patient as if they are a trauma patient

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30
Q

What does the AVPU acronym stand for when assessing the patient’s level of responsiveness?

A

A: alert (patient can answer questions about themselves and their situation)
V: verbal (patient responds to verbal stimuli, even if it’s only loud sounds)
P: pain (patient withdraws from painful stimuli such as pinching of the earlobe)
U: unresponsive (patient does not respond to stimuli and is unconscious)

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31
Q

How should you introduce yourself when approaching the patient?

A
  1. State your name and ask for the patient’s name to know what to refer to them as
  2. State your reason for being at the scene
  3. State that you will be helping the patient
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32
Q

Why should you still introduce yourself and speak to the patient while performing the primary assessment if they’re unconscious?

A

They may still be able to hear your voice and it can be reassuring

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33
Q

What should you avoid saying while talking to the patient?

A

Telling them that everything’s going to be okay; do not provide false reassurance

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34
Q

What should you do if the patient has sustained any type of major trauma?

A

Provide manual stabilization of the patient’s neck as soon as possible to prevent any further injury

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35
Q

What is the usual order for performing a rapid exam to identify life threats?

A

A: airway
B: breathing
C: circulation

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36
Q

What is the order for performing a rapid exam to identify life threats on a patient who is in cardiac arrest?

A

C: circulation
A: airway
B: breathing

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37
Q

What does the ABC or CAB acronym stand for when performing a rapid exam to identify life threats?

A

A: correct any serious airway problems like blockages/make sure it’s clear, open, and patent
B: check for breathing and correct any serious breathing problems like lack of breathing or open chest injuries
C: check the status of circulation and correct serious problems like lack of circulation or serious external bleeding

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38
Q

What is an easy way to check if the patient’s airway is blocked?

A

If the patient can talk, their airway is not blocked

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39
Q

When should you assume the patient’s airway is blocked?

A

If the patient is unresponsive to verbal stimuli

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40
Q

How can you manually check if the airway of an unconscious patient is blocked on?

A

Head tilt-chin lift maneuver or jaw-thrust maneuver (if patient sustained trauma)

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41
Q

What should you do once the airway is open?

A

Check for foreign bodies or secretions and clear it if necessary using finger sweeps or suction

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42
Q

What are airway adjuncts used for?

A

Keeping the airway open

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43
Q

How do you assess the patient’s breathing?

A

Rate: normal is 12-20 breaths per minute
Rhythm: irregular or regular
Quality: bradypnea (slow) or tachypnea (fast)

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44
Q

What should you do if the patient is having trouble breathing or has abnormal breathing sounds?

A

Check for objects in the patient’s mouth and remove it

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45
Q

What should you do if you do not see any movement of the chest and no sounds of air coming from the mouth or nose?

A

Check their carotid pulse

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46
Q

What should you do if a carotid pulse is present but the patient is not breathing?

A

Perform rescue breathing

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47
Q

Where do you check for a pulse in an unconscious patient?

A

The carotid pulse on the neck

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48
Q

What should you do if you do not feel a pulse within 10 seconds?

A

Begin CPR

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49
Q

Where do you check for a pulse in a conscious patient?

A

The radial pulse on the thumb side of the wrist

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50
Q

If severe bleeding is present, what should you do?

A

Apply direct pressure over the wound or use a tourniquet to stop circulation to that area and avoid more blood loss

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51
Q

What do you assess in relation to skin while assessing circulation?

A

Skin temperature, color, and condition

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52
Q

Why should you check the color of the patient’s skin when you first arrive to the scene?

A

To monitor changes in skin color as time goes on

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53
Q

What does a pale skin color indicate?

A

Decreased circulation to that part of the body or all of the body caused by blood loss, poor blood flow, low body temperature, or shock

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54
Q

What does a flushed (red) skin color indicate?

A

Excess circulation to that part of the body, fever, or sunburn

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55
Q

What does cyanosis (blue skin) indicate?

A

Lack of oxygen and possible airway problems

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56
Q

What does jaundice (yellow skin) indicate?

A

Liver problems

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57
Q

What does a pink-ish skin color indicate?

A

Normal

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58
Q

Where should you check for changes in skin color on patients with deeply pigmented skin?

