Study Guide Flashcards
1
Q
Components of the primary survey
A
ASSESSING THE SCENE, OBTAINING PT’S CHEIF COMPLAINTS, SAMPLE/OPQRST, SECONDARY ASSESSMENT, TRANSPORT DECISION
2
Q
MOST IMPORTANT DETERMINATION MADE BY MEDICS
A
IDENTIFY THE PT’S PROBLEM, SET CARE PRIORITIES, DEVELOP A PT CARE PLAN, QUICKLY AND EFFICIENTLY EXECUTE IT
3
Q
How to determine that MOI or NOI at an emergency medical scene. Why is it important to differentiate medical and trauma patients
A
MOI: How the injury occurred
NOI: General type of illness a patient is experiencing
To decide the need for manual stabilization of c-spine.
4
Q
Minimum standard precautions should follow and the PPE that should be worn at a scene.
A
Assume everyone you come in contact with has a infectious disease. Diseases do not discriminate.
Minimum PPE: properly fitting gloves
5
Q
When would additional PPE be appropriate
A
When blood or other bodily fluids can splash or spray: eye protection.
Inhaled particles: properly sized respirator sometimes a gown
And other things that could pose as a health/safety risk.
6
Q
Principal goals of the primary survey process
A
Rapidly Determine and treat life threats, in a pt by prioritizing assessment and interventions on critical areas such as airway breathing circulation. Goal is to quickly stabilize the pt in an emergency.
7
Q
How is a general impression formed as part of the primary survey? Why is it crucial to patient management?
A
General impression is formed by the Patients surrounding, the MOI, Signs and symptoms, chief complaint and inspection.
Crucial for the Patients overall outcome.
8
Q
How to identify life threats by inspecting and palpating
A
Inspection looks for swelling, deformities, or discoloration
Palpation finds where the patient has pain or tenderness
9
Q
POSSIBLE HAZARDS THAT MAY BE PRESENT AT AN EMERGENCY MEDICAL SCENE
A
INFECTIONS, INHALED PARTICLES, BLOOD/ BODY FLUIDS, HAZMAT, DANGEROUS PERSONNEL
10
Q
How do you recognize hazards on scene
A
Situational awareness
11
Q
How to assess the airway status in responsive and unresponsive patients
A
Responsive: talking and crying
Unresponsive: Sounds of breathing, chest rise and fall
12
Q
What are some possible signs and causes of airway obstructions and appropriate response by the Medic
A
Snoring respirations: position problem, Readjust
Gurgling or bubbling respiration: Most likely fluids in the mouth or in the pharynx. Suction
Universal choking sign(food), abdominal thrusts.
13
Q
TYPES OF BSI
A
HEPA/ N95, STEEL TOE BOOTS, LEATHER GLOVES, NITRILE GLOVES, HELMETS, HEAT RESISTANCE OUTERWEAR, SCBA
14
Q
How to assess a patients breathing status
A
Look and listen
15
Q
What care is required for adequate and inadequate breathing
A
Adequate: reassess
Inadequate: rate, effort, chest rise and fall, depth and rhythm
Flail chest: ensure adequate ventilations
Sucking chest would: occlusive dressing, oxygenate and ventilate as needed
Diminished: possible tension pneumothorax, needle decompression
16
Q
HOW TO ASSESS A PT CIRCULATORY STATUS
A
Obtaining Pulse, cap refill, skin temp/ color/ condition, looking for obvious bleeds
17
Q
How to obtain a pulse
A
2-3 fingers in places where arteries cross over bones. Radial, carotid, pedal, etc
18
Q
Responsive:
Unresponsive:
Infant (unresponsive or responsive)
A
- Radial
- Carotid
- Brachial
(In unresponsive pt’s peripheral pulses can be faint or nonexistent, check central d/t lack of profusion)
19
Q
How to assess a patients skin based on color, temp, and condition.
A
Color- reflects the circulation status beneath the skin
Temp- rises when peripheral blood vessels dilate and lowers when vessels constrict
Condition- when the sympathetic NS is stimulated.
