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51 Cards in this Set
- Front
- Back
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What is the scene assessment and evaluation?
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PHSSPERM
PPE Hazards (environment or patient) Scene Safety (mitigation of hazards) Scene Time Patients (Number of) Environment (Inside and Outside) Resources (Request Police + Fire and BLS unit) MOI or NOI (Mechanism of Injury or Nature of Illness) |
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What must you do next based on the MOI and scene assessment?
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Decide whether spinal motion restrictions or C-Spine precautions should be implemented.
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What is after the Scene Assessment?
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The General Impression of the patient.
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What are you looking for in a General Impression?
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You are looking to determine if they are sick or not sick.
Look for obvious bleeding, ecchymosis, angulations What posture is the patient in. Do they look to be in distress, agitated. What do they look like, well kept etc, hygiene etc |
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What is after the general impression?
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The Initial Assessment
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What is the Initial Assessment?
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A very quick intensive assessment process focusing on identifying and management of life threatening problems. In the first 60-90 seconds as you talk with and touch your patient you should be able to identify threats to the ABC's and even form a working diagnosis.
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What is the first stage of the initial assessment?
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Assess the patients mental status and neurologic function.
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How is the patient assessed for mental status and neurologic function?
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Determine the Level of Conciousness (LOC) using the AVPU process.
A - Alert to Person, Place, Time and Event (This is expressed as A x O = 0-4) V - Responds to verbal stimuli such as moans when spoken to in loud voice P - Painful - responds to painful stimuli such as having the nail bed squeezed U - Unresponsive - does not respond to any stimuli |
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What is the Glasgow Coma Scale?
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The glasgow coma scale is a more accurate way of determining metal status and neurologic function.
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List the elements of the Glasgow Coma Scale?
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Eye Opening
Spontaneous = 4 To Verbal Command = 3 To Pain = 2 No Response = 1 Best Verbal Response Oriented and Converses = 5 Disoriented Conversation = 4 Speaking but Nonsensical = 3 Moans or Unitelligible = 2 No response = 1 Best Motor Response Follows Commands = 6 Localizes Pain = 5 Withdraws to Pain = 4 Decorticate Flexion = 3 Decerebrate Extension = 2 No Response = 1 |
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After determining the LOC what comes next?
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Assess the patients airway status?
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How is the Airway Status checked?
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Focused on two questions. Is the airway open and patent? Is this likely to remain the case?
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How do you approach airway management?
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From the Simple to the complex. The easiest problem to solve is one of position using the head tilt chin lift or the jaw thrust technique. For obstructions simple BLS procedures can be used.
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How is assessment of the airway in unconscious patients performed?
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Establish responsiveness and look, listen and feel for breathing.
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What if breathing is ineffective or absent?
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Open the airway with the head-tilt chin lift (non trauma) or jaw thrust (trauma)
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What options are there if you need to maintain the airway?
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Suctioning might be needed to clear an obstruction. Can also use OPA's and NPA's. Other options are to use a BVM or an advanced airway.
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How is the patients breathing assessed?
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The assessment of breathing focuses on two questions. Is the patient breathing? If not then you have to breathe for the patient. Secondly is the breathing adequate?
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What are you assessing for?
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Look listen and feel. Look for chest rise and fall, noting the symmetry of the chest wall and depth of respirations. Listen for adventitious lung sounds and treat the patient accordingly.
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How is the patients Circulation assessed?
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By checking a pulse point. In adults and children that are responsive the pulse is best palpated over the radial and carotid artery using the tips of your index and middle fingers.
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How is it measured?
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Measure the pulse rate by counting the number of beats during 15 seconds and multiplying by 4.
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What else should you look for?
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Note the force of the pulse whether it is strong or weak or more forceful than usual. Also make a note of whether the rhythm was regular or irregular.
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How is the patients breathing assessed?
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The assessment of breathing focuses on two questions. Is the patient breathing? If not then you have to breathe for the patient. Secondly is the breathing adequate?
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What are you assessing for?
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Look listen and feel. Look for chest rise and fall, noting the symmetry of the chest wall and depth of respirations. Listen for adventitious lung sounds and treat the patient accordingly.
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How is the patients Circulation assessed?
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By checking a pulse point. In adults and children that are responsive the pulse is best palpated over the radial and carotid artery using the tips of your index and middle fingers.
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How is it measured?
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Measure the pulse rate by counting the number of beats during 15 seconds and multiplying by 4.
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What else should you look for?
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Note the force of the pulse whether it is strong or weak or more forceful than usual. Also make a note of whether the rhythm was regular or irregular.
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How should pulse rate be recorded?
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Rate, Force and Rhythm....IE
72, Full and Regular or 138 Thready and Regular |
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How do we determine the patients Skin Condition?
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We check the skin using the back of the hand to assess the warmth and moisture of the patients skin as this is more sensitive than the palm.
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List Skin colours and possible causes?
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Red - Fever, hypertension, Allergic Reactions, CO poisoning (late sign)
White (pallor) - Excessive blood loss, Fright, Localized indicates frostbite (along with cold) Blue (cyanosis) - Hypoxemia Mottled - Cardiovascular embarrassment (as in shock) |
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List Skin Conditions and possible causes?
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Hot, dry - Excessive body heat (heat stroke)
Hot Wet - Reaction to increased internal or external temperature Cool Dry - Exposure to Cold Cool Wet - Shock |
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What is the deadly wet check?
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Quick check performed in order to identify any life threatening bleeding.
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What are priority patients - list some?
