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What are the four senses used in doing a patient assessment. List two observations from each sense.
- Smell: Drugs, alcohol, fruity breath for diabetics - fruity breath
- Sight: Rashes, vomiting, external bleeding, seizures, deformities, sweating, color
- Sound: Breath sounds, lung sounds, patient explanations, blood pressure
- Touch: Swelling, pain, palpation, temperature, skin condition, position of trachea, vertebrae, trapped air
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What are the steps of patient assessment?
- Scene Size Up
- Initial Assessment
- Focused Medical
- Focused Trauma
- Detailed Assessment
- Ongoing Assessment
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What are the steps of initial assessments?
- General Impression: Sick or not sick
- L.O.C: Level of conscientiousness, AAOx4
- A: Airway
- B: Breathing
- C: Circulation
- Priority: Emergent, urgent, non-urgent
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What is general impression?
- Sick or not sick
- Across the room assessment
- Sick patients require fast attention
- Based on three main areas
- -Airway
- -Breathing
- -Circulation
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What determines L.O.C.?
- Altered versus decreased mental status
- AAOx4
- A.V.P.U.
- GCS
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What do you look for when assessing airway?
- Patency
- Sounds
- Color
- Phonation
- Mentation
- Position
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What do you look for when assessing breathing?
- Rate
- Color
- Mentation
- Phonation
- Effort
- Sounds
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What do you look for when assessing circulation?
- Central vs peripheral
- Rate
- Strength
- Quality
- Color
- Mentation
- Temperature
- Bleeding
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What are the three levels of priority?
- 1: Emergent
- 2: Urgent
- 3: Non-urgent
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What is done a primary survey?
- Rapid assessment to find and treat all immediate, life threatening conditions
- -Find and fix
- -Treat as you go
- Decide if the patient is a load and go or requires additional on-scene assessment and treatment
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What is done during a secondary survey?
- Discover medical conditions and/or injuries not identified in the primary survery
- Physical examination
- Vital signs
- Reassess changes and trends in the patient's condition
- Determine: chief complaint, history of illness, pertinent past medical history
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What are the requirements for a primary survey?
- Must be performed on: Every patient
- It begins after: The scene is safe and patient access is obtained
- Appropriate protection: PPE, gown, gloves, mask, eye protection
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What are the specific parts of a primary survey?
- General Impression: Sick or not sick
- Airway: Level of responsiveness/cervical spine protection
- Breathing: Ventilation
- Circulation: Perfusion, bleeding control
- Disability: Mini-neurological examination
- Expose: For proper examinations
- Identification of priority
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When doing a general impression, what should be noted about the eyes?
- Patient's eyes should be open
- Patient's eyes should track movement
- Approach a slow to react, agitated, limp, sleeping patient immediately
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When doing a general impression, what should be noted about the patient's breathing?
- Both sides of the chest rise and fall equally
- Normal breathing is quiet, painless, effortless, and at a regular rate
- Things to look for include:
- 1) A patient who is struggling to breath
- 2) A patient with noisy breathing (gurgles, snoring, wheezing)
- 3) A slow or fast breath rate
- 4) Abnormal chest movement
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When doing a general impression, what should be noted about the patient's circulation?
- Normal skin color
- Strong pulse, bilaterally
- Central and peripheral
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When opening a patient's airway, what are the two methods used and when do you use them?
- Head tilt chin lift: Unresponsive patient who is not suspected of trauma
- Jaw thrust: Unresponsive patient who has suspected trauma
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What is A.V.P.U? What is it used for?
- A: Alert
- V: Verbal
- P: Painful
- U: Unresponsive
AVPU is used to determine a patient's responsiveness
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Cervical spine protection
- In-line spinal protection is required
- Anatomically linear
- Do not move head or neck
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What are techniques that can be used in order to help improve a patient's airway?
- Spinal stabilization
- Head tilt chin lift
- Jaw thrust
- Suctioning
- Repositioning
- Removal of a foreign object
- Insertion of an NPA or OPA
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What are signs of adequate breathing?
- Breathing effort is quiet, relaxed, effortless
- Breathing rate is normal
- Breathing pattern is regular
- Equal rise and fall of chest
- Depth is adequate
- Skin color is normal
- Warm, pink, dry
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What are signs of inadequate breathing?