Can tell a lot about a patient overall condition
20
Q
Normal and abnormal findings in skin color and what it means
A
Normal- Warm, dry and pink. In darker skin, using mucous membranes
Red- fever, HTN, superficial burns, allergic reaction, alcohol intake, carbon monoxide poisoning.
White- excessive blood loss, anaphylaxis, hypoglycemia, anxiety
Blue- hypoxemia, o2 desat
Mottled- cardiovascular shock, disseminated intravascular coagulopathy
Jaundice-Liver dysfunction.
21
Q
Determine priority of pt care and transport: give examples
A
Stable Pts: not typically deemed high priority tx
Unstable Pt’s: high priority tx
Ex: Cardiac arrest, in need of life sustaining ventilatory/circulatory support, poor general impression, unresponsive, AMS, difficulty breathing, hypoxia that does not correct its self after 1-2 minutes of treatment, hypoperfusion/ shock, shest pain w/ systolic less than 100mm/hg, suspected AMI/STEMI, CVA, severe pain anywhere, multiple injuries, ABD injuries, severe HTN, can’t move, ALTE
(When treating do only what is necessary on scene, and begin transporting)
22
Q
Skin conditions and possible causes
A
Hot and dry- excessive body heat, possible heat stroke
Hot and wet- Increased internal or external temperatures
Warm and dry- fever
Cool and dry- exposure to cold
Cool and wet- shock
23
Q
MOIs that most likely produce Life threatening injuries
A
Fall 3x the pt’s height(15 ft for adult or 10ft or 2X the height for peds) high risk MVC, Intrusion, ejection, Motorcycle/atv crash higher than 20mph, vehicle v. Pedestrian, death in the same passenger compartment, penetrating wounds to head, neck, torso, or extremities.
24
Q
What is the purpose of obtaining the Patient HX
A
To gain information about the patient and learn about the events surrounding the incident
25
What is the initial approach to a patient
Establishing a professional relationship the patient, good hygiene, gaining trust, be aware of demeanor.
26
What are different techniques that medics may use to obtain information from patients during history taking?
Taking notes, eye contact, introduce yourself, asking the patient their name, cultural intelligence, ask about feelings, communicate empathy, offer reassure, reading nonverbal cues, avoid medical terminology
27
Unique challenges in HX taking for Peds
History of present illness can be difficult d/t child not being able to give detail and/or the guardian not able to give accurate info.
Beware of pt’s guardian concerns
28
Unique challenges that arise when getting a hex from geriatrics
Geriatrics—decreased sensorium, more medical and traumatic conditions not seen in other pt’s, blood thinners can cause deadly outcomes, difficulty seeing and hearing, medication compliance, difficulty distinguishing acute or chronic, polypharmacy(causing iatrogenic conditions.) iatrogenic- caused by medications or other medical treatment and can mask other illnesses that may need immediate attention, accidental OD.
29
What challenges may a medic face when obtained sensitive information?
Non reliable/inaccurate information
30
Elements of Pt HX to be obtained from responsive pts, or from family or bystanders from unresponsive pts
Chief Complaint- why they called for EMS
History of Present Illness- what happened and when (OPQRST) (SAMPLER)
UNRESPONSIVE- majority of your information comes from your head to toe physical assessment.
TRAUMA- majority of your info either comes from your pt, from your assessment of the scene ect..
31
What are strategies that can be used to obtain sensitive information
Facilitation- encourage your pt to feel open to give you any info
Reflection- pause to consider something significant your pt has told you
Clarification- ask more info when some aspect of the pt hx is vague or unclear to you
Confrontation- make your pt aware that you perceive an inconsistency between their behavior( or info) and the actual scene or your exam
Interpretation- infer the cause of the pt’s distress, then asking the pt if you are right
32
How do you use clinical reason from the primary survey and pt hx to form a differential diagnosis
Clinical reasoning combines your knowledge of A&P and patho with information from the patient to form differential DX
Rule in or Rule out.
Consider all possibilities until proven otherwise.
33
What is the purpose of performing a secondary assessment?
The secondary assessment is used to obtain a field impression & differential diagnosis, and an overall full assessment of the pts condition and health, consists of vitals, and full body/ focused exam.
