Patient Assessment & Movement

Question 1

Secondary Assessment of Responsive Medical Patient

Answer 1

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

Question 2

Secondary Assessment of Unresponsive Medical Patient

Answer 2

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

Question 3

Secondary Assessment of Trauma Patient with NO significant MOI

Answer 3

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

Question 4

Secondary Assessment of Trauma Patient w/ significant MOI

Answer 4

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
7. Detailed physical exam
8. Reassessment

Question 5

Body Systems Exam: Respiratory

Answer 5

• 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

Question 6

Body Systems Exam: Cardiovascular

Answer 6

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

Question 7

Body Systems Exam: Neurological

Answer 7

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

Question 8

Body Systems Exam: Endocrine

Answer 8

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

Question 9

Body Systems Exam: GI/GU

Answer 9

• 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)

Question 10

Primary Assessment

Answer 10

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
7. Determine patient priority

Question 11

Components of Rapid Trauma Assessment

Answer 11

• 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

Question 12

Glasgow Coma Scale Components

Answer 12

• Eye opening
• Verbal response
• Motor response

Question 13

Steps to Reassessment

Answer 13

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

Question 14

When to use emergency move

Answer 14

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

Question 15

When to use urgent move

Answer 15

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

Involve moving patient to backboard

Question 16

Emergency Moves

Answer 16

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

Question 17

Non-emergency moves

Answer 17

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