A

Fingernail beds, whites of their eyes, palm of their hands, or inside the mouth

59
Q

What should you include on your report updating responding EMS units on the patient’s condition?

A
  1. Age and sex of patient
  2. Chief complaint
  3. Level of responsiveness
  4. Status of airway, breathing, and circulation
60
Q

If rescue breaths are needed for a patient in respiratory arrest, how should they be delivered?

A

One breath every 6 seconds over 1 second until chest rises

61
Q

What is the chief complaint?

A

The patient’s response to questions such as “What’s wrong?” or “What happened?”

62
Q

Why should you never allow a patient to distract you from completing the entire patient assessment sequence?

A

Because the injuries they point out may not be the most serious injuries they have sustained

63
Q

What is the primary complaint in an unconscious patient?

A

Unconsciousness

64
Q

Why is it important to obtain the patient’s medical history?

A

To gather an account of the patient’s past medical injuries, illnesses, and conditions to determine the signs and symptoms of the current condition

65
Q

What are the acronyms for history taking?

A

SAMPLE, OPQRST, and ASPN

66
Q

What does the SAMPLE acronym stand for?

A

S: signs and symptoms
A: allergies
M: medications
P: pertinent past medical history
L: last oral intake
E: events associated or leading up to the illness or injury

67
Q

What should you ask in relation to the patient’s signs and symptoms of the injury or illness?

A

Why the patient called 911, signs and symptoms at the beginning of the event and currently, if they’re in pain, and to describe pain if needed

68
Q

What should you ask in relation to the patient’s allergies?

A

If they’re allergic to medication, food, or airborne particles/seasonal allergies and how their usual allergic reactions are

69
Q

What should you ask in relation to medications?

A

If the patient is taking prescription medications and the purpose for them
If they are taking OTC supplements or herbal remedies
A list of all their medications if they have one
If they take any drugs (including smoking and alcohol), how often they take drugs, the last time they took drugs, and if they stopped, why

70
Q

What should you ask in relation to pertinent past medical history?

A

If they have an existing medical condition
Any past serious illness or injuries
If they have been hospitalized recently or had surgery
Symptoms leading up to the incident

71
Q

What should you ask in relation to the patient’s last oral intake?

A

When the last time they ate or drink something was and how much/what did they consume
If they had any abdominal pain

72
Q

What should you ask in relation to the events leading up to the injury or illness?

A

What they were doing before and when the signs and symptoms of this event began
If they noticed anything unusual in the hours before the event

73
Q

What does the OPQRST acronym stand for?

A

O: onset
P: provocation/palliation
Q: quality
R: radiation/referred
S: severity
T: time

74
Q

What does onset refer to?

A

If the pain of injury/illness happened suddenly, gradual, intermittently, etc.

75
Q

What does provocation/palliation refer to?

A

Provocation- does anything make the condition worse
Palliation- does anything make the condition better

76
Q

What does quality refer to?

A

How the patient describes their condition

77
Q

What does radiation/referred refer to?

A

Radiation- is there any pain radiating throughout the body
Referred- is there any pain that stays in associated parts of the body of injury/illness

78
Q

What does severity refer to?

A

How bad the patient’s condition is on a scale of 1-10 (they rate it themselves)

79
Q

What does time refer to?

A

When the pain/incident started in that specific moment that made them call for help

80
Q

What does the ASPN acronym stand for?

A

A: associated
S: signs/symptoms

P: pertinent
N: negatives

81
Q

What are associated signs and symptoms?

A

Signs and symptoms that you expect to find based on the complaint and are actually present

82
Q

What are pertinent negatives?

A

Signs and symptoms that you should expect the patient to have based on the complaint but they are not present

83
Q

What are the 2 parts of the secondary assessment?

A
  1. Systematically assess the patient
  2. Assess vital signs
84
Q

What is the purpose of the secondary assessment?

A

To perform a physical examination of the patient head to toe to assess non-life-threatening conditions

85
Q

What is a sign?

A

Something you can observe in a patient (bleeding, temperature, etc.)

86
Q

What is a symptom?

A

A condition the patient tells you

87
Q

What do the acronyms DOTS and DCAP-BTLS help with in relation to the secondary assessment?

