Chapter 13: Patient Assessment

Question 1

primary assessment

Answer 1

after scene is safe and controlled, conducted on every patient regardless of the MOI or NOI

Question 2

the overall purposes of patient assessment served during primary assessment

Answer 2

1) determine whether the patient is injured or ill
2) identify and manage immediately life-threatening conditions
3) determine priorities for further assessment and care on the scene versus immediate transport

Question 3

the main purpose of the primary assessment

Answer 3

identify and manage immediately life-threatening conditions to the airway, breathing, oxygenation, or circulation

Question 4

components of primary assessment

Answer 4

1) form a general impression of the patient
2) assess the level of consciousness (mental status)
3) assess the airway
4) assess breathing
5) assess oxygenation
6) assess circulation
7) establish patient priorities

Question 5

spine motion restriction (SMR)

Answer 5

performed if you suspect spinal cord or vertebral injury (patient has sever MOI) or if patient complains or neck/back pain, loss of motor/sensory functions, or abnormal sensations in extremities

Question 6

self-restriction

Answer 6

patient instructed to bring head and neck in line with umbilicus and not move it

Question 7

penetrating trauma

Answer 7

a force that pierces skin and body tissues, e.g. gunshots, knives, other sharp objects

Question 8

blunt trauma

Answer 8

caused by a force that impacts or is applied to the body but is not sharp enough to penetrate, e.g. blows or crushing

Question 9

chief complaint

Answer 9

the patient’s answer to “why did you call EMS today?” and if patient cannot answer, it may be the response of a family member/bystander or what you infer from observation if no one can answer

Question 10

immediate life threats that require immediate managements

Answer 10

1) an airway compromised by blood, vomit, tongue, etc…
2) obvious open wounds to chest
3) paradoxical movement of chest (moves in on inhalation and out on exhalation)
4) major bleeding
5) unresponsive with no breathing or no normal breathing (agonal or gasping breaths)

Question 11

performing manual SMR

Answer 11

1) place one hand on either side of patient’s head
2) gently bring head into a position in which the nose is aligned with the patients naval
3) position the head neutrally so the head is not extended or flexed

Question 12

performing self-restriction

Answer 12

1) instruct patient to bring his head and neck in line with his navel
2) instruct the patient to bring his legs and feet also in line with his body and to keep his toes in line with his nose and naval
3) instruct the patient not to move his head or neck by extending, flexing, or making any lateral movements until further instructed, a cervical collar is often put in place as a reminder

Question 13

AVPU mnemonic

Answer 13

Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive

Question 14

trapezius pinch

Answer 14

painful stimulus, pinch the trapezius muscle that extends from along the base of the neck to the shoulder, grasp 1-2 inches of the muscle and squeeze

Question 15

supraorbital pressure

Answer 15

slide fingers under the upper ridge of the eye socket and apply upward pressure

Question 16

sternal rub

Answer 16

apply hard downward pressure to center of sternum with knuckles

Question 17

earlobe pinch

Answer 17

pinch the soft tissue portion of the earlobe

Question 18

armpit pinch

Answer 18

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

Question 19

nail bed pressure

Answer 19

apply point pressure to the cuticle area of the nail bed

Question 20

other peripheral painful stimuli

Answer 20

1) pinch the web between thumb and index finger
2) pinch the finger, toe, hand, or foot

Question 21

flexion posturing

Answer 21

aka decorticate posturing, a non-purposeful movement, patient arches back and flexes arms inward towards chest, sign of serious head injury

Question 22

extension posturing

Answer 22

aka decerebrate posturing, a non-purposeful movement, patient arches back and extends arm straight out parallel to the body, sign of serious head injury

Question 23

occluded airway

Answer 23

closed or blocked airway, immediate life-threatening condition

Question 24

patent airway

Answer 24

open airway

Question 25

assess breathing to:

Answer 25

1) determine whether breathing is inadequate or adequate 2) determine need for early oxygen therapy if breathing is adequate 3) provide positive pressure ventilation with supplemental oxygen for inadequate breathing

Question 26

inadequate tidal volume

Answer 26

poor movement (rise) of chest wall (shallow respiration)

Question 27

abnormal respiratory rate

Answer 27

breathing that is either too fast or too slow

Question 28

bradypnea

Answer 28

a respiratory rate that is too slow, causes inadequate minute ventilation leading to hypoxia. can be caused by hypoxia, drug overdose (depressant drugs), head injury, stroke, hypothermia, toxic inhalation

Question 29

tachypnea

Answer 29

respiratory rate that is too fast, can lead to hypoxia. can be caused by hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, other medical conditions

