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4007PM > WEEK6- Patient observations > Flashcards

WEEK6- Patient observations Flashcards

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1
Q

what does the abcde approach stand for

A

airway and oxygen
breathing and ventilations
circulation
disability due to neurological impairment
Exposure and examination

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2
Q

what do clinical observations allow paramedics to measure

A

measure the stability of the patients conditions
measures patients’ vital signs which allows us to detect physiological deterioration of a condition

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3
Q

what are the 14 clinical observations

A
  1. respiratory rate 2. oxygen saturations 3. peak flow 4. pulse rate 5. blood measure 6. capillary refill 7. 3 lead ecg 8. 12 lead ecg 9. blood glucose measurement 10. temperature 11. gcs 12. pupillary response 13. fast test 14. avvv test
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4
Q

(2) what are normal oxygen saturations (spo2) for a normal patient

A

94-100%= normal
less than 94%= hypoxia

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5
Q

(2) what re the normal oxygen saturations (spo2) for a copd patient

A

88-92%= normal for copd
less than 88%= hypoxia for copd

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6
Q

(2) what does spo2 measure

A

oxygen sats= ratio of oxyhaemoglobin to the total concentration of haemoglobin
the pulse oximeter measures the saturation of haemoglobin in arterial blood. Through use of 2 light sources (red and infrared) and a sensor, light absorbed is measured

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7
Q

(2) how do you perform spo2

A

select appropriate probe
place probe on finger (adults) on toe (small children)
not recommended to be put on ear because can give up to 50% variance on the reading

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8
Q

(3) whats a peak flow

A

treats asthmatic patients that present with breathing difficulties
measures the air-flow through the bronchi/ can indicate the degree of obstruction

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9
Q

what is airway resistance

A

airway resistance= narrowing of the airway, muscle constriction, inflamed airway walls and mucus deposit.

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10
Q

(3) how do you conduct peak flow

A

ask if the patient knows their normal range
attach disposable tube to peak flow meter
explain procedure
take deep breath (maximal inhalation)
place mouthpiece between teeth, the take short sharp huff (maximal exhalation)
record and complete for 3 times

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11
Q

(3) what does peak flow meaurenments depend on

A

age
height
gender

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12
Q

(3) what is peak flow measured in and what a normal measurement

A

litres per minute
normal= 400 and 700 litres per minute

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13
Q

what does haemodynamic instability mean

A

perfusion failure represented by clinical features of circulatory shock, advanced heart failure, or simply one or more measurements which may indicate an out-of-range pathological value

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14
Q

(5) what is blood pressure

A

pressure exerted upon the vessels that carry oxygenated blood around the body

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15
Q

what is blood pressure measured in

A

mmHg (millimetres of mercury)

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16
Q

whats the measurement instrument uses for blood pressure

A

sphygmomanometer

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17
Q

what causes systolic pressure

A

when the heart contracts (highest pressure)

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18
Q

what causes diastolic pressure

A

when the heart is at rest (lowest pressure)

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19
Q

which number in 120/80 systolic/diastolic

A

120= systolic
80=diastolic

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20
Q

how do you perfom blood pressure

A

upper arm must be exposed, supported and at heart level
select correct sized cuff (covers 80% of circumferences of the arm and width is 40% of the arm circumference)
apply cuff firmly around upper arm with the indicator line/centre of the bladder of the brachial artery
place measurement scale where can easily be seen

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21
Q

what is Korotkoff’s sound

A

cuff is inflated= blood not getting through brachial artery
pressure released= blood can flow which makes a sound which ca be heard.
pressure decrease= different phrase noises

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22
Q

what are the 5 Korotkoff sound phases

A

phase I= clear tapping
phase II= softening of the tapping and swishing
phase III= like phase I but with distinct sharpening
phase IV= abrupt muffling
phase V= cessation of all sounds

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23
Q

How do you conduct blood pressure

A

place stethoscope over brachial artery just below cuff
deflate cuff slowly (2 mmHg per second/ per heartbeat)
systolic value= taken when phase 1 begins (clear tapping)
when all sounds disappear, the diastolic value is recorded (phase 5) remember the auscultatory gap

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24
Q

whats the normal values for blood pressure

A

100/60 to 140/90= normal
less than 90 systolic= hypotension
140/90 to 160/100= stage 1 hypertension
160/100 to 180/120= stage 2 hypertension
+180 systolic OR +120 diastolic