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Poor General Impression
Unresponsive Patient Responsive but Altered LOC Difficulty Breathing Hypoperfusion or shock Complicated Childbirth Chest pain with a systolic blood pressure less than 90mmHg Uncontrolled bleeding Severe pain anywhere Multiple injuries |
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What is the Rapid assessment?
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Performed quickly on a patient to identify problems and areas needing treatment. Performed prior to giving medications or making interventions.
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What are the stages of the rapid assessment?
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Head
Neck Chest Abdomen Pelvis Legs Arms Back |
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How is the head and neck inspected?
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Inspect and palpate the skull.
Palpate down the posterior cervical spine. Look in and behind the patients ears Check the pupils and palpate the orbits Inspect the nose Assess the mouth Assess the neck Check gloves for signs of bleeding and place a sized cervical collar (if trauma) |
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How is the chest examined?
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Inspect and palpate the chest. Visually check for any irregularities or problems.
Palpate for instability and flail chest. Perform intervention in the case of flail chest or sucking chest wound. Check gloves for blood |
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How is the Abdomen Examined?
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Expose and inspect visually for injuries or medical issues.
Palpate the four quadrants. If any pain then palpate this quadrant last. |
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How is the pelvis examined?
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Visually inspect the pelvic area, look for anything obvious.
Press in and down on the iliac crests checking for instability Palpate over the bladder |
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How are the lower extremities examined?
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Inspect and palpate both lower extremities from hip to ankle. Assess the pedal pulses.
Check gloves for blood |
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How are the upper extremities examined?
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Inspect and palpate both arms assessing pulse motor function and sensation.
Check gloves for blood. |
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How is the back inspected?
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The back is inspected as the patient is prepared for packaging in the case of a trauma exam. Or when asked to move etc for medical.
Inspect and palpate the back looking for obvious trauma or medical issues. Check gloves for blood. |
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What happens then respectively for Trauma and Medical patients?
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Trauma patients are boarded and packaged reassess LOC and interventions after transfer to ambulance.
Medical patients - get history and vitals from partner and then perform any interventions needed / medications |
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In the detailed physical exam how are the head and face inspected?
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Inspect and feel the entire cranium for signs of deformity or asymmetry being careful not to palpate any depressions.
Carefully inspect and palpate the upper and lower orbits starting at the nose and working toward the lateral edge. Assess eyes for shape and symmetry and check pupils for reactivity. Evaluate if they move in harmony and if they track in all field. Note any raccoon eyes. Inspect and palpate the nose for structural integrity and look inside for signs of trauma and fluids. Inspect and palpate the maxilla and mandible assessing the integrity of the structures. Open the mouth and look for missing teeth, unusual odours on the breath and fluids that may need suctioning. Check in and around the ears for fluids and bruising and signs of trauma. Examine the neck for JVD signs for trauma and mid-line placement of the trachea. |
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In the detailed physical exam how are the Chest and Lungs inspected?
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Prior to the physical exam look at the overall symmetry, then assess for equal rise and fall and finally any retractions.
Inspect and palpate the clavicles from the suprasternal notch out to the shoulder girdles. Confirm the sternum is flat and intact by pressing down with the side of the hand. Check the sides of the chest wall for asymmetry and structural integrity If environment is quiet enough assess for hyperresonance with percussion and listen to a minimum of six fields. |
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How is the cardiovascular system inspected?
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Check and compare distal pulses. Reassess the skin condition looking for signs of pallor and diaphoresis
Be alert for sustained bradycardia or tachycardia Run a four lead ECG with all patients with a cardiac history. If significant history then use a 12 lead. If the environment is quiet enough consider auscultating for heart sounds. |
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How is the abdomen inspected in the detailed assessment?
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Inspect the entire area for swelling or bruising.
Bluish discolouration in the periumbilical area (Cullens sign) is indicative of intraperitoneal hemorrhage. Look for rashes or signs of allergic reaction and note any scars from previous trauma or surgery. Palpate each quadrant gently but firmly. Palpate any known area of pain last. |
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How is the peripheral vascular system inspected in the detailed physical assessment?
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Moving from the upper extremities to the the lower limbs look for asymmetry and any skin signs suck as bruising, pallor, mottling or other signs of trauma.
Check skin temperature and moisture. When assessing pulses do both sides simultaneously to compare pulse rate strength and regularity from side to side. Any variation especially when associated with pallor or cyanosis indicates vascular compromise. |
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How is the musculoskeletal system inspected in the detailed assessment?
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Perform a global inspection of the patient. Do all extremities appear to be properly positioned and functioning normally?
Assess posture if seated. Look for the telltale lean with stroke. Look for redness and tenderness at joints, a sign or arthritis. Look for red swollen areas on the joints especially those that are warm to the touch - a sign of a clot or thrombus. Check range of motion and assess for quality of grips. |
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How is the nervous system assessed in the detailed physical assessment?
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Consciousness - LOC checks are they easily distracted
Orientation - Location and also describe current events Activity - Are they anxious or restless? Sitting still or making repetitive motions such as with Meth use. Speech - Rate, volume, articulation and intonation of the patients speech. Thoughts Memory Affect Perception Cranial Nerves Motor System Reflexes Sensory system |
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What are the cranial nerves and how are the ones I need to know examined?
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2 is the optic nerve - light perception and vision
3 is the oculomotor - pupil constriction and eye movements 4 is the trochlear - eye movements |
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What is the ongoing assessment and how is it performed?
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Need to repeat the initial assessment
Repeat the vitals every 5 minutes for critical and 15 minutes for non-critical Repetition of breath sounds Repetition of the detailed survey on focused areas where there were problems found. Reassess any interventions that may have been performed. As the patient if they are working and relieving pain. |
