Patient Assessment Flashcards
(248 cards)
1
Q
Check environment for
A
Dangers to self and pt No fire, wire, gas, glass No needles or weapons No violence Know exits
2
Q
MOI
A
Method of injury or illness: MVC Exposure (weather or bee sting) CP Trauma Psychiatric Drug OD
3
Q
What to do if multiple casualties
A
Call for more ambulances if needed
If one or both ambulatory and family or friends can put both in one ambulance
4
Q
Additional resources
A
Police Fire Ambulances(ACP, supervisor, air ambulance) Hydro Animal rescue CAS
5
Q
PPE
A
Helmet Goggles Mask Gloves Gown / isolation suit Safety footwear High-visibility clothing
6
Q
How to approach a pt
A
Always from the front
Introduce yourself
Obtain consent
Avoid demeaning terms
7
Q
Empathy when approaching the pt
A
Ask about feelings
Be sensitive to pt feelings / experiences
Avoid entering pt personal space
Use appropriate language
8
Q
Things to note about pt when entering scene
A
LOC - drowsy, stupor ( unaware of surrounding) obtunded ( unresponsive to stimuli), coma ( pt cant be aroused no eye movement)
Posture, gait, motor activity
Dress, grooming, hygiene, odors
9
Q
When to control c spine
A
Traumatic MOI
MVC
Have pt stay still, partner or other resource hold c spine still until R/O spinal injury
10
Q
What to do if suspect pt has acute altered LOC (5 steps)
A
- Confirm clear airway and insert oro/ naso airway
- If pt apneic or has inadequate respirations assist ventilation
- Try to find cause of altered LOC (aeiou tips) and further asses and manage
- Do a secondary survey to asses head to toe
- Do trauma assessment if obvious or possible trauma
11
Q
What is chief complaint
A
Main reason ambulance is called
12
Q
What was pt doing prior to event
A
OPQRST - for pain
SAMPLE
13
Q
When does physical assessment begin
A
When you set eyes on pt
14
Q
When does pt assessment formally start
A
With history
15
Q
What is purpose of physical exam
A
Investigate areas that you suspect are involved in pts primary problem
16
Q
What is foundation of physical assessment based on
A
Inspection
Palpation
Auscultation
Percussion
17
Q
What is primary problem
A
Medical cause of the c/c (physical or emotional)
18
Q
What is secondary problem
A
Additional contributing medical injury/illness/ condition leading to pts presentation
19
Q
What is final problem
A
What is determined to be main resulting factor for pts condition after assessment and tx
20
Q
What are two transport calls to choose from
A
Load and go
Stay and play
21
Q
What is differential diagnosis
A
Working diagnosis / variety of potential causes to help choose tx path
22
Q
What to check for airway
A
Is it patent
Do you need to reposition head tilt jaw lift
Any foreign bodies to clear
Decreased LOC? Insert airway protector
Use oropharyngeal airway unless gag intact (or trismus ( lock jaw)
Use nasopharyngeal if cant do oro
Never nasopharyngeal on head trauma pt
23
Q
What to check for breathing
A
Look for chest rise and fall Listen for air movement nose and mouth Listen for quality of breaths Observe if accessory muscles being used Feel for: chest movement symmetry
24
Q
What are accessory muscles for breathing
A
Between ribs, neck, stomach
25
What is flail chest
Two or more ribs fractured in two or more places
| - chest will move paradoxically
26
What is pneumothorax
Punctured or collapsed lung ( spontaneous or traumatic)
Chest will not move symmetrically as lung not filling up with air due to rupture within lung
27
What is crackles breath sounds
Loose fluid or congestion
| - pneumonia, CHF
28
What is wheezes breath sound
Bronchoconstriction
| - asthma, anaphylaxis
29
What is Rhonchi breath sound
Low pitched rattle
| -cystic fibrosis, COPD
30
What is Rub lung sound
Harsh, grating noise
| - infection, pulmonary embolism
31
What is stridor lung sound
High pitched wheeze
