General Assessment Flashcards
(151 cards)
1
Q
What are the components of a patient assessment?
A
Scene Assessment/Survey Primary Assessment/Survey Baseline Vitals Identify any Priority Patients Transport/Treatment Decisions Detailed Secondary Assessment/Survey Ongoing Care
2
Q
When approaching a scene during the scene survey, what should you be looking for?
A
Preparation Responding Hazards MOI Patients Involved
3
Q
The preparation should be done at shift change, what should this include?
A
Vehicle Check
Equipment Check
System Status
4
Q
When responding, what should you be considering?
A
Weather Road Delays: Any construction, what detours do I need to take Dispatch Info The ambulance itself Any extra resources
5
Q
What are the priorities of scene safety?
A
You Your crew Any other responding personnel The patient Bystanders
6
Q
What should your Personal Protective Equipment (PPE) include?
A
Gloves Eyewear Vests Helmets Boots
7
Q
What should your scene assessment or windshield survey include?
A
HEMP
Hazards
Environment
MOI
Patients Involved (#)
8
Q
What are some Hazards you should be watching for?
A
Traffic Power Poles Bystanders Fire Weapons Vehicles Animals
9
Q
What should be done with unsafe scenes before providing patient care?
A
They should be made safe
10
Q
What could an unsafe scene be or include?
A
MVC or rescue scenes Toxic substances Crime scenes Unstable surfaces/structures Violent/Hostile environment Farm emergencies
11
Q
What is a Mechanism of Injury?
A
It is the force applied to (or taken away) from the body and how the body reacts to it
12
Q
What should you be looking for with regards to an MOI
A
Strength
Direction
Nature of the Forces
13
Q
What is Newton’s First Law of Motion?
A
An object, whether at rest or in motion, remains in that state unless acted upon by another force
14
Q
What is the Conservation of Energy?
A
Energy can’t be created or destroyed, it can only change form
15
Q
What are some significant MOI’s
A
Ejection from a vehicle Death in the same passenger compartment Falls > 6 feet or the pt's height Rollover High-speed vehicle collision Auto-ped collision Motorcycle crash Unresponsive or altered mental status Penetrations of the head, chest, or abdomen
16
Q
What is the Primary Assessment?
A
It is used to determine the nature of the illness
17
Q
During the Primary assessment, what are you using to determine the nature of the illness
A
Bystanders, family or the patient
The scene can give you clues
The patients illness may be very different from the chief complaint
18
Q
What are the overall steps of a primary assessment?
A
Form a general impression Stabilize c-spine as needed Assess baseline level of response Assess airway Assess breathing Assess circulation Complete an RBS as needed Assess priority of the patient
19
Q
What is the General Impression?
A
It is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport
20
Q
What is your assessment of c-spine based on?
A
MOI
History of the event
General Impression
21
Q
What is a Patient Assessment?
A
It is a problem-oriented evaluation establishing priorities of care
It is based on existing and potential threats
22
Q
What are some signs to look for when assessing Appearance?
A
Level of Consciousness Signs of Distress Apparent State of Health Vital statics Sexual Development Skin color and obvious lesions Posture, gait, motor activity Dress, grooming and personal hygiene Odours of breath or body Facial expression
23
Q
When assessing level of responsiveness, what scale do we use?
A
AVPU Alert Alert to Voice Alert to Painful stimuli Unresponsive
24
Q
When assessing the airway in the primary survey, what are we looking for?
A
To determine if it is patent or obstructed
25
How do we assess airway patency
Determine if the patient can speak
Note any signs of airway obstruction or respiratory insufficiency such as stridor, wheezing, gurgling
Inspect the oral cavity for foreign objects
26
When assessing breathing, what are we evaluating?
Level of Consciousness
Rate (Tachypnea or Bradypnea)
Depth
Symmetry of chest wall movement
27
When assessing breathing, what are we looking for when we expose the chest
Structural integrity
Tenderness
Crepitus
Also observing if any accessory muscle use
Signs of distress
Audible sounds (quick ascultation of bases and apex)
Listen to the patient when they talk
28
What are we looking for when we assess circulation?
Consists of evaluating the pulse and skin and controlling any bleeding if necessary
Rate (Tachycardic or Bradycardic)
Force
Compare Carotid and Radial
29
If it is required to complete a rapid body survey, what does it consist of?