34
What aspects of the body systems should be covered during HX taking process
All of them. Skin/nails, head/ neck, endocrine, chest and lungs, hematology, GI, GU, Neuro, psych.
(Ask questions based off of your pts c/c. Learn more about what is going on w/ your pt)
35
What are some techniques and equipment used in the secondary assessment
Inspection- Looking at the pt, either in general, or at a specific area
Auscultation- listening to the body sounds w/ a stethoscope
percussion- gently striking the surface of the body, typically where it overlies body cavities
palpation- touching to obtain info, such as tenderness, and DCAP-BTLS
Equipment: stethoscope, sphygmomanometer(bp cuff), pulse ox, capnogography, CBG, reflex hammer, light/pen light, gloves, sheet or blanket
36
What is the importance of assessing a patients mental status
Importance of assessing mental status is assessing a pt’s cognitive ability. Recognizing if the AMS can be fixed.
37
Devices used to monitor a pt’s medical condition, during primary and secondary ax
Vital Signs and repeat vital signs (bp, hr, pupils, skin, rr)
Cardiac monitoring- 12 lead ecg/ekg
CO2 monitoring- (capnometry { co2 output}& capnography {co2 output w/ waveform})
Basic blood chemistry- CBG
I- STAT- dx tests for cardiac markers, lactate, coagulation, blood gasses, chemistries, electrolytes, CMP, BMP, liver function, renal function
38
What are different methods to assess mental status
AVPU, LOC, CBG
A&O, person place, time and event.
General appearance, posture, facial expressions, ability to relax speech and language, hallucinations, insight and judgment.
39
What are general conditions to be considered during the secondary assessment?
Skin, Hair, nails, head, Eyes, ears, nose, throat, c-spine, chest, cardiovascular, abdomen, female and male genitalia, anus, musculoskeletal system, peripheral vascular system, spine and nervous system.
40
Describe normal breath sounds
Normal breath sounds- clear and quiet
41
What should the secondary assessment include on the patients chief complaint?
Going into detail with each body system effected.
42
What is the importance of reassessing a patient?
Reassessment indicates what changes has occurred and which critical conditions have been addressed and corrected.
43
What are things to include in reassessment of a patient?
Compare LOC with baseline
Reassess ABC’s with baseline and stay alert for ventilatory fatigue.
Ensure all bleeding is controlled.
Upon reassessment should routine TXP be stepped up to Priority. Pt condition worsening? Diverting to closer facility? Can priority be stepped down to routine?
Obtain a complete set of vitals and compare to expected outcomes from interventions.
Reassess chief complaint. Have complaints improved? Have complaints worsened?
Document every reassessment and findings in reassessments.
44
Abnormal breath sounds
Stridor- brassy crowing sound
Wheezes- high pitched whistling
Crackles (rales)- wet breath sounds/ moist crackles
Rhonchi- congested breath sounds, low pitch & rattling
Pleural Friction Rubs- squeaking grating sounds
Decreased/ Absent- lessened or no breath sounds
45
Where is PMI found?
Can be palpated at the apex of the heart (apical impulse) the site at which the heartbeat is most strongly felt, usually located on the L anterior part of the chest at the 5th intercostal space, along the midclavicular line.
46
After the scene size up is finished, what is the best reason to begin a primary assessment?
Determining and Treating for life-threats
47
Breakfast Question.
Following an assessment of an unresponsive pt, pt is high priority, life threats addressed, what do you do next?
Rapid secondary assessment.
48
Why wound you find a PMI above and left to the normal position?
Indicates possible L ventricular hypertrophy/ enlarged heart chambers
49
AVPU
AVPU : Responsiveness scale - Alert, recognizes you are there on their own, Verbal, becomes responsive with noises/when spoken to, Painful, responsive to painful stimuli, Unresponsive, does not respond to any stimuli.
50
GCS
GCS - Glasgow Coma Scale - normal GCS scale is 15, Unresponsive or deceased GCS is 3. measures LOC by eye opening, verbal responses, and motor function. Know scale.
(Go over motor)
51
Upon arrival at the scene, the pt is awakened by loud noises, and will respond to you calling their name by mumbling. What is the Most appropriate way to describe loc?
