Flashcards in Chapter 13 Deck (228):
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
Purpose of assessing a patient?
-Determine the nature of the problem
-Manage immediate threats to life
-Establish priorities for treatment & transport
Primary assessment involves obtaining a general impression of the patients?
Level of consciousness
What is immediately treated before moving on to the next portion of the primary assessment?
Any life-threatening condition
The primary assessment is systematic, but not necessarily linear; and completed in how many seconds?
Form a general impression and then?
Correct obvious life threats
After correcting obvious life threats?
Determine whether the patient is a trauma or medical or both
Once determining the patient is a trauma...? T
Determine if there Is a spinal injury/no spinal injury?
After stabilizing a pt? T
Assess their mental status
After assessing the patient's mental status? T
Assess their airway
If the airway is open or closed then? T
Perform the job thrust maneuver or assess breathing status
after assessing the breathing status? T
Determine whether it is inadequate or adequate
If a patient's breathing status is inadequate? T
Begin positive pressure ventilation with supplemental oxygen and assess the circulation
After you assess the circulation. T
Determine if there is a Pulse present or absent
If a pulse is present? T
Assess for major bleeding
If there is an absent Pulse? T
Begin CPR/apply AED and transport
After assessing the major bleeding, if there is present major bleeding?
Control the bleeding and assess the skin
After controlling the bleeding and assessing the skin? T
Perform a secondary assessment trauma patient
If there is no major bleeding? T
Assess the skin and perform a secondary assessment trauma pt
If there is a suspected spinal injury? T
Establish in-line stabilization and assess mental status
If the patient is a medical.....? M
Assess their mental status
After assessing the mental status? M
Assess the patient's airway
If the patient airway is open? M
Assess the patient's breathing status
If the patient's airway is closed? M
Perform head tilt, chin lift and assess their breathing status
after assessing their breathing status.....? M
Determine if the patient's breathing is adequate or inadequate
If a patient's breathing is adequate? M
Assess their circulation
If a patient's breathing status is inadequate.....? M
Begin positive pressure ventilation with supplemental oxygen and assess their circulation
After assessing the patient's circulation? M
Check if there is a Pulse present or absent
If a patient's pulse is present.....? M
Assess the patient's skin and perform a secondary assessment medical patient
If a patient's pulse is absent....? M
Begin CPR/apply AED and prepare to transport
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
Forming a general impression of the patient
Estimate the patient's age
Determine if trauma or medical
Obtain the patient's CC
Identify/manage immediate life threats
Determine if the patient is ill or injured - trauma or medical
Look for the MOI the NOI
If you suspect a spinal injury?
Stabilize the head and spine
Two types of trauma?
Penetrating and blunt force
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
Caused by a force that impacts/is applied to the body, but is not sharp enough to penetrate
Types of blunt trauma
Vehicle crashes, falls, fights, crushing, building collapses, caught in machinery, hit with a hard object
Determine the chief complaint
Why were EMS called
During the general impression, what should you identify?
Immediate life threats and intervene
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
Paradoxical movement of a segment of the chest
Inward movement on inhalation and outward movement on exhalation
After recognizing cardiac arrest, immediately...
Begin chest compressions, open the airway, provide PPV, apply and AED
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)
use in-line stabilization when...
You suspect a spinal injury
In-line stabilization must be maintained until...
The patient is fully immobilized
If you find A patient prone?
Quickly log roll him into a supine position
It is not possible to properly assess the airway or breathing if a patient is
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
When log rolling a patient, if an open wound is on the posterior thorax....?
Quickly occlude the wound, use dressing tape on three sides
Before logrolling, if spinal injury is possible....?
Establish in-line stabilization
Assess level of consciousness by
Quickly assessing the level of responsiveness using the AVPU pneumonic
Verbal (responds to verbal stimulus)
Painful (response to painful stimulus)
When assessing a patient, they are alert and oriented...
If their eyes are open and able to speak
And alert patient maybe....
Oriented or disoriented
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
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
When assessing the level of consciousness, a patient that is responsive to painful stimuli may...
Have no response to verbal, but response to pain
A patient may respond to painful stimuli by...
Grimacing and displaying purposeful or non-purposeful movement
Methods of applying to painful stimuli are done during which assessment?
Level of consciousness
Pinch the trapezius muscle that extends from the base of the neck to the shoulder
Slide your finger under the upper ridge of the eyesocket and apply upward pressure. (Right under the eyebrow on top of the eyeball)
Apply hard downward pressure to the center of the sternum with knuckles of your hand
Pinch the soft tissue portion of the earlobe
Pinch the skin and underlying tissue along the margin of the armpit
Peripheral painful stimuli can be applied when....
Assessing a patient's level of consciousness to see if they respond to painful stimulus
Types of peripheral painful stimuli are...
Nailbed pressure, pinching the web of the finger and thumb, pinching a finger toe hand or foot
A purposeful movement...
An attempt made by the patient to remove the stimulus or avoid pain
If a patient makes a purposeful movement, what would you document this as....