It is a quick head-to-toe and control any of the following if required:
- signs of severe external bleeding
- signs of internal hemorrhage
- fractures
Evaluate the skin color, moisture and temperature
30
What are some signs of Inadequate Circulation?
```
Altered or decreased LOC
Distended neck veins
Pale, cool, diaphoretic skin
Restlessness
Thirst
```
31
What do baseline vitals include?
LOC
Pulse
Respirations
Blood Pressure
32
What is included in a pulse assessment?
Rate:
- Normal Range: 60-100 bpm
- Average (adult): 72 bpm
- Tachycardia > 100 bpm
- Bradycardia
33
What are the peripheral pulse sites?
Temporal - lateral to the eye orbit
Carotid - medial to and below the angle of the jaw
Brachial - just medial to the biceps tendon
Radial - thumb side of the wrist
Ulnar - little finger side of the wrist
Femoral - Just below the inguinal ligament
Popliteal - just behind the knee
Dorsalis pedis - top of the foot
Posterior tibial - behind medial malleolus
34
What are we looking for when assessing respirations?
Rate:
- Normal range for adults is 12-20 bpm
Rhythm:
- Regular, regular-irregular, irregular-irregular
Volume:
- Deep or shallow
Audible noises
Tachypnea > 20 bpm
Bradypnea
35
Describe Tachypnea
Increased respiratory rate
36
Describe Bradypnea
Decreased respiratory rate
37
Describe Apnea
Absence of breathing
38
Describe Hyperpnea
Normal rate, but deep respirations
39
Describe Cheyne-Stokes respirations
Gradual increases and decreases in respirations with periods of apnea
40
Describe Biot's respirations
Rapid, deep respirations (gasps) with short pauses between sets
41
Describe Kussmaul's Respirations
Tachypnea and hyperpnea
42
Describe Apneustic respirations
Prolonged inspiratory phase with shortened expiratory phase
43
What is Blood Pressure
It is the force of blood against the arteries walls as the heart contracts and relaxes
It is measured in mmHg
Expressed as a fraction, Systolic/Diastolic
44
What is the Systolic portion of blood pressure
It is the maximum force of blood against the arteries when the ventricles contract (pumping pressure)
45
What is the diastolic portion of blood pressure?
It is the force of blood against the vessel walls when the ventricles relax
It is the measure of systemic vascular resistance (correlates well to blood vessel size)
It is the resting pressure
46
What are the ways a blood pressure can be assessed?
Auscultation
Palpation
Non-Invasive
47
What is the normal Systolic range in adults?
Adult Male: 100-140 mmHg, up to the age of 50
| Adult Female: 90-130mmHg, up to the age of 50
48
What is the normal diastolic range in adults?
Adult Male/Female: 60-96mmHg
49
What is the 80-70-60 guideline?
It gives a rough estimate of the patients systolic blood pressure by palpating pulse sites.
Radial - 80mmHg or higher
Femoral - 70mmHg or higher
Carotid - 60mmHg or higher
50
Define Pulse Pressure
Difference between systolic and diastolic blood pressure
51
Define Perfusion
Passage of blood through and organ or tissue
52
Define Korotkoff Sounds
Sound of blood hitting the arterial walls
53
What are some major criteria to identify priority patients?
```
Poor general impression
Unresponsive
Responsive but cannot follow commands
Difficultly breathing
Hypoperfusion
Complicated child birth
Chest pain and BP below 100 systolic
Uncontrolled bleeding
Severe pain
Multiple injuries
```
54
What are the four types of patients?
Trauma patient with significant MOI
Trauma patient with isolated injury
Responsive medical patient
Unresponsive medical patient
55
When assessing a Major trauma patient, what are the four components of assessment we are looking for?
Primary assessment
Rapid trauma assessment
Packaging
Rapid transport and ongoing assessment
56
What are predictors of serious internal injury?
```
Ejection from vehicle
Death in the same passenger compartment
Fall from higher than 6 meters
Rollover of vehicle
High speed MVC
Vehicle-passenger collision
Motorcycle crash
Penetration of the head, chest or abdomen
```
57
What should field management be limited to in major trauma patients
Airway control, ventilatory support, spinal immobilization, major fracture stabilization
58
In a major trauma patient, when should the IV be started and administered
Perferrably enroute to the hospital
59
What are the four components of an isolated-injury trauma patients?