AVPU score is VERBAL, Responsive to verbal stimuli, GCS Verbal-2, incomprehensible sounds
52
Arrive on scene to an unresponsive pt witnessed seizure, what info is most beneficial to medical providers if available?
Bystanders description of seizure.
53
What are S/S of fluid overload, Pericardial tamponade, Tension pneumothorax, and CHF?
Fluid Overload: Edema, SOB, elevated BP; could b from R sided heart failure, renal failure, liver cirrhosis
Pericardial Tamponade: heart has so much fluid around it that it can’t pump: Pain, SOB, tachycardia, dizziness, palpations, AMS
Tension Pneuomo: Trapped air in chest, pleural space: JVD, tracheal deviation, SOB, CP, shallow breathing, low O2, increased HR, low BP, decreased or absent lung sounds.
CHF: peripheral edema, SOB, CP, fatigue, palpatations
54
Breakfast question
Pt ejected from vehicle all other variables are equal which of the following crash types motor vehicle crashes will yield to death?
Roll over
55
Why would 3 sets of vitals be important
To have a trend, time frame of potential decline, or reassessment of treatments (did they work? What did they do, what did they change?)
56
What are Typical aspects that you consider when you assess fingernails and toenails?
Color, shape, texture presence/absence of lesions. Normal would be firm/smooth. Aging will change color (yellow tint) & striations, related to reduction of calcium. Thick nails with lines running parallel to finger could be fungal infection. Clubbed fingers, flattening & enlargement of fingertips is assoc w/long term respiratory dz. Beau lines depressions in nails indicate period of growth inhibition, systemic illnesses, infection, or injury. Psoriasis, autoimmune disease. Splinter hemorrhages, red/brown linear streaks in the nail bed, bacterial endocarditis or trichinosis. Terry nails, transverse white bands, cirrhosis.
57
Ready to recheck vital signs, asked why you need to recheck, what would be a good response?
To monitor pts condition, identify any significant changes, monitor treatments.
58
Best reason for rescuers to have a delay in completing a secondary assessment?
Unresponsive, significant MOI, perform rapid full-body ax in 60-90 seconds
59
Acoustic Medus
(Ocustic meat us)
Ear Canal
60
TRAGUS
Small bump of cartilage on outside of ear
61
What are the first 12 steps to preform in order?
Scene Safety
MOI/NOI
BSI
# of pts
additional resources
C-Spine
General Impression
LOC
Airway, open, blocked, patent
Breathing, rate, rhythm, sounds
Circulation, bleeding, pulse (rate, rhythm, strength) skin
Transport decision- immediate or “stay and play”
62
Hyoid
Horseshoe shaped bone at anterior midline of neck between chin and thyroid cartilage
63
Pinna
Outside of ear
64
Breakfast question
Major concepts continued throughout trauma call. Pt assessment process?
Protecting rescuers and others from harm
65
Assess for JVD, do you need your pt to have them in a certain position?
Semi-Fowler’s at 30-45 degree angle
66
What does red/flushed skin indicated
Fever, HTN, superficial burns, allergic reactions, alcohol intake, high carbon monoxide.
67
What does white/pallor skin indicate?
Excessive blood loss, anaphylaxis, hypoglycemia, and anxiety
68
What does blue/cyanosis skin indicate
Hypoxemia and o2 desaturation
69
What does jaundice/yellow skin indicate
Liver dysfunction
70
What does Hot/Dry skin indicate
Excessive body heat(heat stroke)
71
What does hot/wet skin indicate
Reaction to increase temperatures, internal or external
72
What does warm/dry skin indicate
Fever
73
What cool/dry skin indicate
Exposure to cold
74
What does cool/wet skin indicate
Shock
75
How to make an assessment of the pupils?
Check outer aspects of eye socket first. Test reactivity to light, note shape, measure pupil size in MM’s, should be equal in responsiveness, pupils should constrict when light is introduced. If an eye problem that’s being tested for, test each eye individually, hold up fingers to count. Abnormal findings can be an indication of ocular problem or neurologic problem, but the condition must be correlated w/pts overall presentation.
76
Which unresponsive pt needs assisted breathing?