A

Looking and feeling for signs of injury

88
Q

What does the acronym DOTS stand for?

A

D: deformities
O: open injuries
T: tenderness
S: swelling

89
Q

What does the acronym DCAP-BTLS stand for?

A

D: deformities
C: contusions (bruises)
A: abrasions
P: punctures or penetrations
B: burns
T: tenderness
L: lacerations
S: swelling

90
Q

What should you assume all unconscious, injured patients have?

A

Spinal injuries that need to be stabilized while the assessment is being performed

91
Q

What is the backboard used for?

A

Stabilizing unconscious, injured patients before transportation

92
Q

How should upper extremities be examined?

A
  1. Start by observing one extremity at a time and see if it is positioned abnormally or looks broken
  2. Examine for tenderness from the shoulder down while firmly squeezing to check for fractures
  3. Check for movement and see if the patient can squeeze your hand
  4. Check for sensation by asking if the patient can feel tingling or numbness in the extremity and if they can feel you touch it
  5. Check the radial pulse, fingers for capillary refill, and the hand’s temp, color, and moisture
93
Q

If you find any tenderness or deformities on an extremity during the exam, what should you never do?

A

Ask the patient to move that extremity

94
Q

How should lower extremities be examined?

A
  1. Observe extremity for deformities in its position and shape including if it’s rotated
  2. Examine for tenderness from the groin down using firm but gentle pressure to identify tender/injured areas
  3. Check if the patient can move their foot or toes
  4. Check if they can feel your touch and if there’s tingling or numbness
  5. Check the posterior tibial pulse, toes for capillary refill, and the skin’s color, temp, and moisture
95
Q

If you do not feel a radial (upper extremity) or posterior tibial pulse (lower extremity), what does that indicate?

A

Blood vessel damage

96
Q

Where is the posterior tibial pulse on the lower extremities?

A

Behind the ankle bone on the inner side of the ankle

97
Q

If a patient can’t move their extremity by squeezing your hand or moving their foot and toes, what does that indicate?

A

The extremity is seriously injured or paralyzed

98
Q

What does tenderness indicate?

A

Injury

99
Q

What does a tingling feeling or numbness indicate?

A

Potential injury

100
Q

When is an exam of a specific area of the body done?

A

When the patient is responsive or when they have sustained nonsignificant MOIs

101
Q

What do the vital signs consist of?

A
  1. Respiration
  2. Pulse
  3. Blood pressure
  4. Skin condition
102
Q

What is the respiratory rate?

A

Indicates how fast the patient is breathing; normally 12-20 breaths per minute in adults (inhaling and exhaling together)

103
Q

What can rapid and shallow respirations indicate?

A

Shock

104
Q

What can slow respirations indicate?

A

Stroke or drug overdose

105
Q

How can respirations be described?

A

Rapid, slow, shallow, deep, wheezing, gasping, panting, snoring, labored, or noisy

106
Q

What does pulse indicate?

A

The speed and force of the heartbeat

107
Q

What are the 4 common pulse points?

A
  1. Radial: thumb side of wrist (most common)
  2. Carotid: neck
  3. Brachial: inside of arm
  4. Posterior tibial: inner ankle behind ankle bone
108
Q

Where should you check for a pulse on a conscious patient?

A

Radial pulse

109
Q

Where should you check for a pulse on an unconscious patient?

A

Carotid pulse

110
Q

Where should you check for a pulse on an infant?

A

Brachial pulse

111
Q

Where do you assess the circulatory status of a leg?

A

Posterior tibial pulse

112
Q

How do you determine pulse rate?

A
  1. Find the pulse
  2. Count the beats for 30 seconds
  3. Multiply by 2
113
Q

What is the normal resting pulse rate for adults?

A

60-100 bpm

114
Q

What is the normal pulse rate for children?

A

70-150 bpm

115
Q

What can a very slow pulse rate indicate?

A

Serious illness

116
Q

What can a very fast pulse rate indicate?

A

Shock

117
Q

What is a bounding pulse?

A

A strong pulse

118
Q

What is a thready pulse?

A

A weak pulse

119
Q

Which is more dangerous, a bounding pulse or a thready pulse?