Question 30

retraction

Answer 30

sunken-in appearance, tissues pulled in on inhalation

Question 31

tracheal tugging

Answer 31

pendulum motions of the trachea in the anterior neck during inhalatoin

Question 32

apnea

Answer 32

absence of breathing, no chest wall movement and no sensation/sound of air moving in and out of nose/mouth

Question 33

dyspnea

Answer 33

difficulty breathing

Question 34

when to administer oxygen treatment

Answer 34

SpO2 reading below 94%, signs of hypoxia, hypoxemia, poor perfusion, heart failure, respiratory distress

Question 35

circulation assessment

Answer 35

check the: 1) pulse (presence, absence, approx. HR, regularity and strength) 2) possible major bleeding 3) skin color (mucous membranes), temperature, condition 4) capillary refill

Question 36

major bleeding

Answer 36

bright red, spurting bleeding (arterial) OR dark red, steady, rapid bleeding (venous)

Question 37

abnormal skin

Answer 37

1) pale/mottled 2) cyanotic 3) red 4) yellow

Question 38

pale/mottled skin

Answer 38

decrease in perfusion, onset of shock (hypoperfusion), suspect blood loss or other shock cause

Question 39

cyanotic skin

Answer 39

blue-grey skin, indicate reduced oxygenation from chest injuries, blood loss, conditions that disrupt gas exchange in lungs, late sign of poor perfusion

Question 40

red skin

Answer 40

increase in the amount of blood circulating in blood vessels in skin, can indicate anaphylactic or vasogenic shock, poisonings, overdose, diabetic.other medical conditions, alcohol, local inflammation, cold exposure, heat emergency

Question 41

yellow skin

Answer 41

jaundice, indicates liver dysfunction

Question 42

hot skin

Answer 42

from a hot environment or a very elevated body core temperature

Question 43

cool skin

Answer 43

decreased perfusion as seen in shock, exposure to cold temperatures, fright, anxiety, drug overdose, medical conditions that may interfere with body's ability to regulate temperature

Question 44

cold skin

Answer 44

frostbite, significant cold exposure, immersion in cold water, severe hypothermia

Question 45

cool and clammy skin

Answer 45

cool and moist, from blood loss, fright, nervousness, anxiety, pain, other medical conditions, THE MOST common sign of shock (hypoperfusion)

Question 46

dry skin

Answer 46

dehydrated or suffering from severe heat exposure or from some medical emergencies

Question 47

moist skin

Answer 47

sweating (in a hot environment), exercise or exertion, fever...from heart attack, hypoglycemia, shock, many other conditions

Question 48

secondary assessment

Answer 48

to identify any additional injuries or conditions that may be life threatening 1) conduct a physical exam 2) take vital signs 3) obtain a history NOT necessarily in this order

Question 49

cerebrospinal fluid (CSF)

Answer 49

clear fluid that surrounds and cushions the spinal cord, CSF leakage usually indicates a skull fracture

Question 50

consensual reflex

Answer 50

when both pupils react simultaneously and equally to light being shined in either eye

Question 51

fixed and dilated pupil

Answer 51

pupil that is large and not responding to light

Question 52

visual acuity

Answer 52

clarity of vision

Question 53

conjugate movement

Answer 53

eyes should move together

Question 54

nystagmus

Answer 54

jerky eye movements

Question 55

fixed gaze

Answer 55

singular eye that is fixed

Question 56

dysconjugate gaze

Answer 56

eyes do not move together

Question 57

sclera

Answer 57

white portion of eye

Question 58

icterus

Answer 58

yellow sclera, possible liver damage/failure

Question 59

hematoma

Answer 59

collection of blood

Question 60

subcutaneous emphysema

Answer 60

air under the skin, evidence of trauma to the airway

Question 61

tension pneumothorax

Answer 61

air trapped in the chest cavity because of chest or lung injury

Question 62

pericardial tamponade

Answer 62

blood filling the sac around the heart

Question 63

productive cough

Answer 63

mucus produced with cough

Question 64

peritonitis

Answer 64

inflammation or irritation of the abdomen lining

Question 65

priapism

Answer 65

a persistent erection of the penis, sign of a possible spine injury

Question 66

paraplegia

Answer 66

paralysis involving both legs only

Question 67

quadriplegia

Answer 67

paralysis involving both arms and both legs

Question 68

hemiplegia

Answer 68

paralysis of an arm and leg on one side of the body

Question 69

vital signs that need to be assessed during the secondary assessment and reassessed throughout the entire call

Answer 69

breathing (rate and tidal volume), pulse (location, rate, strength, regularity), skin (temperature, color, condition), capillary refill, blood pressure (systolic and diastolic), pupils (equality, size, rate of reactivity), SpO2