Pts with ineffective rate of depth, or apneic. Tachypnea or bradypnea, rates of higher than 24 BPM or lower than 8 BPM
Anything that says SHALLOW and SLOW or FAST
77
What are the S1-S4 heart sounds?
S1: Aortic region - closure of AV valve - 2nd to 3rd intercostal space @ right sternal border
S2: Pulmonic Region - closure of SL valves (A & P) 2nd to 3rd intercostal space @ L sternal border
S3: Tricuspid Region - 4th, 5th, and 6th intercostal space at L sternal border
S4: Mitral Region - Apex of heart - 5th to 6th intercostal space at L midclavicular line.
Listen above the Left Nipple line for S3 and S4
78
Assess for ABD and you need to lift the pts shirt. Pt asks why you need to see her ABD. Why do you need it?
Necessary to properly examine and evaluate the area for any signs of tenderness, swelling, or abnormalities. It allows the healthcare provider to gather important physical information about the pt condition, & make an accurate dx.
79
What is Perioribital ecchymosis?
Bruising around the eyes aka raccoon eyes
Can be cause by trauma or medications
80
What are you listening for when you first assess breathing on the primary assessment.
To make sure the pt is breathing. Make sure lung sounds are present and adequate
81
What is indentation of the occipital skull?
Dent or depression in the (base) back of the skull.
Can be caused by trauma or medical conditions
82
Puss
Thick, foul-smelling, milky fluid, indicates infection
83
Mucus
Clear, slippery, fluid that lines the bodies moist surfaces
84
Cerumen
Ear wax
85
What is sluggish pupils?
Pupil that react slowly to light.
Can be caused by medications such as opioids, trauma, or ICP
86
CSF
Cerebrospinal fluid- secreted w/ in the brain by the choroid plexus
87
What is asymmetrical smile
One side of the mouth is higher or lower than the other side
Can be caused by cva, Bell’s palsy trauma, nerve damage, aging.
88
Tactile Fremitus
Clinical sign that involves feeling vibrations in the chest wall when pt speaks. An increase of tactile fremitus indicates denser or inflamed lung tissue caused by lung disease (pneumonia). A decrease of tactile fremitus indicates air or fluid in the pleural spaces or decrease in lung tissue density (COPD / Asthma).
89
What is the dividing line of the upper and lower airway?
Larynx
90
What sounds would be associated w/each upper and lower airway dysfunction
Signs of UAD - Stridor, hoarseness, snoring, swallowing, & sleep apnea. LAD - wheezing, SOB, chronic cough, chest tightness.
91
What is cranial # III? How do you test intactness?
Oculomotor-controls movement of eye, pupil, and eyelid. Have pt follow finger in Z or H patter and have them blink
92
What is cranial nerve V? How do you test intactness?
Trigeminal - Chewing, Pain, Temp, Touch of mouth and face - ASk pt to smile
93
What is cranial nerve VII? How do you test intactness?
Facial - Movement of face, tears, salivation, taste
Ask the patient to smile.
94
What is cranial nerve X? How do you test intactness
Vagus-sensation & movement of pharynx, larynx, thorax, and GI system
Have pt smile and then swallow
95
Breakfast question
Which of the following settings should rescuers consider the most unsafe scene?
a suicidal pt w/ a small pocket knife in their hand
96
Beaten on the head, neck, and back with crow bar? Serious assault, high suspicion of significant MOI, pt is refusing transport. How do you convince them to go to the hospital?
Stay calm & compassionate, approach w/empathy, express your concerns w/o being confrontational. Listen to their concerns, Provide Info, specific reasons why you believe they need medical attention. Foreseeability
97
What is Eupnea
Normal breathing, regular rate and rhythm
98
What is tachypnea
Rapid and shallow, regular pattern
Potential Causes: stimulants, exercise, excitement, medical causes (lung dz, asthma, anxiety, choking, COPD, CHF, PE)
99
What is Bradypnea
Decreased rate, regular pattern
Potential Cause: Opioids, sedatives, alcohol, pneumonia, sleep apnea, TBI, carbon monoxide poisoning
100
What is apnea?
Absence of breathing
Potential Causes: Hypoxia, depressants, TBI, MI, dysrhythmia, CVA, metabolic disorders, submersion.
