Lecture 5: Primary and Secondary Assessments

Question 1

What is kinetic energy equal to?

Answer 1

Kinetic energy= 1/2 mass x velocity^2

Question 2

In the concept of kinetic energy which is more important, mass or velocity?

Answer 2

Mass is less important than velocity

Question 3

What is the ideal depth and rate of chest compressions?

Answer 3

depths of at least 5cm
rate of 110/ min

Question 4

What should you attempt before an IO?

Answer 4

Attempt IV

Question 5

What does AHA stand for?

Answer 5

American heart association

Question 6

What are the services available at cardiac arrest centers?

Answer 6

Hemodynamic support
Neurological expertise
Emergency cardiac catheterization
targeted temperature management

Question 7

When is defibrillation used?

Answer 7

For cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia

Question 8

What should you administer for a cardiac arrest due to an opioid overdose?

Answer 8

Administer naloxone

Question 9

What are the steps to follow for cardiac arrest during pregnancy?

Answer 9

EMS should notify healthcare facilities in advance to ensure all resources are available for both infant and mother
focus on maternal resuscitation with prep for perimortem caesarean delivery if necessary
Perform left uterine displacement during CPR to improve perfusion

Question 10

What is the order of assessment during primary survey?

Answer 10

U(EMS/911) ABC

Question 11

What is the order of treatment in the primary assessment?

Answer 11

CABd(defib)

Question 12

What should be done right after primary assessment in situations where a secondary assessment is indicated?

Answer 12

Pulse ox should be place and SpO2 should be noted

Question 13

What should you do if there is a pulse but the breathing is absent in an adult?

Answer 13

2 initial breaths followed by 1 breath every 5-6seconds

Question 14

How do you determine level of responsiveness?

Answer 14

With AVPU or the modified Glasgow

Question 15

What does AVPU stand for?

Answer 15

Alert
Verbal
Painful
Unresponsive

Question 16

If someone is alert and responsive x4 what does that mean?

Answer 16

alert and responsive x4 means the person is conscious and is able to answer question regarding person, place, time and event correctly

Question 17

If someone is unconscious what Glasgow’s do they have?

Answer 17

they have a glasgow of 3

Question 18

What is the highest and lowest number you could on the glasgow?

Answer 18

15 and 3

Question 19

What is the mnemonic to remember the Glasgow coma scale?

Answer 19

EVM-456

Question 20

What is the Eye opening scale of the GCS?

Answer 20

4= spontaneous
3= to voice
2= to pain
1= no response

Question 21

What is the verbal response scale of the GCS?

Answer 21

5= oriented and converses
4= disoriented and converses
3= inappropriate words
2= incomprehensible sounds
1= no response

Question 22

What is the motor response scale of the GCS?

Answer 22

6= obeys commands
5= localizes pain
4= flexion/withdrawal
3= flexion/ abnormal
2= extension
1= no response

Question 23

What does a GCS lower than 8 require?

Answer 23

it requires aggressive resuscitation. Under 8, intubate

Question 24

When do you determine the actual GCS score?

Answer 24

At the end of secondary assessment as part of the vitals. Taken then and every 5 minutes after that

Question 25

What are the painful stimuli used to elicit a response when someone is suspected to be unconscious?

Answer 25

Triceps pinch Nailbed pressure No more sternal rub since ILCOR 2005

Question 26

A survival rate as high as 90% has been reported when defibrillation is achieved within how many minutes of the collapse?

Answer 26

within the first minute

Question 27

What is the order of treatment of the secondary assessment?

Answer 27

DEFG disability epithelial fracture General

Question 28

What does SAMPLE stand for?

Answer 28

Signs and symptoms Allergies Medication Past medical history Last intake Events leading to incident

Question 29

What does OPQRST stand for?

Answer 29

Onset Provoke quality radiate severity time

Question 30

What should you do when assessing the head?

Answer 30

Observe for discharge Assess pupil size Observe for bruising behind ears Reassess airway Look for blood or clear fluid coming from ears, nose or mouth

Question 31

What should you do when assessing the neck?