Question 70

SAMPLE history

Answer 70

S: Signs and Symptoms A: Allergies M: Medications P: Past medical history L: Last oral intake E: Events prior to the incident

Question 71

secondary assessment order for a trauma patient

Answer 71

1. physical exam 2. vital signs .3. history

Question 72

rapid secondary assessment

Answer 72

a rapid head-to-toe exam, followed by prompt transport or on-scene emergency care

Question 73

modified secondary assessment

Answer 73

an exam focused on a specific injury site, followed by on-scene emergency care

Question 74

when to do a rapid secondary assessment followed by rapid emergency care and transport

Answer 74

if the mechanism of injury is significant enough to cause critical injuries, if multiple injuries exist, if the patient has an altered mental status, or if any other critical finding identified in the primary assessment makes the patient unstable,

Question 75

when to do a rapid secondary assessment followed by rapid emergency care and transport

Answer 75

if the mechanism of injury is significant enough to cause critical injuries, if multiple injuries exist, if the patient has an altered mental status, or if any other critical finding identified in the primary assessment makes the patient unstable

Question 76

when to do a rapid secondary assessment followed by on-scene emergency care

Answer 76

the mechanism of injury is not significant enough to produce critical injuries but you suspect the patient could be suffering from multiple or serious injuries anywhere on the body, or if the patient has altered mental status

Question 77

when to do a modified secondary assessment followed by appropriate on-scene emergency care

Answer 77

if the patient is suffering from an isolated injury that is not critical, the mechanism of injury is minor, there is no evidence of multiple injuries, and the patient is alert and oriented

Question 78

significant mechanisms of injury

Answer 78

- ejection (partial or complete) of the patient from a vehicle in an automobile crash - a crash that causes death to a person in the same passenger compartment in which the patient is found - a fall of greater than 20 feet - rollover of the vehicle the patient was in - a vehicle collision that has occurred at a high speed - an intrusion of greater than 12 inches into the passenger compartment or greater than 18 inches at any site on the vehicle - a pedestrian/bicyclist struck by a vehicle - a motorcycle crash greater than 20mph with separation of rider from motorcycle - blunt or penetrating trauma that results in an altered mental status from confusion to unresponsiveness - penetrating injuries to the head, neck, torso, or extremities above the knee or elbow - blast injuries from an explosion - seat-belt injuries - collisions in which seat belts are not worn, even if air bags have been deployed - impact causing deformity to the steering wheel - collision that results in prolonged extrication

Question 79

special considerations for infants and children for MOIs

Answer 79

- a fall of greater than 10 feet or 2-3 times the height of the child - a bicycle collision with a motor vehicle - a pedestrian or occupant in a vehicle collision at a medium speed - any vehicle collision where the infant or child was unrestrained - all other adult significant MOIs

Question 80

secondary assessment: trauma patient with significant MOI, multiple injuries, or altered mental status

Answer 80

1) continue in-line stabilization 2) consider ALS request 3) reconsider transport decision 4) reassess mental status 5) perform rapid secondary assessment 6) assess vital 7) obtain history 8) transport 9) perform reassessment

Question 81

secondary assessment: trauma with NO significant MOI, NO multiple injuries, and NO altered mental status

Answer 81

1) perform modified secondary assessment 2) assess vitals 3) obtain history 4) transport 5) perform reassessment

Question 82

AVPU

Answer 82

A: alert V: responds to verbal stimulus P: responds to painful stimulus U: unresponsive

Question 83

Glascow Coma Scale

Answer 83

GCS, to rank the patients level of conciousness between 3-15. A score of 8 or less means that there is a severe alteration in brain function. A score of 13 or less means that there needs to be limited (less than 10 minutes) of on-scene time and rapid transport

Question 84

brain herniation

Answer 84

significant swelling and/or bleeding to or around the brain creates excessive pressure within the skull and causes the brain to be compressed and pushed downward toward the brain stem, when the brain is pushed out of the foramen magnum (the opening where the spinal cord exits the brain) or the fibrous tentorium (divides the upper and lower brain).