101
What is hyperpnea
Rapid deep and regular breathing
Possible Causes: Stimulants, overdose, exercise
102
What is Cheyne-Stokes
Gradual increase in RR & depth, then decreased RR & depth, w/periods of apnea
Pre-Death pattern, brain stem injury, brain herniation syndrome
103
Bruits
Abnormal Whooshing sounds, heard in arteries, most often Carotid, indicates turbulent blood flowing through narrowed artery
104
What are Kussmaul respirations?
Deep, gasping, tachy/hyperpnea
Potential causes: Acidosis, Diabetic acidosis
105
THRILL
Humming vibration, over valves, in the heart, palpable thrill indicates possible bruit or murmur.
106
What are Biot/Ataxic respirations
Irregular pattern rate, & depth w/periods of apnea
Potential causes: Brainstem injury, increased ICP
107
What is apneustic respirations
bradypnea w/prolonged inspiratory phase w/shortened expiratory phase.
Potential Causes: Brainstem Injury
108
What the 4 cornerstones of effective medic practice?
Gathering, evaluating, and processing (SYNTHESIZE) information. Check validity. Use your judgment.
Develop and implement a treatment plan. Determine pt’s primary problem/chief complaint, establish a working diagnosis, and implement the treatment plan according to your protocols and standing orders.
Judgement and independent decision making. As circumstances change, so may your treatment plan.
Your ability to think and work under pressure, knowledge coupled w/excellent clinical skills, could allow you to avert pt care disaster.
109
What are the benefits and drawbacks of patient protocols or standing orders in patient algorithms in the ems system
Benefits-gives general idea of how to treat a patient with a certain complaint
Drawbacks- does not cover every complaint or address pt’s with multiple diseases.
110
Pulsus Paradoxus
An exaggerated decrease in BP during inspiration. Indicates Cardiac Tamponade.
111
How do you distinguish pt with critical life threats and ones with minimal life threats?
If I don’t do something fast, this pt is going to die”, they are sick.
Load and go or stay and play. (Sick or not sick.)
Based off general impression and scene awareness
ABCs, LOC, MOI/NOI.
Complicated w/multiple pts, harder in infants.
112
The care of critical patients, after finding multiple injuries, need what?
Assessing and stabilizing vitals functions. Treat life threats 1st, major bleeds, ABC’s. May also require a team of specialist to treat different body systems involved.
113
When would you palpate a BP
When you can’t get an auscultated one
114
These S/S could indicate what: SUDDEN ONSET OF:
Weakness, Numbness, HA, vision problems, difficulty speaking, balance problems
Stroke
115
What are the 6 R’s of clinical decision making?
Read the scene.
Read the Pt; observe, talk to the pt, touch the pt, auscultate breath sounds, identify and correct any life threats, obtain vital signs.
React. Decide on working dx and treat accordingly.
Reevaluate. Follow-up on interventions.
Revise treatment plan as necessary.
Review performance, quality improvement.
116
These S/S could indicate what:
Chest Pain, Back pain, jaw/arm/shoulder/neck pain, radiating pain, lightheaded, sense of impending doom, diaphoresis, SOB, heart palpatations.
Myocardial Infarction
117
These S/S could indicate what:
Chest pain, pounding or irregular heartbeat, SOB, lightheaded, LOC.
Cardiac Arrest
118
These S/S could indicate what:
Pain, pale/clammy skin, SOB or tachypnea, hypotension, N/V lightheaded, weakness.
Internal Bleeding
119
SAMPLER
Signs/Symptoms, Allergies, Medications, PMHX, LOI, Events leading up to current injury/illness, Risk Factors
120
When is O2 contraindicated in an MI or CVA pt?
If O2 SAT is 94% or higher on room air
121
Poison Control phone number:
1-800-222-1222
122
Treat all pts as potentially infectious, everything can transmit diseases.
Standard Precautions
123
Certain body substances can transmit diseases.
Universal Precautions
124
Describe the 5 stages of critical thinking and thought processing in the prehospital setting
1. Gathering information, critical thinking, situation awareness.
2. Interpretation of data you have gathered
3. Base treatment plan off working diagnosis, protocol, and standing orders
4. Actively treat pt and monitor interventions
5. Run review, critiques, or debriefings after the call.
125
Which body substance does not transfer disease?
