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Steps of the scene size up

1. Take standard precautions
2. Evaluate scene hazards and ensure scene safety (PPE's/Pt/Bystanders)
3. Determine the mechanism of injury or nature of illness
4. Establish the number of patients
5. Ascertain the need for additional resources

1

Purpose of assessing a patient?

-Determine the nature of the problem
-Manage immediate threats to life
-Establish priorities for treatment & transport

2

Primary assessment involves obtaining a general impression of the patients?

Level of consciousness
ABC's
Oxygenation

3

What is immediately treated before moving on to the next portion of the primary assessment?

Any life-threatening condition

4

The primary assessment is systematic, but not necessarily linear; and completed in how many seconds?

60 seconds

5

Form a general impression and then?

Correct obvious life threats

6

After correcting obvious life threats?

Determine whether the patient is a trauma or medical or both

7

Once determining the patient is a trauma...? T

Determine if there Is a spinal injury/no spinal injury?

8

After stabilizing a pt? T

Assess their mental status

9

After assessing the patient's mental status? T

Assess their airway

10

If the airway is open or closed then? T

Perform the job thrust maneuver or assess breathing status

11

after assessing the breathing status? T

Determine whether it is inadequate or adequate

12

If a patient's breathing status is inadequate? T

Begin positive pressure ventilation with supplemental oxygen and assess the circulation

13

After you assess the circulation. T

Determine if there is a Pulse present or absent

14

If a pulse is present? T

Assess for major bleeding

15

If there is an absent Pulse? T

Begin CPR/apply AED and transport

16

After assessing the major bleeding, if there is present major bleeding?

Control the bleeding and assess the skin

17

After controlling the bleeding and assessing the skin? T

Perform a secondary assessment trauma patient

18

If there is no major bleeding? T

Assess the skin and perform a secondary assessment trauma pt

19

If there is a suspected spinal injury? T

Establish in-line stabilization and assess mental status

20

If the patient is a medical.....? M

Assess their mental status

21

After assessing the mental status? M

Assess the patient's airway

22

If the patient airway is open? M

Assess the patient's breathing status

23

If the patient's airway is closed? M

Perform head tilt, chin lift and assess their breathing status

24

after assessing their breathing status.....? M

Determine if the patient's breathing is adequate or inadequate

25

If a patient's breathing is adequate? M

Assess their circulation

26

If a patient's breathing status is inadequate.....? M

Begin positive pressure ventilation with supplemental oxygen and assess their circulation

27

After assessing the patient's circulation? M

Check if there is a Pulse present or absent

28

If a patient's pulse is present.....? M

Assess the patient's skin and perform a secondary assessment medical patient

29

If a patient's pulse is absent....? M

Begin CPR/apply AED and prepare to transport

30

Components of the primary assessment

1. Form a general impression of the patient
2. Assess the level of consciousness (mental status)
3. Assess airway
4. Assess breathing
5. Assess oxygenation
6. Assess circulation
7. Establish patient priorities


31

Forming a general impression of the patient

Estimate the patient's age
Patients sex
Determine if trauma or medical
Obtain the patient's CC
Identify/manage immediate life threats

32

Determine if the patient is ill or injured - trauma or medical

Look for the MOI the NOI

33

If you suspect a spinal injury?

Stabilize the head and spine

34

Two types of trauma?

Penetrating and blunt force

35

Penetrating trauma

A force that pierces the skin and body tissues, often from gunshots and knives, also from impalement, screwdrivers, ice picks, handlebars, broken glass, metal, wood, or any other sharp object

36

Blunt trauma

Caused by a force that impacts/is applied to the body, but is not sharp enough to penetrate

37

Types of blunt trauma

Vehicle crashes, falls, fights, crushing, building collapses, caught in machinery, hit with a hard object

38

Determine the chief complaint

Why were EMS called

39

During the general impression, what should you identify?

Immediate life threats and intervene

40

Obvious life threats

Compromised airway (blood, vomit, etc)
Open wounds to the chest
Paradoxical movement of a segment of the chest (retraction of sorts)
Major bleeding (flowing/squirting)
Unresponsive with no breathing/Agonal breaths
Cardiac arrest

41

Paradoxical movement of a segment of the chest

Inward movement on inhalation and outward movement on exhalation

42

After recognizing cardiac arrest, immediately...

