Chapter 13 - Patient Assessment Flashcards Preview

EMT - Basic - Prehostpital Emergency Care 10th Edition > Chapter 13 - Patient Assessment > Flashcards

Flashcards in Chapter 13 - Patient Assessment Deck (95):
1

Components of primary assessment

Form general impression of pt
Assess level of consciousness
Assess the airway
Assess breathing
Assess oxygenation
Assess circulation
Establish patient priorities

2

The main purpose of the primary assessment is to:

Identify and manage immediately life threatening conditions to the airway, breathing, oxygenation, or circulation.

3

Chief complaint

What the patient tells you is wrong with him

4

Forming general impression:

Estimate pt age
Note pt sex
Determine trauma/medical
Chief complaint
Identify and manage immediate life threats

5

There are two types of trauma:

Blunt and penetrating

6

Type of force that pierces the skin and body tissues.

Penetrating

7

Steps of scene size-up:

Standard precautions
Scene hazards/scene safety
Moi Noi
# of patients
Need for additional resources

8

Bringing the patients head into a neutral in-line position and holding it there.

In-line stabilization

9

In-line stabilization procedure:

Place one hand on each side of the patient's head.

Gently bring the head into a position in which the nose is in line with the patient's navel.

Position the head neutrally so the head is not extended (tipped backward) or flexed (tipped forward).

10

AVPU

Alert
Voice
Pain
Unresponsive

11

Central painful stimulus:

Trapezius pinch
Supraorbital pressure
Sternal rub
Earlobe pinch
Armpit pinch

12

Peripheral painful stimuli:

Nail bed pressure
Pinch to the web between thumb and index finger
Pinch to the finger, toe, hand or foot

13

Purposeful movements

Attempts made by the patient to remove the painful stimulus or avoid the pain. Documented as "withdraws the stimulus" or "withdraws from pain"

14

Nonpurposeful movements:

Flexion posturing and extension posturing. Both signs of a serious head injury.

15

Flexion posturing

(Decorticate posturing) The patient arches the back and flexes the arms inward toward the chest.

16

Extension posturing

(Decerebrate posturing) Patient arches back and extends the arms straight out parallel to the body.

17

Occluded

Closed or blocked

18

Patent

Open

19

Sounds that may indicate partial airway obstruction:

Snoring-a rough, snoring-type sound on inspiration and/or exhalation
Gurgling-a sound similar to air rushing through water on inspiration and/or exhalation
Crowing-a sound like a cawing crow on inspiration
Stridor-harsh, high pitched sound on inspiration

20

Airway sound heard that is an indication that the tongue and likely the epiglottis are partially blocking the airway.

Snoring

21

Airway sound that is an indication that a liquid substance is in the airway.

Gurgling

22

High-pitched sounds produced on inspiration. Commonly associated with the swelling or muscle spasms that can result from conditions such as airway infections, allergic reactions, or burns to the upper airway.

Crowing/Stridor

23

Breathing assessment:

Determine if breathing is adequate or inadequate

Determine the need for early oxygen therapy if breathing is adequate

Provide positive pressure ventilation with supplemental oxygen for inadequate breathing

24

Amount of air breathed in and out.

Tidal volume

25

Best method to assess breathing:

Looking
Listening
Feeling

26

Poor movement (rise) of the chest wall. Typically described as shallow respiration.

Inadequate tidal volume

27

Breathing that is either too fast or too slow (outside the ranges of 8-24 per min for an adult, 15-30 per min for a child, 25-50 per min for an infant)

Abnormal respiratory rate

28

Abnormally slow breathing. Respiratory rate that is too slow.

Bradypnea

29

Conditions that may cause bradypnea:

Hypoxia (especially in young children and infants), drug O/D on depressant drugs, head injury, stroke, hypothermia (cold emergency), and toxic inhalation.

30

A respiratory rate that is too fast

Tachypnea

31

Conditions that may lead to tachypnea:

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

32

Identified by a sunken-in appearance of tissues that are pulled inward on inhalation.