Answer 31

Assess for abnormalities in the airway, tracheal deviation, jugular vein distension/ flatness, cervical trauma

Question 32

How would you assess the chest and back?

Answer 32

Assess for abnormalities Look and listen for more subtle signs of breathing difficulties

Question 33

What should you do when assessing the abdomen?

Answer 33

gently feel the top of the abdomen palpate for: rigidity and tenderness

Question 34

What should you do when assessing the pelvis?

Answer 34

observe for incontinence and or blood place hands on both side of pelvis: in-flare, alternate rotation. DO NOT open book a potential pelvic fracture

Question 35

If you suspect a pelvic fracture while assessing the pelvis what should you do?

Answer 35

Maintain manual stabilization until a pelvic binder is attached. Remember to rule out femoral fractures before applying a SAM pelvic binder

Question 36

What should you do when assessing the lower and upper extremities?

Answer 36

Palpate for deformities PMSC x2

Question 37

When should vitals be done in a sport medicine setting?

Answer 37

within 3-5 minutes of arrival and every 5 minutes thereafter (if stable- every 15 minutes)

Question 38

What are the 4 vital signs?

Answer 38

Pulse, Vent rate, BP, Pulse Ox

Question 39

What are the average pulse values?

Answer 39

adult: 60-80 bpm child: 80-100 bpm toddler: 100-120 athlete: 50-60

Question 40

What are some interpretations of a rapid/shallow ventilatory rate?

Answer 40

shock, bleeding, heat exhaustion

Question 41

What are some interpretations of a rapid/deep ventilatory rate?

Answer 41

cheyne-stokes, neurologic, metabolic

Question 42

What are some interpretations of a prolonged expiratory ventilatory rate?

Answer 42

Lower airway obstruction, asthma

Question 43

What are some interpretations of a prolonged inspiratory ventilatory rate?

Answer 43

upper airway obstruction

Question 44

What are some interpretations of a deep gasping labored ventilatory rate?

Answer 44

obstructive, chest injury

Question 45

What are some interpretations of an absent ventilatory rate?

Answer 45

obstructive, respiratory arrest, many cases

Question 46

What are some interpretations of a bright frothy coughed up blood ventilatory rate?

Answer 46

lung injury

Question 47

What are the different systolic rate of the different pulses?

Answer 47

radial pulse: 80 mmHg Brachial pulse: at least 70 mmHg Femoral pulse: at least 70 mmHg Carotid pulse: at least 60 mmHg

Question 48

When should you start O2 therapy?

Answer 48

Below 93% O2 saturation

Question 49

Should you give supplemental O2 for acute stroke/MI when their SpO2 is between 93-100%?

Answer 49

NO

Question 50

What are some interpretations of a cool/clammy skin?

Answer 50

shock, bleeding, heat exhaustion

Question 51

What are some interpretations of a hot/moist skin?

Answer 51

reaction to increased temperature, exercise

Question 52

What are some interpretations of a hot/dry skin?

Answer 52

heat stroke, high fever

Question 53

What are contraindications to rectal temperature taking?

Answer 53

cardiac issues (vagus nerve stimulation) Hemorrhoids Recent rectal surgery Diarrhea

Question 54

What are the different GCS scores possible for a brain injury?

Answer 54

Concussion: GCS from 15-13 (minor brain injury) GCS: 12-8 (moderate brain injury) GCS: 7-3 (severe head injury, intubate)

Question 55

What can indicate the presence of life-threatening TBI?

Answer 55

GCS< 14 in combo with abnormal pupil exam

Question 56

What is a decorticate posture?

Answer 56

elbows/ wrist flexed to chest legs in extension

Question 57

What is a decerebrate posture?

Answer 57

elbows extended, forearm pronated, wrist flexed

Question 58

What should the vitals look like when in physiological shock?

Answer 58

decreased BP Increased pulse Increased ventilatory rate

Question 59

What should the vitals look like when in neurogenic shock

Answer 59

decreased BP No change in pulse

Question 60

What should the vitals look like with Cushings signs?

Answer 60

increased BP decreased pulse increased temperature change in ventilatory rate increase in intercranial pressure