Withdraws the stimulus, withdraws from pain
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
two types of non-purposeful movements
Flexon posturing and extension posturing
Decorticate posturing and decerebrate posturing
Patient arches the back and flexes the arms toward the chest
When the patient protects it core
Patient arches the back and extends their arms straight out parallel to the body.
When the patient cannot protect their core
Both types of non-purposeful movements may be signs of....
Serious head injury
Unresponsive patients are high-priority for...
Emergency care and transport
If a patient is unresponsive to verbal or painful stimuli this can indicate....
The patient's loss of ability to maintain their airway
During the level of consciousness, be sure and specific to document the level of responsiveness to establish what?
A baseline for later comparison
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
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.
Unresponsive patients do not respond to what
Verbal or painful stimuli
Unresponsive patient commonly lose their...
Gag and cough reflexes and the ability to control the tongue and epiglottis
When an unresponsive patient loses their abilities to maintain gag cough and ability to control tongue and epiglottis....
The airway can become compromised
A patient is considered to have an altered mental status when
The patient is not alert, but responds to either verbal or painful stimulus
Like unresponsive patients, AMS patients Who are not unresponsive, May be prone to what...?
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
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
Once you have assess the patient's level of responsiveness, you must immediately proceed to the assessment of
There are two types of airways during assessment
If a patient's airway is not patent, you must immediately open it by using....
Manual techniques or mechanical devices
A quick way to determine the airway status can be
During the AVPU check
A patient who is alert, responsive, and talking without signs of distress can be assumed to have...
A patent airway
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
If there are signs of respiratory distress during an alert patient talking....
Examine closely for a blocked or partially blocked airway
If ever any doubt that the airway is open, you should immediately...
Take steps to open the airway
Unresponsive or severely AMS patients tend to have a high incidence for....
Airway occlusion resulting from relaxation of the muscles in the upper airway
What causes the tongue and epiglottis to fall back and partially blocked the lower part of the pharynx and the opening to the trachea
Sounds that may indicate partial airway obstruction
Snoring, gurgling, crowing, or stridor
A rough snoring type sound on inspiration and exhalation
A sound similar to air rushing through water on inspiration and exhalation
A sound like a cawing crow on inspiration
Harsh, high-pitched sound on inspiration
If a patient's muscles relax and their airway becomes obstructed, immediately do what?
Open the airway by using manual techniques or mechanical devices
For a snoring patient, to correct the sound...
Use the head tilt chin lift or jaw thrust maneuvers
Or use oropharyngeal or nasopharyngeal airway
If a patient is gurgling, immediately do what?
Suction out the contents or turn the patient and sweep the mouth
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
Crowing in stride door are both high pitch sounds produced on inspiration, most commonly associated with
Swelling or muscle spasms
What kind of conditions cause crowing or Stridor?
Airway infections, allergic reactions, or burns to the upper airway
After you secure an open airway, you need to assess the patient's?
A patient's breathing assessment can only be done after
Securing an open airway
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)
The best method to assess a patient's breathing is by
Looking, listening, and feeling
One respiration consists of
One inhalation and one exhalation
While assessing the rate and quality of breathing, make sure to assess both the...
Tidal volume and respiratory rate
And in adequate rate or inadequate tidal volume equal
Adequate rate and adequate tidal volume equal
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
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
Respiratory rate that is too slow, May cause the minute volume to be inadequate, this low rate will lead to hypoxia
Amount of air breathed into the lungs in one minute
In adequate oxygen delivery to the tissues
Bradypnea may be caused by
Hypoxia, especially in young children and infants, drug overdose on depressant drugs, head injury, stroke, hypothermia, and toxic inhalation
A respiratory rate that is too fast
A patients rate becomes excessive and the lungs do not have enough time between breaths to fill adequately therefore the minute volume becomes inadequate
During tachypnea, what may lead to hypoxia
In adequate breathing
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
Tachypnea May be caused by
Hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, or other medical conditions
Chemoreceptors constantly measure the amount of
Carbon dioxide and oxygen in the arterial blood
Carbon dioxide is a strong stimulus to
When carbon dioxide levels in the blood increase
The respiratory rate increases in and attempt to eliminate the excess carbon dioxide from the body
An early sign of hypoxia is
Pale, cold, clammy moist skin
What is a late sign of hypoxia
If a patient does not have asymmetrical movement of the chest wall, this may be an indication of
A significant chest injury
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
When assessing the breathing rate and quality use these three things?
Look, listen, feel
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
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
When assessing a patient's breathing you will listen and feel for...
Absent or in adequate breathing
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
Absence of breathing
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
A patient with an SPO to reading of less than 94% should be considered to be
Hypoxemic and receive supplemental oxygen
Primary assessment for circulation
Pulse - present or absent
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
If a patient has in adequate blood circulation, The patient may be suffering from?
A perfusion problem or shock
When assessing the Pulse of an unresponsive patient, The first thing you want to do is...?
AsCertain whether the heart is beating
In an unresponsive patient, if you cannot feel a radial pulse, you should immediately assess which pulse?
The carotid pulse
The carotid pulse is typically the most....