Begin chest compressions, open the airway, provide PPV, apply and AED

43

Establishing in-line stabilization

1. Place one hand on each side of the patient's head
2. Align the patient's nose with his navel
3. Position the head neutrally so the head is not extended (tipped backward) or flexed (tipped forward)

44

use in-line stabilization when...

You suspect a spinal injury

45

In-line stabilization must be maintained until...

The patient is fully immobilized

46

If you find A patient prone?

Quickly log roll him into a supine position

47

It is not possible to properly assess the airway or breathing if a patient is

Prone

48

Before log rolling the patient, quickly assess....?

The entire posterior side. Inspect and palpate for major bleeding, deformities, open wounds, bruises, burns, tenderness, or swelling

49

When log rolling a patient, if an open wound is on the posterior thorax....?

Quickly occlude the wound, use dressing tape on three sides

50

Before logrolling, if spinal injury is possible....?

Establish in-line stabilization

51

Assess level of consciousness by

Quickly assessing the level of responsiveness using the AVPU pneumonic

52

AVPU

Alert
Verbal (responds to verbal stimulus)
Painful (response to painful stimulus)
Unresponsive

53

When assessing a patient, they are alert and oriented...

If their eyes are open and able to speak

54

And alert patient maybe....

Oriented or disoriented

55

During assessing the level of consciousness, a patient responds to verbal stimuli....

If the patient opens their eyes and responds, or attempts to respond to your voice

56

When assessing the level of consciousness, if A patient does not speak, during response to verbal stimuli, see if the patient will....

Follow a command, lift your finger, squeeze my finger, wiggle your toes, blink

57

When assessing the level of consciousness, a patient that is responsive to painful stimuli may...

Have no response to verbal, but response to pain

58

A patient may respond to painful stimuli by...

Grimacing and displaying purposeful or non-purposeful movement

59

Methods of applying to painful stimuli are done during which assessment?

Level of consciousness

60

Trapezius pinch

Pinch the trapezius muscle that extends from the base of the neck to the shoulder

61

Supraorbital pressure

Slide your finger under the upper ridge of the eyesocket and apply upward pressure. (Right under the eyebrow on top of the eyeball)

62

Sternal rub

Apply hard downward pressure to the center of the sternum with knuckles of your hand

63

Earlobe pinch

Pinch the soft tissue portion of the earlobe

64

Armpit pinch

Pinch the skin and underlying tissue along the margin of the armpit

65

Peripheral painful stimuli can be applied when....

Assessing a patient's level of consciousness to see if they respond to painful stimulus

66

Types of peripheral painful stimuli are...

Nailbed pressure, pinching the web of the finger and thumb, pinching a finger toe hand or foot

67

A purposeful movement...

An attempt made by the patient to remove the stimulus or avoid pain

68

If a patient makes a purposeful movement, what would you document this as....

Withdraws the stimulus, withdraws from pain

69

During response to painful stimulus assessment, if a patient grab your hand, you can be sure that the patient has...

A higher level of brain function then a patient who just moved their arm toward the pain

70

two types of non-purposeful movements

Flexon posturing and extension posturing
Decorticate posturing and decerebrate posturing

71

Flexion/decorticate posturing

Patient arches the back and flexes the arms toward the chest

When the patient protects it core

72

Extension/Decerebrate posturing

Patient arches the back and extends their arms straight out parallel to the body.

When the patient cannot protect their core

73

Both types of non-purposeful movements may be signs of....

Serious head injury

74

Unresponsive patients are high-priority for...

Emergency care and transport

75

If a patient is unresponsive to verbal or painful stimuli this can indicate....

The patient's loss of ability to maintain their airway

76

During the level of consciousness, be sure and specific to document the level of responsiveness to establish what?

A baseline for later comparison

77

Because the peripheral stimulus may not ever reach the brain, it is appropriate to assess what kind of painful stimuli instead?

