Chapter 10 (Patient Assesment)

Question 1

What are the 5 main parts of Patient Assessment?

Answer 1

1. Scene Size Up
2. Primary Assessment
3. History Taking
4. Secondary Assessment
5. Reassessment

Question 2

Scene Size-Up

Answer 2

Ensure scene safety, take standard precautions, determine mechanisim of injury/nature of illness, determine number of patients, consider additional/specialized resources (stabalization of spine, EMS assistance).

Question 3

Primary Assessment

Answer 3

Form a general impression, assess LOC (AVPU + AA x 4), assess the airway: identify and treat life threats, assess breathing: identify and treat life threats, assess circulation: identify and treat life threats, perform primary assessment, determine priority of patient care (chief complaint) and transport.

Question 4

History Taking

Answer 4

1. Investigate the chief complaint (history of present illness) = OPQRST.
2. Obtain SAMPLE history (past medical history).

Question 5

Secondary Assessment

Answer 5

Systematically assess the patient. (Assess in detail body system affected + Detailed Vital Sign Obtaining = BP, Pulse, respiratory rate and quality)

Interventions can also occur during this step (Psychomoter = ye).

Question 6

Reassessment

Answer 6

Repeat Primary Assessment
Reassess Vital Signs
Reassess the Chief Complaint
Recheck Interventions
Identify and treat changes in patient condition
Reasesss the patient (Unstable = 5min) (Stable = 15 min)

Clarifying Questions:
Neurological: PPTE
Pulmonary: Breath Sounds
Reproductive: Preggy?
Palpate the abdomen

Question 7

AVPU (Patient Responsiveness Testing)

Answer 7

Awake and Alert: Eyes open and tracking, aware of EMTs, responsive to the environment, and follows commands.
Responsive to VERBAL Stimuli: Responds when talked to. Does so unintelligibly (moaning).
Responsive to PAIN: Responds to sternum pinch.
Unresponsive: Answers to nothing above. No cough or gag reflex - airway is unprotected.

Question 8

Orientation Test (4)

Answer 8

Person?
Place?
Time?
Event?

If deviation occurs = altered mental status.

Question 9

Unresponsive Patient Found (Primary Assessment)

Answer 9

Immediately check for patency of the airway. If obvious obstruction noted in airway, noisy breathing, or shallow/absent breathing is present… then suction airway as needed.

Question 10

Rapid Exam

Answer 10

Primary Assessment (time = 1minute). Look for DCAP-BTLS while examining patient. Start from head and work down to the pelvis (axial skeleton). Listen to breath of patient on both sides of chest. Check extremities.

Question 11

Deformity

Answer 11

Mishapen body part. (Bent ass arm)

Question 12

Contusion

Answer 12

Bruising. (Blood collected).

Question 13

Abrasion

Answer 13

Rubbing or scraping damage.

Question 14

Punctures

Answer 14

Holes in the skin into the soft tissue.

Question 15

Symptom

Answer 15

Patient problems that can not be observed by others.

Question 16

Sign

Answer 16

Patient problem that can be observed objectively by others.

Question 17

SAMPLE history.

Answer 17

(History)
Signs and Symptoms:
Allergies:
Medications: Normal medications, supplements, herbal remedies, recreational drugs?
Pertinent past medical history: Surgical or trauma occurences? Family history (bipolar)?
Last Oral Intake: When did you last eat or drink?
Events before injury: What happened?

Question 18

Ascultation

Answer 18

Process of listening to sounds the body makes using a stethoscope.

Question 19

Pulse Oximetry

Answer 19

Evaluates effectiveness of oxygenation. Device moniters the saturation of hemoglobin in the capillary beds. (94-99%). Depends on proper perfusion. If perfusion not there (loss of blood, vasoconstriction = shock or hypothermia + others), then reading could be wrong.

Question 20

OPQRST

Answer 20

Onset: What were you doing when the symptoms began?
Provocation: Does anything make the symptoms better or worse?
Quality: What does the symptom feel like? (Sharp, dull, crushing, tearing?)
Region/radiation: Where does the symptom feel like it’s coming from? Do it be moving?
Severity: Scale of 1-10, what is your pain?
Timing: How long have you had the symptom? When did it start?

Question 21

What conditions identify a patient as a high-priority patient?

Answer 21

Unresponsive, difficulty breathing, uncontrolled bleeding, altered LOC, severe chest pain, pale skin or other signs of poor perfusion, complicated childbirth, and severe pain in any area of the body. (Life threatening).

Immediate transport should be the focus.

Question 22

A crackling sound produced by air bubbles under the skin is called:

Answer 22

Subcutaneous emphysema.

Question 23

The Golden Hour

Answer 23

Period inbetween the time of injury and definitive care (hospital setting). Ability to compensate for shock depletes with time! Vamanos!

Question 24

Paradoxical Motion

Answer 24

When only one section of the chest rises on inspiration while another area of the chest falls.

Question 25

Rhonchi

Answer 25

Congested breath sounds = mucus or fluid in the lungs. Should sound low pitched and noisy during expiration - kinda like a fart.

“Junk in the Lungs” = Pneumonia

Question 26

Wheezing

Answer 26

High pitched whistle tone = lower airway obstruction/narrowing.

BRONCHOCONSTRICTION

A: Asthma
A: Anaphalaxyis
C: COPD

Question 27

Snoring

Answer 27

Upper airway obstruction.

Question 28

Stridor

Answer 28

Brassy crowing sound heard when breathing in = obstruction in neck or upper part of chest.

1. Croup
2. Epiglottitis
3. Inhalation burn
4. Anaphalaxyis
5. Obstruction

Question 29

Cackles

Answer 29

Rice cripsies under milk = fluid in the lungs.

Question 30

Hand Over Verbal Report

Answer 30

SBAT

Situation/scene: Concise statement of problem. (Trauma alert, hypotensive 28 y/o female, injuries)
Background: Relevant! (Struck by car…35mph…20mins ago)
Assessment: Findings and current thoughts (LOC, Vitals {BP, Pulse, Respiration Quality}, body scan evidence, medical history)
Treatment: Interventions (Applied oxygen, stabalized pelvis and leg)

Question 31

CHART Reporting

Answer 31

C: Chief Complaint or Concern. (Complaint = headache, concern = signs of stroke)
H: History: Details of the scene of incident + Patient medical history
A: Assessments: LOC, Vital signs, physical assessment
R: (RX) = Treatments and results of treatments
T: Transport details of patient. Ex: how moved onto stretcher?