| - croup, airway obstruction
32
What is silent chest lung sound
Inability to hear lung sounds
| - pneumothorax, asthma exacerbation
33
Bradypnea
<8 breaths / min
34
Tachypnea
>28 breaths/min
35
Eupnea
Normal for pt age ( 12-20 breaths/min for adults)
36
Hypopnea
Decreased rate and depth of breath
37
Hyperpnea
Increased rate and depth of breath
38
Orthopnea
SOB when pt lies down
39
Dyspnea
Difficult/ laboured breathing
40
Paroxysmal nocturnal dyspnea
Onset of SOB at night / while sleeping ( sleep apnea)
41
Apnea
Absence of breathing
42
What are the 8 + 2 vital sign measurements
```
HR
Respiratory rate
BP
Body temp
SpO2
Skin
Pupils
LOA (GCS)
```
cardiac monitor
Blood glucose
43
How many vitals does every pt need min
2 sets even if not going to ER
44
What HR rate, rhythm and quality refer to
Rate : # pulses in 1 min
Rhythm: pattern and regularity of intervals btw beats
Quality: strength( weak, strong, thready, bounding)
45
What is normal HR
Btw 60-100 bpm
46
What is bradycardia
HR of 59 bpm or lower
47
What is Tachycardia
HR of 100 bpm or higher
48
What is rate, rhythm, effort and quality in reference to respirations
```
Rate: # breaths in 1 min
Rhythm: affected by speech, emotions
-( abnormal respiration in pt with altered mental status is serious concern)
Effort: how hard pt works to breath
Quality: depth and pattern of breathing
```
49
What is bradypnea
Slow breathing
50
What is Tachypnea
Fast breathing
51
Respiration comparisons
CAO pt taking 10 breaths / min may be norm but if unresponsive or only taking 10 breath/min could = problem
52
What is BP
Force of blood against arteries walls as heart contracts and relaxes
53
What is systolic BP
Maximum force of blood against arteries when ventricles contract
54
What I'd diastolic BP
Force of blood against the vessel wall when ventricles relax ( measure of systemic vascular resistance and correlates well to blood vessel size)
55
What is hypertension
BP higher than norm
| Usually > 140/90
56
What is hypotension
BP lower than norm
| Based on pts normal BP
57
What is normotension
BP 90/100 systolic and less than 140 systolic
58
What is pulse pressure
Diff btw systolic and diastolic pressures
| Wide or narrow pulse pressure can be concerning
59
What is perfusion
Passage of blood through organ or tissue
60
What are Korotkoff sounds
Sound of blood hitting arterial walls
| Sounds hear while taking BP
61
What variables can affect BP result
Pt anxiety, position, previous activities, movement
62
Equipment used to measure BP
Palpation, auscultation, doppler
| Non-invasive BP asses
63
In what context do we take BP
Must be correlated to other vital signs and pt condition to be of value
64
How to check temp
```
1st note with hand (dorsal surface)
Tympanic (ear) used by ems
Oral
Rectal
Axillary
```
65
What is normal temp
37°c or 98.6°F
66
What is plae skin color indicate
Vasoconstriction, blood loss or both
67
What does cyanosis indicate
Inadequate oxygen or poor perfusion due to suffocation or hypoventilation
68
What does flush skin indicate
Heat exhaustion, vasodilation, fever or late CO poisoning
69
What does jaundice indicate
Possible liver disease or other organ failure
70
What are contusions
Bruises
71
What does ashen skin indicate
Often cardiac issue or heart attack
72
What is normal skin presentation
Pink warm and dry
73
What can moist, clammy skin indicate
Possible shock, hyperthermia, cardiac emergency
74
What can dry skin indicate
Dehydration or spinal injury
75
What can skin turgor tell you
If there is fluid loss or dehydration
76
What is hyperthermia
Increased core body temp > 38°C
77
What can hyperthermia cause
Heat cramps, exhaustion, stroke
78
What is hypothermia
Decreased core body temp <35°C
79
What can hypothermia cause
Leads to organ shut down
80
What can cause dilated pupils