Central stimuli instead, which will be transmitted to the brain as to not get a false reading to the peripheral stimulus

78

It is important to remember during a sternal rub method, that the patient may

React to the stimulus, but it may not be a purposeful movement.

79

Unresponsive patients do not respond to what

Verbal or painful stimuli

80

Unresponsive patient commonly lose their...

Gag and cough reflexes and the ability to control the tongue and epiglottis

81

When an unresponsive patient loses their abilities to maintain gag cough and ability to control tongue and epiglottis....

The airway can become compromised

82

A patient is considered to have an altered mental status when

The patient is not alert, but responds to either verbal or painful stimulus

83

Like unresponsive patients, AMS patients Who are not unresponsive, May be prone to what...?

Airway compromise

84

The more specific you are regarding how the patient responds to either verbal or painful stimulus makes it easier for others to assess what?

A deteriorating mental status at a later point of time

85

AVPU check should take how long?

No longer than a few seconds and i
quickly establishes A baseline for mental status, to be later compared too

86

Once you have assess the patient's level of responsiveness, you must immediately proceed to the assessment of

The airway

87

There are two types of airways during assessment

A closed/blocked/occluded
OR
PATENT/OPEN

88

If a patient's airway is not patent, you must immediately open it by using....

Manual techniques or mechanical devices

89

A quick way to determine the airway status can be

During the AVPU check

90

A patient who is alert, responsive, and talking without signs of distress can be assumed to have...

A patent airway

91

If a patient is alert and talking without difficulty or if a child or infant is crying, you can assume that The patient's airway is...

Patent and can move onto the assessment of breathing

92

If there are signs of respiratory distress during an alert patient talking....

Examine closely for a blocked or partially blocked airway

93

If ever any doubt that the airway is open, you should immediately...

Take steps to open the airway

94

Unresponsive or severely AMS patients tend to have a high incidence for....

Airway occlusion resulting from relaxation of the muscles in the upper airway

95

What causes the tongue and epiglottis to fall back and partially blocked the lower part of the pharynx and the opening to the trachea

Muscle relaxation

96

Sounds that may indicate partial airway obstruction

Snoring, gurgling, crowing, or stridor

97

Snoring

A rough snoring type sound on inspiration and exhalation

98

Gurgling

A sound similar to air rushing through water on inspiration and exhalation

99

Crowing

A sound like a cawing crow on inspiration

100

Stridor

Harsh, high-pitched sound on inspiration

101

If a patient's muscles relax and their airway becomes obstructed, immediately do what?

Open the airway by using manual techniques or mechanical devices

102

For a snoring patient, to correct the sound...

Use the head tilt chin lift or jaw thrust maneuvers

Or use oropharyngeal or nasopharyngeal airway

103

If a patient is gurgling, immediately do what?

Suction out the contents or turn the patient and sweep the mouth

104

Do not waste time when clearing the airway, the key is to be....

Prepared and use whichever device or technique is most readily available so that they do not aspirate into the airway, respiratory tract, or lungs

105

Crowing in stride door are both high pitch sounds produced on inspiration, most commonly associated with

Swelling or muscle spasms

106

What kind of conditions cause crowing or Stridor?

Airway infections, allergic reactions, or burns to the upper airway

107

After you secure an open airway, you need to assess the patient's?

Breathing status

108

A patient's breathing assessment can only be done after

Securing an open airway

109

When assessing a patient's breathing you must determine what?

If the breathing is adequate or inadequate,

if there is a need for early oxygen therapy (adequate),

and if PPV with supplemental oxygen is needed (inadequate)

110

The best method to assess a patient's breathing is by

Looking, listening, and feeling

111

One respiration consists of

One inhalation and one exhalation

112

While assessing the rate and quality of breathing, make sure to assess both the...

