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Flashcards in Patient Assessment & Movement Deck (17):
1

Secondary Assessment of Responsive Medical Patient

1. Gather History of Present Illness
-Onset
-Provocation
-Quality
-Radiation
-Severity
-Time
2. Gather Past Medical History of Patient
-Signs and Symptoms (if additional info needed)
-Allergies
-Medications
-Past medical history
-Last oral intake
-Events leading up to illness
3. Conduct focused physical exam, as applicable
4. Obtain baseline vitals
-Pulse
-Respiratory rate
-Blood pressure
-Pupils
-Skin color and temperature
-Oxygen saturation
-Blood glucose (as applicable)
5. Reassessment

2

Secondary Assessment of Unresponsive Medical Patient

1. Rapid physical exam
-Head
-Neck
-Chest
-Abdomen
-Pelvis
-Extremities
-Posterior
2. Obtain baseline vital signs
-Respiratory rate
-Pulse
-Blood pressure
-Skin color and temperature
-Pupils
-Oxygen saturation
-Blood glucose (as applicable)
3. Gather history of present illness from family/bystanders
-Onset
-Provocation
-Quality
-Radiation
-Severity
-Time
4. Gather past medical history from family/bystanders
-Signs & Symptoms
-Allergies
-Medications
-Past medical history
-Last oral intake
-Events leading up to illness
5. Reassessment

3

Secondary Assessment of Trauma Patient with NO significant MOI

1. Determine chief complaint, get history of present illness (how was patient injured?), Reconsider MOI
2. Perform secondary assessmen/ focused physical exam based on chief complaint and mechanism of injury
-Assess for DCAP BTLS
3. Assess baseline vital signs
-Respiratory rate
-Pulse
-Blood pressure
-Skin color and temperature
-Pupils
-Oxygen saturation
4. Obtain PMH
5. Reassessment

4

Secondary Assessment of Trauma Patient w/ significant MOI

1.Determine chief complaint, rapidly obtain history of present illness (how was patient injured?)
2. Continue manual in-line stabilization of the neck
3. Consider requesting ALS personnel
4. Perform rapid trauma assessment
5. Assess baseline vitals
-Respiratory rate
-Pulse
-Blood pressure
-Skin color and temperature
-Pupils
-Oxygen saturation
6. Obtain PMH
8. Detailed physical exam
7. Reassessment

5

Body Systems Exam: Respiratory

-Note work of breathing/position
-Auscultate lung sounds
-Pedal & sacral edema (swelling in ankles&feet/ lower back)
-Lung sounds
-Pulse oximetry

-Respiratory specific history
-Dyspnea on exertion
-Orthopnea (shortness of breath while lying flat)
-Weight gain

6

Body Systems Exam: Cardiovascular

-Check pulse presence, rate, regularity
-Skin color/temp/condition
-Blood pressure
-Orthostatic blood pressure changes
-JVD
-Components of respiratory exam

7

Body Systems Exam: Neurological

-Cincinnati Prehospital Stroke Scale (when applicable)
-Pupils
-Mental status over time

8

Body Systems Exam: Endocrine

-Blood glucose monitoring
-Skin color/temp/conditon
-Breath odors
-Excessive thirst, hunger, urination
-Diabetic specific history (Oral intake, medication history/use, recent illness)

9

Body Systems Exam: GI/GU

-Palpation of abdominal quadrants
-GI/GU specific history (input/output & frequency, question bright red blood or dark blood in stool/vomit/urine, menstrual history/pregnancy as applicable)

10

Primary Assessment

1. Obtain General Impression
2. Assess mental status (AVPU)
3. Assess & maintain Airway
4. Assess & maintain Breathing (rate, rhythm, quality; can bare chest & palpate)
5. Assess & maintain Circulation (pulse RRQ, cap refill)
6. Determine if oriented to person, place, time, event
6. Determine patient priority

11

Components of Rapid Trauma Assessment

-Head: Check for DCAP-BTLS & crepitation
-Face: Check for DCAP-BTLS (gently palpate structural bones)
-Ears: Check for DCAP-BTLS, fluid
-Eyes: Check for DCAP-BTLS, unequal pupils, discoloration, foreign bodies
-Nose: Check for DCAP-BTLS, fluid
-Mouth: Check for DCAP-BTLS, breath odor, airway obstructions, discoloration
-Neck: Check for DCAP-BTLS, JVD, tracheal deviation, crepitation
**Apply cervical collar, if not done
-Chest: Inspect & palpate for DCAP-BTLS, crepitation, paradoxical movement. Auscultate breath sounds (presence, absence, equality)
-Abdomen: Inspect & palpate for DCAP-BTLS, tenderness, firmness, distention
-Pelvis: Inspect & palpate for DCAP-BTLS (use gentle pressure; in & out)
-Lower extremities: Check for DCAP-BTLS, CSM
-Upper extremities: Check for DCAP-BTLS, CSM
-Posterior: Check for DCAP-BTLS, gently palate spine

12

Glasgow Coma Scale Components

-Eye opening
-Verbal response
-Motor response

13

Steps to Reassessment

1. Reassure patient
2. Reassess vital signs
3. Repeat appropriate portions of physical exam
4. Check and adjust interventions
5. Record trends in patient's condition

14

When to use emergency move

- Scene is hazardous
- Care for life threatening conditions requires repositioning
- You must reach other patients

15

When to use urgent move

- Treatment of patient can only be performed if patient is moved
- Factors at scene cause patient decline

Involve moving patient to backboard

16

Emergency Moves

1. Clothes drag
2. Incline drag (head first)
3. Shoulder drag
4. Foot drag
5. Firefighter's drag
6. Blanket drag
7. One rescuer assist
8. Cradle carry
9. Pack strap carry
10. Firefighter's carry
11. Piggyback carry
12. Two rescuer assist
13. Firefigher's carry with assist

17

Non-emergency moves

1. Direct ground lift
2. Extremity lift
3. Draw-sheet method
4. Direct carry