Retractions at:
The suprasternal notch (above the sternum)
Intercostal spaces (between ribs)
Supraclavicular spaces (above the clavicles)

33

Identified by no chest wall movement and no sensation or sound of air moving in and out of the nose or mouth

Absence of breathing (apnea)

34

A bluish or blue-grey tone of the skin seen early around the lips, nose, and fingernail beds indicating inadequate oxygenation.

Cyanosis

35

Dyspnea

Difficulty breathing

36

An assessment of circulation includes:

Pulse
Possible major bleeding
Skin color, temp, and condition
Capillary refill

37

Bradycardia

Heart rate les than 60bpm

38

Tachycardia

Heart rate greater than 100bpm

39

Skin that is _____ or ______ typically indicates a decrease in perfusion and the onset of shock (hypoperfusion).

Suspect that the patient is losing blood internally or externally or suffering another cause of shock.

Pale/Mottled

40

Blue-gray, skin may indicate reduced oxygenation from chest injuries, blood loss, or conditions like pneumonia or pulmonary edema that disrupt gas exchange in the lungs. It is a late sign of poor perfusion.

Cyanotic

41

______ refers to the amount of moisture found on the skin surface.

Skin condition

42

Critical finding making the patient unstable :

Obvious blood, vomitus, secretions, or other obstructions to the airway

Immediately suction or clear the obstruction from the airway

43

Critical finding making the patient unstable :

Obvious open would to the anterior, lateral, or posterior chest

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

44

Critical finding making the patient unstable :

Paradoxical movement of the chest

Stabilize the segment with your hand, or provide bag-valve-mask ventilation, if necessary for inadequate breathing.

45

Critical finding making the patient unstable :

Major bleeding that is spurting or flowing steadily

Apply direct pressure to the site of bleeding

46

Critical finding making the patient unstable :

Mechanism of injury that might produce spinal injury

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

47

Critical finding making the patient unstable :

Altered mental status to include a patient who is confused, responds only to verb or painful stimuli, or one who does not respond

Closely assess airway, breathing, and oxygenation status. Administer supplemental oxygen.

48

Critical finding making the patient unstable :

Blood, secretions, vomitus, or other substance in mouth and airway (gurgling, stridor, or crowing sounds)

Immediately suction the airway and clear any other obstructions

49

Critical finding making the patient unstable :

Occluded from the tongue (sonorous sounds)

Immediately perform a head-tilt, chin-lift, or jaw-thrust maneuver if a spine injury is suspected.

50

Critical finding making the patient unstable :

Inadequate respiratory rate (too slow or too fast, with other signs of inadequate breathing)

Immediately begin positive pressure ventilation with supplemental oxygen connected to the ventilation device

51

Critical finding making the patient unstable :

Rapid and weak pulses

Stop any major bleeding. Administer supplemental oxygen

52

Critical finding making the patient unstable :

Carotid pulse present, but absent peripheral pulses

Stop any major bleeding administer supplemental oxygen

53

Critical finding making the patient unstable :

Pale, cool, clammy skin

Stop any major bleeding. Administer supplemental oxygen

54

Critical finding making the patient unstable :

Capillary refill greater than 2 seconds with other signs of poor perfusion

Stop any major bleeding. Administer supplemental oxygen.

55

Critical finding making the patient unstable :

Major bleeding that is spurting or flowing steadily

Immediately stop the bleeding by applying direct pressure

56

Critical finding making the patient unstable :

Absent carotid pulse in the adult or child; absent brachial pulse in the infant

Immediately initiate CPR, beginning with chest compressions, and apply AED.

57

Three major steps to the secondary assessment:

Conduct physical exam
Take baseline vital signs
Obtain history

58

A clear fluid that surrounds and cushions the brain and the spinal cord.

Cerebrospinal fluid (CSF)

59

Ecchymosis

Black and blue discoloration

60

The white portion of the eye.

Sclera

61

Hematoma

Collection of blood

62

Subcutaneous emphysema

Air under the skin

63

Tension pneumothorax

Air trapped in the chest cavity as a result of chest or lung injury

64

Pericardial tamponade

Blood filling the sac around the heart - congestive heart failure.