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25
what complications can occur within hypotension
acute coronary syndrome internal blood loss seizure blood clot in lung (PE) life threatening asthma
26
what complications can occur within hypertension
pregnancy chronic hypertension cocaine, cannabis etc intracerebral haemorrhage
27
what does capillary refill measure
assess' the adequacy of tissue perfusion measures the time taken for the cpoliy bed to regain coloir afyer pressure has been applied.
28
when should capillary refill be conducted
for patients who are in a "shock" like state/ when there haemodynamically unstable
29
how do you perform capillary refill
apply pressure to nail ned for about 5 seconds nail bed will return white release pressure count how many seocnds it takes for the colour to return
30
how do you perform capillary refill
apply pressure to nail ned for about 5 seconds nail bed will return white release pressure count how many seocnds it takes for the colour to return
31
what's normal cap refill time
2 seconds capillary refill of +2 seconds may indicate poor perfusion unless extremely cold
32
what does the 3 lead ecg measure
measures rate and regularity of the cardiac rhythm shouldn't be used as a diagnosis tool as not accurate
33
when should you conduct 3 lead ecg
when investigating an acutely unwell patient when monitoring a haemodynamically unstable patient to monitor after giving drugs if irregular rhythm or abnormal heart rate is found
34
how do you perform a 3 lead ecg
R (red)- place near right mid-clavicular line, directly below clavicle L (yellow)- place near left mid-clavicular line, directly below clavicle F (green)- place between 6th and 7th intercostal space on patients left mid-clavicular line N (black)- place between 6th and 7th intercostal space on patient's right mid-clavicular line
35
what's the similarities and differences between NSR SB and ST
normal sinus rhythm, sinus bradycardia and sinus tachycardia all have a structured pqrst nsr, sb and st all differ in rhythm (normal, slow, fast)
36
how do you measure a 12 lead ecg
provides 12 views of the electrical activity of the heart like cameras being placed around the heart to build a 3D picture
37
how do you perform 12 lead ecg
V1- 4th intercostal space @ right sternal margin V2- 4th intercostal space @ sternal margin V3- midway between V2 and V4 leads V4- 5th intercostal space at mid-clavicular line V5- same transverse level as V4 at lest anterior- axillary line V6- same transverse level as V4 at left mid-axillary line
38
whens 12 lead ecg conducted
drug overdose collapse that's unknown why chest pain (to rule out an MI) if the 3 lead ecg is abnormal seizure diagnosed/known cardiac problems
39
how many limb leads does a 12 lead ecg consist of and what's their job
6 (I, II, III, aVR, aVL and aVF) these look at the electrical activity of the heart in a vertical plane
40
what's blood glucose levels measured in
millimoles per litre
41
how does the body regulate blood glucose levels
through the production pf insulin and glycogen by the pancreas
42
how to conduct blood sugar
explain that the procedure hurts insert test strip into monitor clean the site- side of finger for adults' heel for children use the lancet to pierce the skin and introduce test strip to take the sample whilst monitor analyses the sample apply gauze and pressure
43
normal values for blood sugar
4.0-7.0 mmol/L = normal less than 4.0 mmol/L = hypoglycaemia more than 7.0 mmol/L = hyperglycaemia
44
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
44
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
44
how do you measure temperature
tympanic thermistor technique- measures the superficial body temperature
45
what could change in temperature mean
infection central nervous system event hypoglycaemia
46
how to take a temperature
apply the single use tympanic cover turn the thermometer on insert into the ear press the analysis button to take the reading
47
normal values for temperature
36.5 to 37.5= normal less than 35= hypothermia more than 40 degrees= hyperthermia above 38 degrees= pyrexia (fever)
48
what does gcs measure
the Glasgow coma scale records the conscious state of a person for initial and subsequent assessment evaluates 3 key categories of behaviour
49
what are the 3 aspects of behaviour
motor responsiveness, verbal performances and eye opening
50
whats the highest and lowest gcs number that can be given
15= highest 3= lowest
51
what are the 3 aspects of behaviour marked out of
eye-opening response= 4: spontaneously 3: to speech 2: to pain 1:no response verbal response= 5: recognizes time, person, place 4: confused 3: inappropriate words 2: incomprehendible sounds 1:no response motor response= 6: obeys command 5: moves to localised pain 4: flex to withdraw from pain 3: abnormal flexion 2: abnormal extension 1:no response
52
how do you measure the pupillary response
identifies any abnormality of the pupils and tests the normal reactions of the pupils.
53
what size in diameter should an adult's pupil constrict
2-4mm to bright light 4-8mm in the dark
54
how to conduct a pupil check
observe pupil size, shape, equality, and position of pupils. shine pen torch in one eye and observe the direct response (constriction) shine pen torch in the same eye and observe the construction of the opposite pupil repeat to the other eye
55
what does anisocoria mean
one pupil is bigger than the other
56
what does the fast test measure
fast is a stroke recognition tool which can identify a person having an acute stroke
57
what does fast stand for
face, arms, speech and time
58
how to conduct fast
ask patient is they have abnormalities normally face- symmetrical, droop arm- equal power, does arm drift speech- slurred speech and speaking normally, ask challenging words like hippopotamus
59
what percent does fast test identify strokes
70%
60
how do we measure avvv
another stroke detection tool but measures different symptoms to fast
61
how to conduct avvv
ask patient to stand, walk assess co-ordination ask about eyesight, is it blurry, double vision, black patches

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