Tidal volume and respiratory rate

113

And in adequate rate or inadequate tidal volume equal

Inadequate breathing

114

Adequate rate and adequate tidal volume equal

Adequate breathing

115

In adequate tidal volume

Poor movement or rise of the chest wall, indicating that an in adequate amount of air is being breathe in with each respiration. This is typically described as shallow respirations

116

Abnormal respiratory rate

Breathing that is either too fast or too slow and ranges outside of 8 to 24 for adults, 15 to 34 children, 25 to 50 for infants

117

Bradypnea

Respiratory rate that is too slow, May cause the minute volume to be inadequate, this low rate will lead to hypoxia

118

Minute volume

Amount of air breathed into the lungs in one minute

119

Hypoxia

In adequate oxygen delivery to the tissues

120

Bradypnea may be caused by

Hypoxia, especially in young children and infants, drug overdose on depressant drugs, head injury, stroke, hypothermia, and toxic inhalation

121

Hypothermia

Cold emergency

122

Tachypnea

A respiratory rate that is too fast

123

During tachypnea

A patients rate becomes excessive and the lungs do not have enough time between breaths to fill adequately therefore the minute volume becomes inadequate

124

During tachypnea, what may lead to hypoxia

In adequate breathing

125

A patient will likely become hypoxia during Tachypnea

When the respiratory rate is greater than 40 per minute and an adult because the time for the lungs to refill is too short, and the title volume will become inadequate

126

Tachypnea May be caused by

Hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, or other medical conditions

127

Chemoreceptors constantly measure the amount of

Carbon dioxide and oxygen in the arterial blood

128

Carbon dioxide is a strong stimulus to

Breathe

129

When carbon dioxide levels in the blood increase

The respiratory rate increases in and attempt to eliminate the excess carbon dioxide from the body

130

An early sign of hypoxia is

Pale, cold, clammy moist skin

131

What is a late sign of hypoxia

Cyanosis

132

If a patient does not have asymmetrical movement of the chest wall, this may be an indication of

A significant chest injury

133

If an airway is obstructed you can use what to relieve a foreign object?

Manual thrusts to the abdomen for adults or chest thrusts and back blows for infants

134

When assessing the breathing rate and quality use these three things?

Look, listen, feel

135

When you LOOK during breathing assessment, look for

In adequate tidal volume, abnormal respiratory rate (Bradypnea or tachypnea), retractions, use of accessory muscles, nasal flaring

136

While assessing a patient's breathing, LOOK for,

Tracheal tugging, pale cool clammy skin, cyanosis, pulls oximetry of less than 95%, asymmetrical chest wall movement

137

When assessing a patient's breathing you will listen and feel for...

Absent or in adequate breathing

138

In the patient who is breathing adequately, consider the SPO2 reading, complaints of dyspnea, & look for signs and symptoms of....

Hypoxia, hypoxemia, poor perfusion, heart failure, respiratory dress

139

Apnea

Absence of breathing

140

Dyspnea

The uncomfortable sensation of breathing difficulty, is produced when the oxygen demands of the cell are not being met by the respiratory or circulatory system

141

Apneic

Not breathing

142

A patient with an SPO to reading of less than 94% should be considered to be

Hypoxemic and receive supplemental oxygen

143

Primary assessment for circulation

Pulse - present or absent
Major bleeding
Skin color/temperature/condition
Capillary refill

144

The primary reason for checking circulation is to determine whether...

The heart is beating, there is severe bleeding, and whether blood is circulating adequately throughout the patient's body

145

If a patient has in adequate blood circulation, The patient may be suffering from?

A perfusion problem or shock

146

When assessing the Pulse of an unresponsive patient, The first thing you want to do is...?

AsCertain whether the heart is beating

147

In an unresponsive patient, if you cannot feel a radial pulse, you should immediately assess which pulse?

The carotid pulse

148

The carotid pulse is typically the most....

Prominent Pulse and is the last to be lost in the patient

149

Hey pulls that is growing faint can still be filled in the __________ artery even when it can no longer be felt in a peripheral artery?

Carotid

150

Hypoxia

Oxygwn starvation

151

Tachycardia May indicate

Anxiety, blood loss, shock, abnormal heart rhythm, heart attack, drug overdose come early hypoxia, fever, and other medical or Trumatic conditions

152

Peripheral Pulse can be found where?

Radial, brachial, femoral

153

Your central Pulse is what

Carotid pulse

154

If the carotid pulse is absent immediately begin ....?

Chest compressions with the supplemental oxygen and apply and AED

155

When identifying a major bleeding you will...