A

Thready pulse

120
Q

What is capillary refill?

A

The ability pf the circulatory system to return blood to the capillary vessels after the blood has been squeezed out

121
Q

How do you perform a capillary refill test?

A
  1. Squeeze the patient’s nailbed firmly
  2. Release pressure once the nailbed looks pale
  3. Wait 2 seconds and the nailbed should turn pink normally
122
Q

What can a delayed or absent capillary refill be related to?

A

A patient losing a lot of blood and experiencing shock or blood vessel damage in that limb

123
Q

In cold environments, should a capillary refill test be used to assess the circulatory status of an extremity?

A

No

124
Q

What can a high blood pressure indicate?

A

The patient is susceptible to stroke

125
Q

What can a low blood pressure indicate?

A

One of the several possible types of shock

126
Q

What is the systolic blood pressure?

A

The top number on the BP measurement; the force exerted on the walls of the arteries as the heart contracts

127
Q

What is the diastolic blood pressure?

A

The bottom number on the BP measurement; the arterial pressure during relaxation phase of the heart

128
Q

What is hypertension?

A

High blood pressure; higher than 130/90 mm Hg

129
Q

What is hypotension?

A

Low blood pressure; systolic BP is lower than 90 mm Hg

130
Q

How do you find a patient’s BP by palpation?

A
  1. Apply the BP cuff to the uninjured or less injured arm
  2. Locate the radial pulse
  3. Pump the cuff until you can no longer feel the radial pulse +30 mm Hg
  4. Slowly release the pressure in the cuff
  5. When you feel the radial pulse come back, that is the systolic BP
131
Q

How do you find a patient’s BP by auscultation?

A
  1. Apply the BP cuff to the uninjured or less injured arm
  2. Place the diaphragm of the stethoscope over the brachial pulse
  3. Pump the cuff until you can no longer hear the pulse +30 mm Hg
  4. Slowly release pressure in the cuff
  5. When you hear the pulse again, that is the systolic BP
  6. When you no longer hear the pulse, that is the diastolic BP
132
Q

What is the normal skin condition described as?

A

Warm, pink, and dry

133
Q

How do you check the pupil size after vital signs have been completed?

A

Shining a light into the patient’s eyes

134
Q

What do pupils of unequal size indicate?

A

Stroke or injury to the brain

135
Q

What do pupils that remain constricted indicate?

A

The patient may be taking narcotics or has central nervous system diseases

136
Q

What do pupils that remain dilated indicate?

A

A relaxed or unconscious state; head injuries or drug use (barbiturates or sleeping pills)

137
Q

How should you assess the level of responsiveness during the secondary assessment?

A

Observe and note any changes if any occur after the first level of consciousness assessment which was done in the primary assessment based on the AVPU scale

138
Q

What are the 7 parts of the reassessment?

A
  1. Repeat the primary assessment
  2. Reassess vital signs
  3. Reassess the chief complaint
  4. Recheck the effectiveness of the treatment
  5. Identify and treat changes in the patient’s condition
  6. Reassess the patient
  7. Provide a handoff report
139
Q

How should you repeat the primary assessment?

A
  1. Recheck their level of responsiveness
  2. Recheck their airway, breathing, and circulation
  3. Continue maintaining an open airway and monitor breathing and pulse rate (rate, rhythm, quality)
140
Q

How often should you reassess unstable patients?

A

Every 5 minutes

141
Q

How often should you reassess stable patients?

A

Every 15 patients

142
Q

What information should be included in the handoff report?

A
  1. Age and sex of patient
  2. History of the incident
  3. Patient’s primary or chief complaint
  4. Patient’s level of responsiveness
  5. How you found the patient (their condition and position)
  6. Status of vital signs (ABC) and if severe bleeding is present
  7. Results of the secondary assessment
  8. Pertinent medical conditions (SAMPLE)
  9. Interventions provided and how patient responded to them
143
Q

How long should the patient assessment take to complete?

A

2 minutes

144
Q

What adjustment should you make to the patient assessment sequence when dealing with a trauma patient?

A

Perform the secondary assessment before taking the patient’s medical history to gain info on the patient’s injuries

EMT (8 decks)

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