No significant MOI
Shows no signs of systemic involvement
They do not require an extensive history
They do not require a comprehensive physical exam
60
What are the differences in a responsive medical patient?
The history takes precedence over the physical exam
| The physical exam is aimed at identifying medical complications rather than signs of injury
61
What are the components of an unresponsive medical patient?
Initial assessment
Rapid medical assessment
Brief history from bystanders or family
62
What does the secondary assessment include?
History
Vitals
Detailed secondary (head-to-toe) assessment
63
What is one of the main challenges in completing a history
To get as much relevant patient information and history to provide rational for treatment and transport decisions
64
What are some obstacles when trying to collect a patient history
Establishing a rapport in a patient that you have just met
Conduct primary and secondary assessments and implements treatments simultaneously
Do so within the time constraints of effective prehospital care and the patients primary problem
65
Define Chief Complaint
It is the main reason that you were called to attend to the patient
Differentiate from the primary cause
66
Define Differential Diagnosis
The working diagnosis that you come up with based on the patient's signs and symptoms and the variety of potential causes
67
What is Rapport?
By asking the patient the right questions you will discover their chief complaint and symptoms
By responding with empathy, you will win their trust and encourage them to discuss their problems with you
68
When you are setting the stage during history taking, what are you doing?
Looking for the patients chart if there is one available (nursing home, hospital transfer)
Ensure that insight does not turn into bias
As much as possible choose an environment that allows for the most effective interaction
69
What are some good ways to use language and communication?
Use appropriate language
Use an appropriate level of questioning, but do not appear condescending
Generally start with open-ended questions and progress to more closed questions
Avoid a pre-arranged script of questions, modify questioning in response to the patients response
70
When using Active Listening, what does it mean to use Facilitation?
Eye contacts, facial gestures, posture, verbal cues
71
When using Active Listening, what does it mean to use Reflection?
To repeat your patient's words back to them
72
When using Active Listening, what does it mean to use Clarification?
What means one thing to you may mean something different to the patient, so ensure to explain what you are saying to the patient and understand what they are saying to you
73
What are some topics that your patient's may experience problem's talking to you about, sensitive topics?
Sexual activities, violence, physical deformities
74
In a comprehensive history, what is the preliminary data?
```
Date and Time
Age
Sex
Race
Birthplace
Occupation
```
75
In a comprehensive history, what is the chief complaint?
It is the main reason that you were called, the primary cause
Ask the patient, "What seems to be the problem?"
76
When completing a comprehensive history and you are using OPQRST-ASPN ,what does it mean?
```
Onset of the problem
Provocative/Palliative factors
Quality
Region/Radiation
Severity
Time
Associated Symptoms
Pertinent Negatives
```
77
When completing a comprehensive history, what is a SAMPLE history?
```
Signs and Symptoms
Allergies
Medications
Past/Present Medical History
Last...
Events preceeding
```
78
When completing a comprehensive history, what is included in a Past History?
```
General state of health
Childhood diseases
Adult diseases
Psychiatric illnesses
Accidents or injuries
Surgeries or hospitalizations
```
79
When completing a comprehensive history, what is included in the current health status?
```
Current medications and rx information
Allergies
Tobacco
Alcohol, drugs and related substances (use/misuse)
Diet
```
80
When discussing medications with the patient, what are you asking?
Are they compliant?
| What is the dose and frequency
81
What is included in a current health status?
```
Screening tests
Immunizations
Sleep patterns
Exercise and leisure activities
Environmental hazards
Use of safety measures
Family history
Home situation
Daily life
Important exercises
Religious beliefs
The patients outlooks
```
82
What is a review of systems?
It is a functional inquiry
It is a system-by-system series of questions designed to identify problems your patient has not already identified
Mainly determined by patient chief complaint, condition and clinical status
83
What systems are included in a review of systems?
```
General (Overall)
Skin
HEENT
Respiratory
Cardiac
Gastrointestinal
Urinary
Genitalia
Peripheral Vascular
MSK
Neurologic
Hematologic
Endocrine
Psychiatric
```
84
What are some special challenges when questioning patients?