Expose the area by cutting away the clothing, always use gloves, apply direct pressure to control the bleeding, dress the bleeding

156

Perfusion

The sufficient supply of oxygen to the body cells that results from adequate circulation of blood through the capillaries

157

A patients perfusion can be assessed by checking...?

Skin color, temperature and skin condition

158

Capillary refill is typically a reliable indicator of _______ infants and children

Perfusion

159

Abnormal skin colors are

Pale or mottled
Cyanotic
Red
Yellow

160

Pale or mottled skin usually indicate a decrease in...

Perfusion and the onset of shock (hypoperfusion)

161

If a patient's skin is pale or mottled, suspect that the patient is....

Losing blood internally or externally or suffering another cause of shock

162

If a patient's skin is cyanotic you should suspect that the patient May have

Reduced oxygenation from chest injuries, blood loss, or conditions like pneumonia or pulmonary enema that disrupt gas exchange in the lungs, it is a late sign of poor perfusion

163

The hemoglobin in the red blood cells change color when

Starved of oxygen

164

When the hemoglobin in the red blood cells change color from being starved of oxygen what happens to the skin

The patient is hypoxic and their skin turns cyanotic

165

A patient with anemia has a low number of what

Red blood cells or low hemoglobin content to start with, this may take longer to become cyanotic when hypoxic

166

A patient with red or flushed skin usually indicates an increase in

The amount of blood circulating in the blood vessels under the skin

167

When a patient is red in color that can indicate what

Anaphylactic or vasogenic shock, poisoning, overdose or some diabetic or other medical conditions

168

What are some other things that can turn the skin red?

Alcohol ingestion, local inflammation, cold exposure, or a severe heat emergency, heatstroke.

169

A patient with yellow skin would indicate..

Possible liver dysfunction, jaundice, common in patients suffering from some form of liver disease, chronic alcoholism, or endocrine disturbance caused by increased bilirubin.

170

Bilirubin is

A product of hemoglobin breakdown that is normally eliminated by the liver

171

How do you best assess the patient's temperature

By placing the back of your bare hand or fingers on the patient's abdomen, face or neck

172

If a patient has a hot skin this may be a result from

Hot environment or extremely elevated body court temperature

173

If a patient has a cool skin this may be from

Decreased perfusion as seen in shock as well as exposure to cold temperatures for right anxiety drug overdose or other medical conditions that interfere with the bodies ability to regulate temperature

174

If a patient has cold skin, this may be from

Frostbite, significant cold exposure, Emerson in the cold water, or severe hypothermia.

175

Hypothermia

General cooling resulting from cold exposure

176

If a patient has cold skin, their skin may appear to be

From or stiff

177

If a patient has skin that appears to be firm or stiff, this is a significant sign of

Frost bite or a cold induced injury

178

If a patient has cool and clammy skin their skin will appear to be

Moist

179

If a patient displays moist, cool and clammy skin this may be related to

Blood loss, fright, nervousness, anxiety, pain, or medical conditions.

180

Cool and clammy skin is the most common sign of

Shock or hypoperfusion

181

A patient's skin condition refers to the amount of ______ found on the skin surface

Moisture

182

If a patient is displaying dry skin they may be suffering from

Dehydration or suffering from severe heat exposure/heatstroke or from some medical emergencies

183

If a patient has moist skin that is wet to the touch it may indicate

Sweating in a hot environment, exercise or exertion, fever or heart attack hypoglycemia shock/perfusion or many other condition

184

Moist clammy skin associated with medical or trauma conditions is typically produced from

Circulating epinephrine

185

What property in the Epinephrine stimulates the sweat glands?