Stimulants, hypoxia, cardiac arrest, intracranial hemorrhage, dim lighting, eye drops
81
What can cause constricted pupils
Opiates use, bright light, head injury
82
What is miosis
Excessive constriction of pupil
83
What can cause unequal / ispilateral pupil dilation dilation
CVA, previous head injury, post cataract removal
84
What would slow reactivity of pupils indicate
Hypoxia or decreased perfusion
| MI, Substance abuse, cardiac arrest, sever shock can cause fixed pupils
85
What are the 3 categories of GCS
Eye opening, verbal, motor
86
What are the scores for eye opening on GCS
4 spontaneous
3 to voice
2 to pain
1 unresponsive
87
What are the scores for verbal responses on GCS
```
5 oriented
4 confused
3 inappropriate words
2 incomprehensible sounds
1 unresponsive
```
88
What are scores for motor responses on GCS
```
6 obeys commands
5 localizes (pain)
4 withdraws (pain)
3 flexion (decorticate)
2 extension (deceribrate)
1 unresponsive
```
89
What is flexion or Decorticate
When first com into body/ chest toes point straight down body tensed
90
What is Extension or Deceribrate
When fists and arms tense straight parallel to body toes point straight head bends back whole body tense
91
What does the general survey consist of
Take in :
- appearance
- vital signs
- additional assessment as needed
- cardiac monitoring, BG, neuro exam
92
What can Appearance tell you
```
LOC
signs of distress
State of health
Vital statistics
Skin color, lesions
Posture, gait, motor activity
Dress, grooming, hygiene
Odors breath and body
Facial expression
```
93
What are 2 LOA
```
Altered = GCS less than norm for pt
Unaltered = GCS that's normal for pt
```
94
What is hypoglycemic in children under 2
< 3.0 mmol/L
95
What is hypoglycemic level in pt 2 and older
4.0 mmol/L
96
Hyperglycemia level
Dependent on pt norm
97
Normal BG
4.0 to 7.0 mmol/L but DM pt may have a diff normal
98
What happens when core body temp reaches 39°C
Neurons of brain start to denature
99
What happens when core body temp reaches 41°C
Brain cells start to die and seizures may occur
100
What happens when core body temp dips below 34°C
Body's warming mechanisms begin to fail
101
What happens when core body temp goes under 31°C
Heart sounds diminish and cardiac irritability increases
102
Resp rate and HR pt 0-3 months
30-60 resp and 90-180 HR
103
Resp rate and HR pt 3-6months
Resp rate 30-60 HR 80-160
104
Resp rate and HR pt 6-12 months
Resp 25-45
| HR 80-140
105
Resp rate and HR pt 1-3 years
Resp 20-30
| HR 75-130
106
Resp rate and HR pt 6 y/o
Resp 16-24
| HR 70-110
107
Resp rate and HR pt 10 y/o
Resp 14-20
| HR 60-90
108
Resp rate and HR adult
Resp 12-20
| HR 60-100
109
What is upper limit of child pulse
150 - (5 times age )
110
What is normotension for kids aged 1 to 10
> 90 mmHg + (2x age in years)
111
What is hypotension calculation kids aged 1 to 10
< 70 mmHg + (2x age in years)
112
What is normal BP in adult
120/80
113
What is adult normotension SBP
SBP > 100 mmHg
114
What is adult hypotension SBP
< 90mmHg
115
What is adult Hypertension range
SBP > 140 but depends on pt norm and Hx
116
How long should normal cap refill take
< 2 seconds
117
What SpO2 range do you aim for
92 to 96 %
118
What is largest organ in human body
The skin including hair and nails
119
What approx % of total body weight is skin
16% average about 20lbs
120
What two layer of skin
Dermis
| Epidermis
121
What are the 5 layers of tissue of the scalp
```
Skin
Ct
Aponeurosis (membrane connecting muscles)
Loose tissue
Periosteum (tissue around bones)
```
122
What is exophthalmos
Abnormal protrusion of the eyeball
123
What is ptosis
Drooping of upper eyelid
124
What is Cullen's sign
Discoloration around the umbilicus suggesting intra-abdominal hemorrhage
125
What is Grey-Turner's sign
Discoloration over the flanks suggesting intra-abdominal bleeding
126