Sweat
126
HANDWASHING
Probably the answer according to Bob
127
4 exam techniques - Least Invasive to most invasive
Inspection: look at
Auscultation: listen to
Percussion: hand placed on body, then tapped with other hand
Palpation: touch
128
Need good BLS in order to have
Good ALS
129
Amount of air you are breathing each minute
Minute Volume
130
Formula for determining Minute Volume
Tidal Volume X’s BPM
131
R heart failure, typically presents w/JVD, indicates possible:
L sided heart failure
132
4 types of pain associated w/abdominal pain:
Visceral - Vague/Generalized
Inflammation - All of it hurts
Referred - Presents in different location of injury/illness
Parietal - Pinpoint, specific location
133
Orthostatic Vital Signs: Tilt Test
BP/HR taken 3 different, in 3 different positions, supine, sitting, standing.
Will determine extent of volume depletion, if hypovolemic.
Generally considered positive if there is a decrease in systolic pressure of 20mm and increase of diastolic by 10mm, and increase in HR by 20.
134
Bruising or discoloration around umbilicus, sign of intra-abdominal bleeding
Cullen Sign
135
Rare sign of bruising or discoloration on the lower back or flanks, late indicator of acute pancreatitis
Grey Turner Sign
136
Fluid filling in peritoneal cavity; liver disease, distended abdomen
Ascites
137
MONA
Morphine, Oxygen, Nitro, ASA
Treatment for chest pain
138
FONA
Fentanyl, Oxygen, Nitro, ASA
Treatment of chest pain
139
AEIOU-TIPS (AMS)
A- Alcohol/Acidosis
E- Epilepsy/Electrolytes/Endocrine/Encephalopathy
I- Infection
O- Overdose or O2 deficiency
U- Uremia or Underdose, UTI
T- Trauma
I- Insulin
P- Poisoning/Psychosis
S- Stroke, Seizure, or Syncope
140
Orthopnea
Difficulty breathing while lying flat
141
ALTE - Apparent Life Threatening Event
INDICATIONS OF HIGH PRIORITY TRANSPORT INCLUDING, APNEA, CHOKING OR GAGGING, CHANGES IN MUSCLE TONE OR COLOR CHANGE
142
Wolff-Parkinson-White Syndrome
Bundle of KENT Sends an extra electrical signal back and forth from atria to ventricle and back to atria, instead of following normal pathway
143
Directly correlates with Bundle of KENT on EKG
Extra pathway from atria to ventricles
No downward of the Q wave, shoots right up into R wave
Treatment is an abrasion of extra pathway
Delta Wave
144
Life threatening MOI for a fall for an adult
15ft or 3x’s pts height
145
Life threatening MOI for a fall for a child
10ft or ground level fall w/LOC, 2x pt height
146
Delirium - Sudden Onset of AMS
Can be caused by substance withdrawals, infections, medications, dehydration, metabolic disorders, brain injury, mental disorders
147
Electrode Placement
R - White - arm lead; Green - leg lead (SNOW OVER GRASS)
L - Black - arm lead; Red - Leg lead (SMOKE OVER FIRE)
V1- 4th IC Space, R sternal border
V2- 4th IC space, L sternal border
V3- Between V2 & V4
V4- 5th IC space, Midclavicular line
V5- Lateral to V4 at the auxiliary line
V6- Lateral to V5 at the mid-auxiliary line
148
What is COASTMAP?
C- consciousness
O- Orientation
A- Activity
S- Speech
T- Thought
M-Memory
A-Affect (mood)
P-Perception
149
What is Facilitation?
Encouraging the patient to feel open to give information?
150
What is Reflection
When you pause to consider something significant that patient has told you earlier
151
What is Clarification
When you ask for more information about a patients history or something they said when it is vague or unclear to you.
152
What is Confrontation?
Making your patient aware that you perceive and inconsistency with their behavior, information, scene, and exam.
153
What is Interpretation
Inferring the cause of a the patients distress and the asking the patient to confirm your hypothesis