- Anxious appearance
- Confusion, restlessness
- Breathing rate is too fast or too slow
- Breathing pattern is irregular
- Breathing depth is deep or shallow
- Noisy breathing (snoring, gurgling, wheezing)
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If a patient is unresponsive but breathing adequately
- Maintain an open airway
- Use adjuncts if needed (NPA and OPA)
- Give oxygen with an NRB
- Recovery position if no spinal injuries or other contraindications
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If a patient is breathing and is responsive
Let the patient rest in a comfortable position
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If the patient is unresponsive and breathing is inadequate, or the patient is not breathing
- Begin positive pressure ventilation
- Watch the patient's chest while giving positive pressure
- -Chest rise
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What are some emergency care techniques that may be utilized for a breathing problem in a patient?
- Give oxygen
- Suction
- Reposition
- Remove any foreign objects
- Insert NPA or OPA
- Positive pressure ventilation
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Proper circulation assessment involves
- Signs of obvious bleeding
- Central and peripheral pulses
- Skin color, temperature, condition
- Capillary refill
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List two central pulses and four peripheral pulses
- Central: carotid, femoral
- Peripheral: Brachial, radial, dorsalis pedis, posterior tibial
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What are the five skin colors, and two causes of each
- Pale: Poor perfusion, shock, fright, anxiety, blood loss
- Cyanotic: Low levels of oxygen (hypoxia), shock
- Mottled: Shock, hyperthermia, cardiac arrest
- Jaundice: Liver problems, gallbladder problems
- Flushed: Heat exposure, high blood pressure, allergic reaction, alcohol, CO poisoning
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What are the skin conditions associated with circulation and causes of each?
- Warm: Normal
- Hot: Heat exposure, fever
- Cool: Inadequate circulation, exposure to cold
- Cold: Extreme exposure to cold or shock
- Clammy: Shock
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Capillary refill
- Normal: <2 seconds
- Delayed: 3-5 seconds - poor perfusion, exposure to cool temperatures
- Markedly delayed: >5s - shock
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Emergency procedures to help assist with circulation include:
- Giving oxygen
- Patient positioning
- Chest compressions and CPR
- Control of bleeding
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Glascow Coma Score explanation
- Assesses three categories
- Eyes 1-4
- Verbal 1-5
- Motor 1-6
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Glascow Coma Score in depth
- Eyes:
- 4) Open
- 3) Open to verbal command
- 2) Open to painful stimulus
- 1) No response
- Verbal:
- 5) Oriented
- 4) Confused, but able to answer questions
- 3) Answers questions with inappropriate words
- 2) Incomprehensible sounds
- 1) No response
- Motor:
- 6) Obeys commands
- 5) Responds to pain
- 4) Withdraws from pain
- 3) Abnormal flexxion (decorticate) - straight
- 2) Abnormal extension (decerebrate) - curled
- 1) No response
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Secondary surveys are performed
- Head-to-toe
- Performed only after life threatening complications have been performed
- Physical examination
- Rapid trauma
- Rapid medical
- Focused physical
- Look, listen, feel
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What is DCAPBTLS
- D: Deformities
- C: Contusions (bruises)
- A: Abrasions (scrapes)
- P: Puncture / Penetration
- B: Burns
- T: Tenderness
- L: Lacerations
- S: Swelling
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Vital Signs
- Breathing (respirations)
- Pulse
- Blood pressure
- Pupils
- Skin (Warm pink dry)
- Oximetry
- Two complete sets
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SAMPLE
- S: Signs and symptoms
- A: Allergies
- M: Medications
- P: Pertinent past medical history
- L: Last oral intake and last menses
- E: Events leading up to the problem
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Patient history
- Direct, open-ended questions
- Pertinent positives and negatives
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OPQRST
- O: Onset - When did it start?
- P: Palliation and provocation - What makes it better (palliation) and what makes it worse (provocation)
- Q: Quality - What kind of pain
- R: Region and radiation
- S: Severity - 0-10 scale
- T: Time - How long has it been like this?
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Rapid trauma assessment
- Reassess mental status
- Assess
- -Head
- -Neck
- -Chest
- -Abdomen
- -Pelvis
- -Lower extremities
- -Upper extremities
- -Back
- Compare sides of the body
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Ongoing assessment
- Repeat unstable every 5 minutes
- Repeat stable every 15 minutes
- Reassess mental status and maintain airway
- Repeat physical examination
- Check the treatments to make sure they are working
- Monitor trends
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