What is Ascites
Fluid accumulation in abdomen - from liver cirrhosis
127
What is Borborygmi
Loud, prolonged, gurgling bowel sounds (stomach growling) an hour glass stomach
128
What 6 things can cause asymmetrical distension in abdomen
```
Hernias
Tumors
Cysts
Bowel obstruction
Enlarged abdominal organs
Distended bladder
```
129
What could a pulsatile mass indicate
Leaking or ruptured AAA
130
What could indicate mono
Enlarged spleen
131
What are 5 possible causes of rectal bleeding
```
Trauma
Hemorrhoids
Anal fissure
Crohn's/ colitis
Cancer
```
132
What demographics are hemorrhoids common in
Elderly and pregnant
133
Observe, palpate and inspect musculoskeletal and joint for these 6 things
```
Pain
Swelling
Deformities
Symmetry
Tissue changes
Crepitus
```
134
What is included in complete examination of extremities
```
Wrists and hands
Elbows
Shoulders
Ankles and feet
Knees
Hips
```
135
What should you be checking on extremities
```
Swelling
Tenderness
Increase heat
Redness
Decreased function
Stability
Hips/ pelvis squeeze once and push down
```
136
What is peripheral vascular system
System that delivers oxygenated blood to the tissues of the extremities
137
Name 6 signs that something could be going on with peripheral vascular system
```
Swollen or asymmetrical extremities
Pale or cyanosis
Weak or diminished pulses
Skin cold to the touch
Absence of hair growth
Pitting edema
```
138
What are the 4 questions you are trying to answer when doing neuro exam
1. Are the findings symmetrical or unilateral?
2. If unilateral, where do they originate?
3. Is there weakness or full paralysis?
4. Is there numbness or pain?
139
What are the 5 areas of a Neuro exam
1. Metal status and speech
2. Cranial nerves
3. Motor system ( grips, pedals)
4. Sensory system
5. Reflexes
140
What should you be looking for when evaluating mental status and speech
```
AVPU
Appear and and behaviour
Speech and language
Mood
Thought and perceptions
Insight and judgment
Memory and attention
```
141
How to act when examining infants and children
- dont treat them like adults
- diff age groups have specific fears and characteristics
- position yourself at eye level, use soft voice, smile often
- may have to explain more often
142
Age specific emax differences for 0-6 months
```
Easy to perform assessment
Keep them warm
Poor head control if any
Belly breathers
Observe fontanelles
```
Skin color and nasal flaring indicate dyspnea
143
Age specific exam differences for 7 months to 3 years
```
Usually less cooperative
Unreliable Hx
Separation anxiety
Injury may be viewed as punishment
Approach quietly
Use simple direct questions
```
144
Age specific emax differences for 4-10 y/o
```
Usually cooperative
Can provide limited Hx
Separation anxiety
Injury may be viewed as punishment
Approach quietly
Allow child to help with exam
Reluctant to discuss pain/ discomfort in privates
Advise child of any unexpected pain
```
145
Age specific emax differences for 11-18 y/o
- Generally calm and helpful
- Concerned about modesty, pain, disfigurement, disability, death
- require reassurance during exam
- privacy
- if possible separate from friends and family
- consider the possibility of alcohol, drugs and pregnancy
146
Age specific emax differences for elderly
```
Allow for extra time
Stay close to pt
Repetition may be required
Dont patronize or offend
Multiple health problems
Decreased sensory function
May fail to mention changes in daily activities
Be alert to chronic pain
```
147
Changes to make when assessing infants and children
Scene assessment take in "big picture"
Involve the parents, caregivers (Hx and care)
Kids have less blood and will crash fast
Ask what child's norm is
Anatomical differences
!airway and breathing ! Watch for resp distress
Be prepared to suction and ventilations