Prominent Pulse and is the last to be lost in the patient
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?
Tachycardia May indicate
Anxiety, blood loss, shock, abnormal heart rhythm, heart attack, drug overdose come early hypoxia, fever, and other medical or Trumatic conditions
Peripheral Pulse can be found where?
Radial, brachial, femoral
Your central Pulse is what
If the carotid pulse is absent immediately begin ....?
Chest compressions with the supplemental oxygen and apply and AED
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
The sufficient supply of oxygen to the body cells that results from adequate circulation of blood through the capillaries
A patients perfusion can be assessed by checking...?
Skin color, temperature and skin condition
Capillary refill is typically a reliable indicator of _______ infants and children
Abnormal skin colors are
Pale or mottled
Pale or mottled skin usually indicate a decrease in...
Perfusion and the onset of shock (hypoperfusion)
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
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
The hemoglobin in the red blood cells change color when
Starved of oxygen
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
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
A patient with red or flushed skin usually indicates an increase in
The amount of blood circulating in the blood vessels under the skin
When a patient is red in color that can indicate what
Anaphylactic or vasogenic shock, poisoning, overdose or some diabetic or other medical conditions
What are some other things that can turn the skin red?
Alcohol ingestion, local inflammation, cold exposure, or a severe heat emergency, heatstroke.
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.
A product of hemoglobin breakdown that is normally eliminated by the liver
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
If a patient has a hot skin this may be a result from
Hot environment or extremely elevated body court temperature
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
If a patient has cold skin, this may be from
Frostbite, significant cold exposure, Emerson in the cold water, or severe hypothermia.
General cooling resulting from cold exposure
If a patient has cold skin, their skin may appear to be
From or stiff
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
If a patient has cool and clammy skin their skin will appear to be
If a patient displays moist, cool and clammy skin this may be related to
Blood loss, fright, nervousness, anxiety, pain, or medical conditions.
Cool and clammy skin is the most common sign of
Shock or hypoperfusion
A patient's skin condition refers to the amount of ______ found on the skin surface
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
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
Moist clammy skin associated with medical or trauma conditions is typically produced from
What property in the Epinephrine stimulates the sweat glands?
The Alpha stimulant
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
Treatment for shock
control bleeding, keep Pt warm, provide O2, splint fractures,
Establish Pt priority
unstable vs stable
a 2nd assessment
conduct physical exm
obtain pt history
2 types of physical exams are?
head-to-toe/rapid or modified/focused
Obvious blood, vomitus, secretion, other obstructsion
immediately suction or clear the obstruction from the airway
Obvious open wound to the anterior, lateral, posterior chest
Immediately cover the open wound w/ a nonporous or occlusive dressing taped on three sides
paradoxical movement of the chest
Stablize the segment w/ your hand or provide BVM vent. if necessary for inadequate breathing
Major bleeding that is spurting or flowing steadily
apply direct pressure to the site of bleeding
mechanism of injury that might produce spinal injury
establish and hold manual in-line stabilization of the head and neck
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
Blood secretions, vomitus, other substances in mouth/airway (gugling, stridor, crowing)
immediately suction the airway & clear any other obstructions
OCCLUDED FROM THE TONGUE (SONOROUS SOUNDS)
immediately performm a head titlt, chin lift or jaw-thrust maneuver if a spine injury is suspected
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
inadequate Vt (shallow breathing or poor chest rise)
immediately big ppv w/ supp o2 connected to the vent device
rapid & weak pulse
stop any major bleeding, admin supp o2
Carotid pulse present, but absent peripheral pulses
stop any major bleeding, admin supp o2
pale, cool, clammy skin
stop any major bleeding, admin supp o2
capillary refill greater than 2 seconds w/ other signs of poor perfusion
stop any major bleeding, admin supp o2
major bleeding that is spurting or flowing steadily
stop any major bleeding, admin supp o2
absent carotid pulse in the adult or child, absent brachial pulse in the infant
immediately initiate CPR, beginning w/ chest compressions, and apply aed.
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
unresponsive pt or pt w/ an ams who lacks a gag/cough reflex
this is significant because the pt cannot protect his open airway
a responsive pt who is not obeying commands
inability to establish or maintain a patent airway
a pt experiencing difficulty in breathing or who exhibits signs of respiratory distress
absent or inadequate breathing for which the pt reqs continuous ppv
a pulseless patient
uncontrolled hemorrhage / severe blood loss
a pt w/ pale cool clammy skin who you suspect is in shock (hypoperfusion)
severe chest pain w/ a systolic bp of less than 100mmHg
extremely high body temp - above 104*
signs of generalized hypothermia
severe allergic reactino
poisoning or overdose of unknown substance
a 2ndary assessment is performed afterthe primary assessment to identify what?
any addt'l injuries or conditions
The three components of a 2ndary assessment are...?
physical exams use what techniques to identify signs & symptoms?
inspection, palpation, auscultation
an anatomical approach proceeds from....?
head to toe
a 2ndary assessment is performed on what types of Pt's?
unstable or critical/ medical or trauma