```
Silence
Overly talkative patients
Multiple symptoms
Anxiety
Depression
Sexually attractive or seductive patients
Confusing behavior
Patients needing reassurance
Anger
Intoxication
Crying
Limited intelligence
Language problems
Hearing
Speech
To busy talking with family or friends
```
85
What are some causes of dilated or unresponsive pupils?
```
Cardiac Arrest
CNS Injury
Hypoxia/Anoxia
LSD, Atropine, Amphetamines, Barbiturate Drug Use
Lack of Light
```
86
What are some causes of constricted or unresponsive pupils?
```
CNS Injury
CNS Disease
Narcotic Use
Eye Medications
Bright Light
```
87
What are some causes of unequal pupils?
```
CVA
Head Injury
Direct trauma to the eye
Eye Medications
Prosthetics
```
88
When assessing the Skin, what is considered normal?
Color: Pink
Temperature: Warm
Moisture: Dry
89
When evaluating skin color, what are causes of Pale (Pallor) skin?
Decreased perfusion
Cold Injury
Dehydration
Shock
90
When evaluating skin color, what are some causes of Cyanosis (blue)?
Cardiorespiratory insufficiency
| Cold environment
91
When evaluating skin color, what are some causes of red color skin?
Fever
Inflammation
CO Poisoning
92
When evaluating skin color, what are some causes of jaundiced skin?
Liver problems
| RBC Destruction
93
When evaluating skin temperature, what are some causes of cold skin?
Decreased perfusion
| Cold related illness/injury
94
When evaluating skin temperature, what are some causes of hot skin?
Possible fever
| Heat related illness/injury
95
When evaluating skin moisture, what are some causes of clammy skin?
Shock
CV Compromise
Heat Illness/Injury
96
When evaluating skin moisture, what are some causes of diaphoretic skin?
Shock
CV Compromise
Heat Illness/Injury
97
What is the approximate temperature that the body works hard at maintaining?
37 degrees Celcius
98
Where are the four main sites to obtain a temperature?
Oral
Rectal
Axillary
Tympanic
99
What is the purpose of the physical exam?
It is to investigate areas that you suspect are involved in your patients primary problem
100
What are the four aspect's that build the foundation of physical assessment?
Inspection
Palpation
Auscultation
Percussion
101
What are you looking for when assessing the head? (6)
```
DCAP-BLS
Drainage of fluid or blood from the ears, nose or mouth
Raccoon eyes
Battle sign
Burns of the face, nasal hairs or mouth
Pupils PEARLA
```
102
When assessing the head and you look in the mouth, what are you assessing? (3)
The color of the mucous membranes
Blood, vomitus, summer teeth, lacerated/swollen tongue
Suctioning as necessary
103
When assessing the head and you are palpating the bones of the face, what are you assessing?
Looking for the presence of any tenderness, instability or crepitation
104
When assessing the neck, what are we inspecting for? (2)
DCAP-BLS
| Distended neck veins
105
When assessing the neck, what are we palpating for? (3)
Anterior Neck for tracheal deviation
Cervical vertebrae for tenderness and deformity
Anterior and posterior neck for subcutaneous emphysema
106
When assessing the chest ,what are we assessing? (3)
DCAP-BLS
Auscultate
Palpating for TIC
107
What are three types of chest wall abnormalities?
Funnel chest
Pigeon chest
Barrel chest
108
When assessing the posterior chest, we should palpate for tactile fremitus, what is this?
Vibrations felt during speech
109
When assessing the abdomen, how many quadrants are we inspecting and palpating?
Four
110
What are the other three things we are looking for when assessing the abdomen?
DCAP-BLS
Tenderness, rigidity, masses
Nausea, vomitting
111
What is Cullen's sign?
It is a discoloration around the umbilicus suggestive of intra-abdominal hemorrhage
112
What is Grey-Turner's sign?
It is discoloration over the flanks suggesting intra-abdominal bleeding
113
What is an ascites?
Swelling in the flanks and abdomen
114
What is Borborygmi?
It is loud, prolonged, gurgling bowel sounds
115
What are the five things we are looking for when assessing the pelvis?
```
DCAP-BLS
Incontinence
Priapism
TIC if no obvious pain
Pelvic squeeze
```
116
What are the steps of conducting a pelvic squeeze?