Constantly monitor vitals as they can crash quickly
148
Where are fontanelles located
- Sphenoidal and posterior close during first few months
| - anterior closed btw 9 and 18 months
149
What does bulging fontanelle indicate
Could be increased pressure inside skull
150
What does concave / sunken fontanelle indicate
Infant may be dehydrated or in shock
151
What area do you take pulse usually in infant
Brachial
152
Where do you usually check pulse in children
Radial or brachial
153
Are BP readings essential for children
Not for children under 3
154
What could cold hands and feet indicate in infants and children
Possible shock
155
What to continuously observe about infants and children
Skin color
Breathing rate
Breathing quality
Cap refill
156
7 tips for secondary assessment of pediatric pts
1. Asses child on parent lap
2. Radiate confidence, competence, friendliness
3. Be at eye level and do toe to head exam
4. Keep eye contact while explaining everything in way they can understand calmly
5. Kids take words literally so watch wording
6. Be honest even if it will hurt
7. Keep painful things for last
157
What comes after Hx and physical exam
Record finding on pt chart in as much depth and detail you can
158
What is the pt assessment
A problem oriented evaluation establishing priorities of care
- based on existing potential threat
- rule in and out diff diagnosis
159
Role of pt care provider (6)
- provide scene control
- gather scene info
- talk to relatives / bystanders
- obtain vital signs
- perform interventions
- act as triage group leader
160
Components of patient assement (4)
1. Primary assessment ( AEMCA)
2. Focused Hx and secondary assessment
3. Ongoing assessments
4. Detailed secondary assessment
161
As you walk on scene what do you need to observe and take in (10)
* Is it Medical or Trauma
* Body substance Isolation
* Scene safety
* Location of all pts
* MOI
* Nature of illness
* possible # of casualties
* Scene hazards
* Best access and egress routes
* Begin triage as soon as you possible
162
Who is top safety priority at scene
You the paramedic and your crew
163
When may you need more resources
```
Multiple casualty event
Hazmat emergency
Violent incident or potentially violent
Fire, gas leaks, downed wires
Special rescue situations
```
164
4 possible signs of danger aat a scene
1. Violence or indication violence may take place
2. Signs of intoxication or illegal drug use
3. Weapons of any kind
4. Any unusual behavior from bystanders
165
Techniques to help calm a pt with a behavioral emergency
- maintain comfortable distance
- be clear about who you are and what you can do to help
- ask questions in calm, reassuring voice speaking directly to pt
- encourage pt to tell you what is troubling them
- acknowledge it feeling, respond honestly to questions
- no quick moves
- act quietly and slowly
- dont threaten, belittle, challenge or argue
- dont play along with visual or auditory disturbances
- involve friends and family if pt wants
- maintain eye contact if appropriate
166
When to suspect a vehicle is unstable
```
Always but especially:
If it's on tilted surface like hill
If part of it is stacked on another vehicle
If it's on a slippery surface
If its overturned
```
167
What are hazards involved in rescuing pt with confined space emergency
Low O2 levels
| Poisonous or explosive atmosphere
168
What to note in cold environment extraction
* O2 devices loose malleability = less effective
* Aluminum stretches and cylinders cool fast - can cause frostbite on contact
* nitrile gloves become stiff
* blankets need to be available
169
"Reach throw row go tow"
| What is reach
Holding out object to pt to grab and pull them in
170
"Reach throw row go tow"
| What is throw
Throw flotation device to pt so have more time to make rescue
171
"Reach throw row go tow"
| What is row