The Alpha stimulant

187

If a patient assessment reveals pale cool clammy skin, specially If there is a significant mechanism of injury, and altered mental status, or severe bleeding you should assume that the patient is in

Shock/hypo perfusion

188

Treatment for shock

control bleeding, keep Pt warm, provide O2, splint fractures,

189

Establish Pt priority

unstable vs stable

190

a 2nd assessment

conduct physical exm
baseline vs
obtain pt history

191

2 types of physical exams are?

head-to-toe/rapid or modified/focused

192

GEN IMP.
Obvious blood, vomitus, secretion, other obstructsion

ER CARE
immediately suction or clear the obstruction from the airway

193

GEN IMP.
Obvious open wound to the anterior, lateral, posterior chest

Immediately cover the open wound w/ a nonporous or occlusive dressing taped on three sides

194

GEN IMP
paradoxical movement of the chest

Stablize the segment w/ your hand or provide BVM vent. if necessary for inadequate breathing

195

GEN IMP
Major bleeding that is spurting or flowing steadily

apply direct pressure to the site of bleeding

196

GEN IMP
mechanism of injury that might produce spinal injury

establish and hold manual in-line stabilization of the head and neck

197

MENTAL STATUS ASSESSMENT (AVPU)
AMS to include a Pt w/ is confused/responds only to verbal/painful stimuli/one who does not respond

closely asses ABC (O2nation) status
administer supp O2

198

AIRWAY
Blood secretions, vomitus, other substances in mouth/airway (gugling, stridor, crowing)

immediately suction the airway & clear any other obstructions

199

AIRWAY
OCCLUDED FROM THE TONGUE (SONOROUS SOUNDS)

immediately performm a head titlt, chin lift or jaw-thrust maneuver if a spine injury is suspected

200

BREATHING
Inadequate respiratory rate (too slow or too fast, w/ other signs of inadequate breathing)

immediately begin PPV w/ supp O2 connected to the vent device

201

BREATHING
inadequate Vt (shallow breathing or poor chest rise)

immediately big ppv w/ supp o2 connected to the vent device

202

CIRCULATION
rapid & weak pulse

stop any major bleeding, admin supp o2

203

CIRCULATION
Carotid pulse present, but absent peripheral pulses

stop any major bleeding, admin supp o2

204

CIRCULATION
pale, cool, clammy skin

stop any major bleeding, admin supp o2

205

CIRCULATION
capillary refill greater than 2 seconds w/ other signs of poor perfusion

stop any major bleeding, admin supp o2

206

CIRCULATION
major bleeding that is spurting or flowing steadily

stop any major bleeding, admin supp o2

207

CIRCULATION
absent carotid pulse in the adult or child, absent brachial pulse in the infant

immediately initiate CPR, beginning w/ chest compressions, and apply aed.

208

RAPID TRANSPORT
poor general impress

(pt looks ill/severly injured)
cyanosis, pale skin, significant blood loss, multiple wounds, injuries to head, chest, abdomen, pelvis, posterior thorax, multiple extremities

209

RAPID TRANSPORT
unresponsive pt or pt w/ an ams who lacks a gag/cough reflex

this is significant because the pt cannot protect his open airway

210

RAPID TRANSPORT

a responsive pt who is not obeying commands

211

RAPID TRANSPORT

inability to establish or maintain a patent airway

212

RAPID TRANSPORT

a pt experiencing difficulty in breathing or who exhibits signs of respiratory distress

213

RAPID TRANSPORT

absent or inadequate breathing for which the pt reqs continuous ppv

214

RAPID TRANSPORT

a pulseless patient

215

RAPID TRANSPORT

uncontrolled hemorrhage / severe blood loss

216

RAPID TRANSPORT

a pt w/ pale cool clammy skin who you suspect is in shock (hypoperfusion)

217

RAPID TRANSPORT

severe chest pain w/ a systolic bp of less than 100mmHg

218

RAPID TRANSPORT

complicated childbirth

219

RAPID TRANSPORT

extremely high body temp - above 104*

220

RAPID TRANSPORT

signs of generalized hypothermia

221

RAPID TRANSPORT

severe allergic reactino

222

RAPID TANSPORT

poisoning or overdose of unknown substance

223

a 2ndary assessment is performed afterthe primary assessment to identify what?

any addt'l injuries or conditions

224

The three components of a 2ndary assessment are...?

physical exam
baseline v/s
Hx

225

physical exams use what techniques to identify signs & symptoms?

inspection, palpation, auscultation

226

an anatomical approach proceeds from....?

head to toe

227

a 2ndary assessment is performed on what types of Pt's?

unstable or critical/ medical or trauma

228

priapism can indicate what type of injury?

spinal