65

Segments of the chest that are moving inward during inspiration and outward during exhalation, the opposite to the direction of the rest of the chest.

Paradoxical movement

66

Peritonitis

Inflammation or irritation of the lining of the abdomen

67

Priapism

Persistent erection of the penis - sign of a possible spinal cord injury

68

Paraplegia

Paralysis involving both legs only

69

Conjuctiva

Mucous membrane that covers the covers the front of the eye and lines the inside of the eyelids

70

Quadriplegia

Paralysis involving both arms and both legs

71

Hemiplegia

Paralysis of an arm or leg on one side of the body

72

the major body systems assessment includes the:

respiratory (pulmonary)
cardiovascular
neurological
musculoskeletal

73

body system assessment of respiratory (pulmonary) system:

chest shape and symmetry
accessory muscle use (retractions)
auscultation (normal and abnormal breath sounds)

74

body system assessment of cardiovascular system:

peripheral and central pulse (rate, rhythm, strength, location)
blood pressure (systolic, diastolic, pulse pressure)

75

body system assessment of neurological system:

mental status (AVPU, orientation)
posture and motor activity appropriateness of posture and movement, arm drift)
facial expression (anxiety, depression, anger, fear, sadness, pain, facial asymmetry or droop)
speech ad language (slurred, garbled, aphasia)
mood (nature, intensity, suicidal ideation)
memory and attention (orientation to person, place, time, purpose)

76

body system assessment of musculoskeletal system:

pelvic region (symmetry, tenderness)
lower extremities (symmetry, superficial findings, range of motion, sensory, motor function)
upper extremities (symmetry, superficial findings, range of motion, sensory, motor function, arm drift)
peripheral vascular system (tenderness, temp., distal pulses)
perfusion (distal pulses, skin color, temp., condition)
posterior body (symmetry, contour, superficial findings, flank tenderness, spinal column tenderness)

77

components of the SAMPLE history:

Signs and Symptoms
Allergies
Medications
Past medical history
Last oral intake
Events prior to the incident

78

secondary assessment sequence for trauma patient:

physical exam
baseline vital signs
history

79

potentially deadly side effect of very high intracranial pressure that occurs when a part of the brain is squeezed across structures within the skull.

Brain herniation

80

secondary assessment for a medical patient who is responsive:

rapid secondary assessment (head to toe)
baseline vital signs
history

81

secondary assessment for a medical patient who is unresponsive:

history
modified secondary assessment (focused on the chief complaint, signs, and symptoms)
baseline vital signs

82

Two or more adjacent ribs that are fractured in two or more places

Flail segment

83

The patient arches the back and flexes the arms inward toward the chest. A sign of serious head injury. Also called Decorticate posturing.

Flexion posturing

84

Breathing a substance into the lungs

Aspiration

85

The patients answer to the question "why did you call the ambulance?"

Chief complaint

86

Black-and-blue discoloration to the mastoid area behind the ear, a late sign of skull or head injury.

Battle sign

87

The movement of a section of the chest in the opposite direction of the rest of the chest during respiration.

Paradoxical movement

88

Open; not blocked

Patent

89

The absence of breathing

Apnea

90

Fluid that surrounds the brain and spinal cord

Cerebrospinal fluid

91

Following inspection and palpating f extremities in the rapid secondary assessment of the trauma patient, the EMT should check for PMS. "PMS" refers to:

Pulses
Motor function
Sensation

92

Baseline vital signs:

Respiration
Pulse
Skin
Blood pressure
Pulse oximetry
Pupils

93

History for medical patient who IS alert and oriented - OPQRST questions:

Onset
Provocation
Quality
Radiation
Severity
Time

94

during rapid trauma assessment - DCAP-BTLS:

deformities
contusions
abrasions
punctures
burns
tenderness
lacerations
swelling

95

crepitation

crackling, or rattling sound

Decks in EMT - Basic - Prehostpital Emergency Care 10th Edition Class (44):