Use boat to get pt
172
"Reach throw row go tow"
| What is go
Swimming to pt
173
"Reach throw row go tow"
| What is tow
Tow them to safety
174
Do EMS do water rescue
No wait for pt to be out of water then do what is needed
Ventilations
Suction
Conserve body heat of pt - remove wet clothing
175
7 step protocol for trapped pt
1. Be sure scene safe vehicle stable
2. Appropriate PPE
3. When gain access provide regular trauma care ( stabilize head and neck - do primary assessment- provide critical interventions)
4. Protect self and pt from glass & debris
5. Remain with pt during extraction
6. Continually monitor pt condition, advise extraction crew if it deteriorates
7. Try to keep pt calm during extraction
176
7 steps of primary assessment
1. Form general impression
2. Stabilize c spine as needed
3. Asses baseline LOA LOC
4. Asses Airway
5. Asses breathing
6. Asses circulation
7. Asses priority
177
What is general impression
Intial, intuitive evaluation of pt to determine general clinical status and priority of transport
178
When in particular should you suspect a spinal injury
- MVC
- pedestrian car crash
- falls
- hangings
- diving accidents
- blunt trauma
- penetrating trauma to head, neck or torso
- GSW
- speed sport accident ( roller bladding, biking, skiing, sledding,)
- any unconscious trauma pt
179
What is AVPU
Alert
Verbal
Painful stimuli
Unresponsive
180
When can you assume airway is patent
If pt is responsive and can speak cleary
181
How are pediatric air passage different
Smaller
Less reserve air capacity
Can be compromised by less trauma or infection
182
How are pediatric airway structures different
Not as long or as large
Can close off if neck flexed or extended too far
Best position is neutral or slight extension
183
What to watch when doing pediatric jaw thrust
Hand must be on bony part of chin so as not to let tongue block airway
184
How do children typically breath
Threw nose with abundant secretions
185
What to do if child wont tolerate O2 mask
Hold it slightly away from face and let O2 blow bu
186
If child's signs and symptoms subside what is next step
Always try to bring child to hospital as there vitals can change quickly
187
A Airway how to.secure airaway
- Is airway patent
- Reposition (if possible) to ensure airway patency
- If there is foreign body obstruction, roll pt and remove obstruction
- if decreased LOC or unresponsive, with no gag reflex or mandible trauma, insert oropharyngeal to maintain patency
188
Pts to consider the possibility of airway obstruction
Smoke inhalation, anaphylaxis, epiglottitis, foreign body aspiration or oropharyngeal malignancy
189
If pt has decreasing LOC with intact gag reflex or mandible trauma how do you secure airway patency
Use nasopharyngeal airway
190
Who cannot get nasopharyngeal airway
Pts with head trauma
191
What to do after airway is patent
Can move on with rest of primary survey I.e Breathing (ABC)
| - if cant secure airway, initiate rapid transport
192
What are you assessing for whither breathing
```
Altered mental status
SOB
Retractions
Asymmetric chest wall movement
Accessory muscles use
Cyanosis
Audible sounds
Abnormal rate or pattern
Nasal flaring
```
193
How to get best results during breathing auscultation
- Ask pt to breath slowly and deeply through their mouth
| - compare breath sounds of both lungs by comparing spices of each lung and the bases of each lung
194
What is circulation assessment
C in ABC
| Consists of evaluating the pulse and skin and controlling hemorrhage
195
Too priority ABC pts
* Poor general impression
* unresponsive
* responsive but cannot follow commands
* difficulty breathing
* hypoperfusion
* complicated child birth
* CP & BP < 100 Systolic
* uncontrolled bleeding
* severe pain
* multiple injuries
196
4 types of pts
- trauma pts with significant MOI