Push posteriorly on the iliac crests
Push medially on the iliac crests
Push down on symphysis pubis
**DO NOT ROCK THE PELVIS FROM SIDE TO SIDE**
117
When assessing the extremities, what are the four things we are looking for?
DCAP-BLS
TIC
PMS
Compare to the opposite extremity
118
When assessing the MSK system, what are doing with the joints?
Observing
Inspecting
Palpating
Checking structure and mobility
119
What are the 6 P's of assessment on extremities?
```
Pain
Pallor
Paresthesia
Pulses
Paralysis
Pressure
```
120
What is considered normal cap refill?
Less than 2 seconds
121
When do you assess the posterior body?
If not already immobilized, do so when log rolling onto backboard
122
What is considered a normal spinal curvature?
Concave in cervical region
Convex in thorax
Concave in lumbar region
123
What is Lordosis?
Exaggerated lumbar concavity (Swayback)
124
What is Kydphosis?
Exaggerated thoracic concavity (hunchback)
125
What is Scoliosis?
Lateral curvature of the spine
126
When conducting a neurological exam, what two questions are we trying to answer?
Are the findings symmetrical or unilateral?
| If they are unilateral, where do they originate?
127
What are the five areas of the Neurological exam?
```
Mental status and speech
Cranial nerves
Motor system
Sensory system
Reflexes
```
128
What are the seven areas we are assessing when assessing mental status and speech?
```
Level of response
Appearance and behaviour
Speech and language
Mood
Thought and perceptions
Insight and judgment
Memory and attention
```
129
What are some motor activities that you would see with anxiety?
Tense posture
Restlessness
Fidgeting
130
What are some motor activities that you would see with agitation?
Crying
Hand wringing
Pacing
131
What are some motor activities that you would see with depression?
Hopeless
Slumped posture
Slowed movements
132
What are some motor activities that you would see with manic behaviour?
Singing
Dancing
Expansive movements
133
What are the twelve cranial nerves?
```
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Acoustic
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal
```
134
What is the function of the Olfactory nerve?
Sensory (smell)
135
What is the function of the Optic nerve?
Sensory (sight)
136
What is the function of the Oculomotor nerve?
Motor (Pupil construction, rectus muscles)
137
What is the function of the Trochlear nerve?
Motor (Superior oblique muscles)
138
What is the function of the Trigeminal nerve?
Sensor (Opthalmic{forehead}, maxillary{cheek}, mandibular{chin})
Motor (Chewing muscles)
139
What is the function of the Abducens nerve?
Motor (Lateral rectus muscle)
140
What is the function of the Facial nerve?
Sensory (Tongue)
| Motor (Facial muscles)
141
What is the function of the Acoustic nerve?
Sensory (Hearing and balance)
142
What is the function of the Glossopharyngeal nerve?
Sensory (Posterior pharynx, taste to anterior tongue)
| Motor (Posterior pharynx)
143
What is the function of the Vagus nerve?
Sensory (Taste to posterior tongue)
| Motor (Posterior palate and pharynx)
144
What is the function of the Accessory nerve?
Motor (Trapezius and sternocleidomastoid muscles)
145
What is the function of the Hypoglossal nerve?
Motor (Tongue)
146
What are three pieces of information can be collected as vital signs?
ECG (4, 12, 15 lead)
O2 Sats
Blood Glucose
147
What is the purpose of an on-going assessment? (4)
To continue monitoring the patient's status en route and provide treatment as necessary
Detects trends
Determines changes
Assesses intervention's effects
148
When doing the on-going assessment, why are we reassessing vital signs?
Observe changes, that occur over time, in the patients condition that may indicate the need for a change in care or treatment
149
During the on-going assessment, why are we assessing interventions? (2)
To assess the response to the management plan
| Continuous assessment of the patient may allow the paramedic to recognize a 'trend' in the assessment components
150
What are the components of an on-going assessment? (7)
```
Repeat initial assessment
- Stable patient, q 15 mins
- Unstable patient, q 5 mins
Reassess mental status
Reassess airway
Monitor breathing for rate and quality
Reassess the circulation
Reestablish patient/transport priorities
Don't forget to consider hypo/hyperthermia
```
151
What should the radio patch include?
```
Ambulance Identification
Patient profile (age and sex)
Chief complaint
If trauma, give MOI and major injuries only
Mental status
Vital signs
Treatments already given
ETA
```