Question 85

aspiration

Answer 85

the patient breaths a substance into the lungs

Question 86

aniscoria

Answer 86

unequal pupils (normally)

Question 87

subcutaneous emphysema

Answer 87

air trapped under the lower layer of the skin, good indicator of significant neck or chest injury

Question 88

tension pneumothorax

Answer 88

trachea shifted to one side due to air in the chest cavity, the result of severe lung or chest injury (trachea deviates away from the injured side), when a lung is completely collapsed from air trapped in pleural space

Question 89

tracheal tugging

Answer 89

pendulum motion of the trachea, indicates airway obstruction

Question 90

paradoxical movement

Answer 90

a section of the chest sinks inward on inhalation while the rest of the chest moves outward

Question 91

flail segment

Answer 91

two or more adjacent ribs fractured in two or more places, alters negative chest pressure, life threatening injury (reduces breathing and oxygenation adequacy), CPAP can be good here

Question 92

tenderness

Answer 92

a pain response elicited upon palpation

Question 93

markle test/heel jar test

Answer 93

strike bottom of heel sharply with fist while patient is supine, tests for rebound tenderness and possible internal injury to abdominal organs

Question 94

DCAP-BTLS

Answer 94

for rapid secondary assessment (trauma) D: Deformities C: Contusions A: Abrasions B: Burns T: Tenderness L: Lacerations S: Swelling

Question 95

PMS

Answer 95

for rapid secondary assessment of the extremities P: Pulses (distal pulses) M: Motor function S: Sensation

Question 96

breathing assessment: rapid secondary assessment (trauma patient)

Answer 96

rate, tidal volume, quality of breathing (normal, shallow, labored, deep, noisy)

Question 97

pulse assessment: rapid secondary assessment (trauma patient)

Answer 97

radial pulse (adult and child patient), brachial pulse (infant less than 1 year), if radial not present, assess carotid

Question 98

skin assessment: rapid secondary assessment (trauma patient)

Answer 98

pale or cyanotic nail beds, pale skin, pale oral mucosa, pale conjunctiva, feel skin w/ back of hand for temperature and condition, capillary refill

Question 99

pupil assessment: rapid secondary assessment (trauma patient)

Answer 99

size and reactivity

Question 100

blood pressure assessment: rapid secondary assessment (trauma patient)

Answer 100

via auscultation, determine systolic and diastolic, narrow pulse pressure and hypotension = signs of serious blood loss and shock

Question 101

pulse oximeter assessment: rapid secondary assessment (trauma patient)

Answer 101

apply to determine oxygen level, any reading less than 94% is suspicious

Question 102

revised trauma score

Answer 102

includes Glasgow Coma Scale, has 3 major components (respiratory rate, systolic blood pressure, GCS score)

Question 103

secondary assessment: medical patient who is responsive, alert, and oriented

Answer 103

1) assess complaints plus signs and symptoms (OPQRST) 2) obtain history 3) perform a modified secondary assessment 4) assess vital signs 5) make transport decision 6) reassessment

Question 104

secondary assessment: medical patient who is unresponsive, not responsive to verbal or painful stimuli, not alert or oriented

Answer 104

1) perform a rapid secondary assessment 2) assess vital signs 3) position patient 4) obtain history 5) transport 6) reassessment

Question 105

orthopnea

Answer 105

inability to breathe/shortness of breath while lying flat

Question 106

crackles/rales

Answer 106

fine crackling noises on inhalation similar to hair being rubbed together close to your ear, indication of fluid in/around alveoli and terminal end of bronchioles

Question 107

wheezing

Answer 107

a musical sound on inhalation and exhalation, indicates higher resistance in bronchioles with restricted airflow, usually from bronchiole constriction or swelling/inflammation

Question 108

peritonitis

Answer 108

irritation of the abdomen lining (peritoneum)

Question 109

peripheral edema

Answer 109

swelling around the hands, feet, ankles

Question 110

recovery/coma position

Answer 110

left lateral recumbent position (modified), avoids the potential for aspiration

Question 111

reassessment

Answer 111

conducted following the secondary assessment, reassess vital signs every 5 minutes for unstable patient or every 15 minutes in the stable patient

Question 112

three basic reasons to perform a reassessment

Answer 112

- to detect any change in the patient's condition - to identify any missed injuries or conditions, especially those that are life-threatening - to adjust the emergency care as needed

Question 113

breathing assessment for an unresponsive medical patient

Answer 113

tachypnea, abnormal respiratory patterns

Question 113

pulse assessment for an unresponsive medical patient

Answer 113

radial pulse, then carotid pulse if radial pulse is not present, determine rate and quality

Question 114

pupil assessment for an unresponsive medical patient

Answer 114

document size, equality, reactivity to light

Question 115

skin assessment for an unresponsive medical patient

Answer 115

assess temperature, color, condition (pale cool and clammy may indicate vasoconstriction)

Question 115

blood pressure assessment for an unresponsive medical patient

Answer 115

get both systolic and diastolic, pay attention to pulse pressure

Question 115

pulse oximeter

Answer 115

determine SpO2 on room air

Question 116

general steps of reassessment

Answer 116

1) repeat primary assessment 2) reassess and record vital signs 3) repeat secondary assessment for other complaints, injuries, or a change in the chief complaint 4) check interventions 5) note trends in the patient's condition