- trauma pt with isolated injury
- responsive medical pt
- unresponsive medical pt
197
Major trauma severity of injury depends on: (4)
- distance of fall
- anything that interrupt the fall
- the body part that interrupted the fall
- the surface the pt landed on
198
What could wet skin indicate
Diaphoresis (sweating)
Hypovolemia
Cardiovascular emergency
Increased sweat gland activity
199
What could hot skin indicate
Fever or heat related illness or injury
200
What could cold skin indicate
Decreased tissue perfusion or cold related injury
201
MOI that could = serious internal injury
```
Ejection from vehicle
Death in same passenger compartment
Fall from higher than 6m
Rollover of vehicle
High speed motor vehicle collision
Vehicle passenger collision
Motorcycle crash
Penetration of the head, chest, abdo
```
202
Severe trauma predictors for infants / children
- fall from higher than 3m
- bicycle collision
- medium speed vehicle collision with severe vehicle deformity
203
What is a Rapid trauma assessment
- not a detailed exam
| - fast, systematic assessment for other life threatening injuries
204
When should you put a special emphasis on ares suggested by c/c
During detailed physical exam
205
Which pts can you assume NEED a surgical theater
Internal bleeding
Major Fx
Head injuries
Multisystem trauma
206
How fast should pts who likely need sx be packaged in
Within 10 mins of EMS arrival
207
In Rapid transport trauma pts what can you do on scene and in transport
```
Start IV enroute
Limit field management to:
- A/w control and ventilation support
- Spinal immobilization
- Major # stabilization
```
208
General trauma assessment
| CLAPSD
C - contusions (size,shape, changing bruises)
L - lacerations (length, depth, shape, type)
A - abraisions (oozing, bleeding, made by, impregnated with)
P - penetrations ( angle, depth, maee by) / Pulsating masses (abdominal aneurysm) / Paradoxical Motion ( unequal movement flail chest)
S - Symmetry (and side vs other)
D - Deformity (broken bones) / Distention (abdominal bleed)
209
When inspecting Neck LOOK FOR:
```
Contusions
Lacerations
Abraisions
Penetrations
Swelling
```
Jugular Vein Distention
210
When inspecting the Neck PALPATE FOR:
```
○Subcutaneous emphysema ( tear in tracheo-bronchial tree)
○Tenderness
○Instability
○Crepitus
○Deformity
```
○Tracheal Deviation
211
Asses the chest LOOK FOR:
```
Contusions
Lacerations
Abraisions
Penetrations
Paradoxical Motion
Symmetry
```
212
Assess the Chest PALPATE FOR:
```
Subcutaneous emphysema(from pneumothorax)
Tenderness
Instability
Crepitus
Deformity
```
213
Asses the abdo LOOK FOR:
```
Contusions
Lacerations
Abraisions
Penetrations
Pulsatile Mass
```
214
Asses the Abdo PALPATE FOR:
```
Pulsatile Mass
Distention
Asymmetry
Rigidity
Tenderness
```
215
What is acute vs chronic
Sudden onset vs ongoing issue
216
Acute abdo odors from pt mouth: (5)
```
Sweet smell may = DM
Fecal odor may = bowel obstruction
Acid smell usually = recent vomitting
Coffee ground nemesis = upper GI bleed
Fresh blood = very recent upper GI bleed
```
217
For acute abdo asses for (4)
1 odors in pts mouth
2. Guarding abdominal wall
3. Sudden diaphoresis and pallor
4. Incontinence
218
Asses pelvis FEEL FOR:
Asymmetry
Crepitus
Instability
Deformity
219
How to asses pelvis and why
Squeeze only once and push down
Avoid quick movements
Risk of severing large blood vessels
220
What is a possible indication of hip or pelvic fx or dislocation
Unequal leg lengths or rotation
221
How to asses extremities
- Compare R and L to each other
- For all injuries, asses distal pulses every time limb is moved or complaint changes
- asses 5 p's before and after splinting
222
What to asses extremities for :
```
5 P's
Paralysis
Paresthesia
Pulse
Pallor
Pain
```
223
Asses the Back LOOK FOR:
```
Contusions
Lacerations
Abraisions
Penetrations
Paradoxical Motion
```
224
Asses the Back PALPATE FOR:
```
Subcutaneous emphysema
Tenderness
Instability
Crepitus
Deformity (C-T-L-S and coccyx for step deformities)
```
225
When are good times to asses Back
If pt Supine when arrive then check quickly right away
| - at time of log roll onto backboard
226
Differences with isolated injury trauma pt
No significant MOI
Shows no sign of systemic involvement
Does not require extensive Hx
Does not require a comprehensive physical exam
227
2 important tasks in responsive medical pt
1. Hx takes president over full physical exam
| 2. Focus physical exam surrounding complaints
228
What to look for with past medical hx
```
General state of health
Childhood and adult diseases
Psychiatric illness
Accidents and injuries
Sx's and hospitalizations
```
229
Things to look for with current health status
```
Current meds
Allergies
Tobacco use
Alcohol and substance abuse
Diet
Screening exams
Immunizations
Sleep patterns
Excercise and leisure activities
Environmental hazards
Use of safety measures
Family hx
Social hx
```
230
Focused physical exam HEENT
- lip and oral mucosa color
- sputum and color
- swelling, hives, redness
- symmetry
231
Focused physical exam Neck
- accessory muscle use and retractions
- Carotid arteries
- JVD - SITTING at 45°, not supine
- Trachea position
232
Focused physical exam Chest
- Respiratory rate and pattern
- Symmetry of chest wall
- Surgical scars
- Lung sounds
- Percussion
233
Focused physical exam Cardiovascular
- Signs of arterial insufficiency
- Peripheral pulses
- Heart sounds
234
Focused physical exam abdomen
- surgical scars, bruising
- Abdominal muscle use
- Distention, pulsatile masses
- Edema
- Pulsation of descending aorta
- Palpate the quadrants, guarding, rigidity
235
Focused physical exam Pelvis
- Incontinence, rectal bleeding
| - Ruptured membranes
236
Focused physical exam Extremities
- Pulses, sensation, movement
| - Edema/ pitting edema, digital clubbing, needle Mark's, medic alert
237
Focused physical exam Spine
- obvious deformity
| - discomfort with movement
238
What is Orthostatic vitals
Move pt from supine to standing then in 30- 60 seconds take HR and BP, if HR up 10-20 bpm or systolic down 10-20 mmHg suspect hypovolemia
239
Baseline vitals
```
BP
Pulse
Respiration
SpO2
Temperature
Pupils
Orthostatic vitals
```
240
Additional assessments (like vitals)
```
Cardiac monitoring
BG determination
12 Lead assessment
Neuro assessment
Auscultation
```
241
Reasons for unresponsiveness
```
AEIOU HOTTIPS
Alcohol
Epilepsy
Insulin
Overdose
Uremia/ metabolic
```
```
Hypoxia
Obstetrics
Temperature
Trauma
Infection
Psychiatric
Syncope/ stroke
```
242
2 key points about detailed secondary assessment
1. Never forget importance of a physical exam
| 2. Move pt from environment into ambulance before assessment
243
Detailed secondary assessment will be based on
```
Which of 4 categories pt falls into
Trauma w/ significant MOI
Trauma w/ isolated injury
Medical responsive
Medical unresponsive
```
244
5 areas of nervous system exam in secondary assess
```
Mental status and speech
Cranial nerves
Motor system
Reflexes
Sensory system
```
245
6 reflex tests of secondary assessment
```
Biceps
Triceps
Brachioradialis
Quadriceps
Achilles
Abdominal plantar
```
246
6 sensory system tests in secondary assessment
```
Pain
Light touch
Temperature
Position
Vibration
Discriminative
```
247
Why are ongoing assessments important
```
Detect trends
Determines changes to pt presentation
Asses effects of tx
Observe changes to vitals
Listen to changes about c/c
```
248
What to check during ongoing assessments
```
Mental status
Airway patency
Breathing rate and quality
Pulse rate and quality
Skin condition
Transport priorities
Vital signs
Focused assessment
Effects of interventions
Management plans
```
