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175 Cards in this Set
- Front
- Back
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The pain, discomfort, dysfunction that caused the patient to request help is...
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The Chief Complaint
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The principal medical cause of the complaint is...
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The primary problem
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Define
OPQRST-ASPN |
Onset, Provocation, Quality, Radiation, Severity, Time, Associated Symptoms, Pertinent Negatives
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When does the physical examination officially begin?
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When you first set eyes on the patient
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What is the purpose of the physical exam?
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To investigate areas suspected to be involved w/ pt primary problem
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What 4 techniques are the foundation of the physical exam?
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Inspection
Palpation Auscultation Percussion |
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What are the vital signs?
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Pulse
Respirations Blood Pressure Temperature |
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What is Eupnea?
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Normal breathing and patterns
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What is tachypnea
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Increased breathing rate
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What is Bradypnea
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Decreased respiratory rate
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What is Apnea
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No breathing
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What is Hyperpnea
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Normal rate but Deep respirations
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What is Cheyne-Stokes?
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Gradual increasing and decreasing respirations with periods of apnea
Indicative of intracranial pressure |
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What is Biot's repirations
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Rapid, deep respirations, gasping with short pausing
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What is Kussmauls respirations
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Tachypnea and Hyperpnea
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What is apneustic?
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Long inspiratory rate with shortened expiratory rate
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Light cracking, popping usualoly heard diring inspiration
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Crackles
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Continuous high pitched sounds similar to whistle
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Wheezes
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Lowe pitch contnuous snoring
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Rhonchi
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Discoloration around the umbilicus indicating internal hemmorhage
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Cullen's sign
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Discoloration over the flanks
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Grey-Turner's sign
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Swelling in the flanks
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Ascites
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Loud prolonged gurgling bowel sounds
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Borborygmi
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Swayback
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Lordosis
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Hunchback
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Kyphosis
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Lateral spine curvature
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Scoliosis
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What system delivers oxygenated blood to the extremity tissues
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Peripheral Vascular system
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Where on the foot is the dorsalis pedis pulse?
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ON the top of foot
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Where is the posterior tibial pulse
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Behind the ankle
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What is the most important element of the physical assessment?
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thoroughness
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Where to place all contaminated items
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Biohazard bag
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With a suspected TB patient you must take what BSI precautions
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A mask on the patient and a respirator on yourself
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The initial assessment identifies what
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A, B C and any other life threatening condition
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The initial intuitive evaluation of the patient
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General Impression
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The inital assessment should take how long?
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Less than a minute
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On a pediatric patient what shoudl be done to assist in c spine and airway?
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Place pad under shoulders
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What is AVPU?
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Alert
Painful Verbal Unresponsive |
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The initial assessment identifies what
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A, B C and any other life threatening condition
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The initial intuitive evaluation of the patient
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General Impression
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The inital assessment should take how long?
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Less than a minute
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On a pediatric patient what shoudl be done to assist in c spine and airway?
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Place pad under shoulders
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What is AVPU?
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Alert
Painful Verbal Unresponsive |
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If the patient has suspected spine trauma, what is sued to open airway?
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Jaw Thrust manuever
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Respiratory Rate
Adult |
12-20
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Respiratory Rate
Newborn |
30-60
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Respiratory Rate
Toddler 1-2 years |
24-40
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Respiratory Rate
Preschooler |
22-34
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Respiratory Rate
School Age |
18-30
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Respiratory Rate
Adolescent |
12-26
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The circulation assessment consists of
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Pulse, skin condition and controlling any hemmorrage
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If patient is in possible shock what shoudl be done?
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Elevate the feet
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Normal Heart Rate
Newborn |
100-180
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Normal Heart Rate
INfant <1 yr |
100-160
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Normal Heart Rate
Toddler |
80-110
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Normal Heart Rate
Pediatric |
65-110
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Normal Heart Rate
Adolescent |
60-90
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Normal Heart Rate
Adult |
60-100
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What should be done once the initial assessment in completed?
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Determine Patient Priority
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What are two reasons of difference between the responsive medical patient and the trauma patient?
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History takes priority over the physical exam
The physical exam is aimed at identifying medical problems rather than injury |
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What are 3 additional techniques to use for assessment?
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Pulse Oximetry
Cardiac Monitor Blood Glucose |
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What three things does the ongoing assessment do?
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Detects trends
Determines changes Assesses effects |
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What lays the foundation for good patient care?
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A good History
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What is the purpose of the ICS?
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Fix responsibility of command on a certain postition
Provide for the orderly transfer of command to subsequent arriving officers |
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What are the resposibilitites of command
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Designate the endangered and ensure injured treatment
Remove endangered and provide treatment Safety of personnel Stabilize and stop further progress Conserve property |
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What is the establishment of command based on rank
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EMS paramedic
ambulance supervsor fire department personnel fire officer Quint officer Battallion Chief |
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Transfer of Command should be done..
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on a face to face basis or via radio
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Transfer of command should include
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General situation report
Need for rescue, evac Number of patients and condition Deployment and assignments of companies Need for addtl resources |
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What are command responsibilities
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Transmit brief initial sizeup
rapidly evaluate the situation Develop action plan Assign resources Request additional resources Transfer command |
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What is a Division
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geographical areas within the incident
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What is a group
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A tactical unit assigned a specific taskEMS is assigned to group to receive and transport patients or to be rehab
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Who do all resource requests go through
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IC
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Level 1 MCI
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involve 10 or more patients and require 3 plus ambulances
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LEVEL 2 MCI
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involve less than 10 patients and require 3 plus ambulances
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When a Level 1 MCI is decalred what is automatic
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establishment of a Medical Group
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When all vistims have been located triaged and removed what should be reported
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Primary Search Complete
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Where should MICU be at accidents
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downstream
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At acccident AFD appaatus will
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block trafffic upstream and take lanes for protection
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What should be worn & used on roadway incidents
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vests, flashlights and watch out for each other
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Do not stage...
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within eyesight of location
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What does PD Code Blue Mean
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PD needed at scene
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What doe APD Code mean
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no imminent threat and inform dispatch of circumstances
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What should not be done when a patient has a significant chief complaint?
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never walk to the stretcher
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What items should be take by AFD to medical call
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Airway/O2 kit
Medical/IV kit Defibrillator Suction Device posible Trauma kit - spinal immobilization |
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The most important characteristic of a physical assessment is
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thoroughness
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What order should scene safety be ensured
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self
crew other responders patient bystanders |
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All conaminated items go where
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biohazard bag
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With a TB patient what should be done
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mask placed on pt
NIOSH respirator on self monitor patients airway |
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Scene size up includes a search of
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area for all patients
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The NPA rests between
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the tongue and the posterior pharyngeal wall
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If a radial pulse cannot be felt...
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assess a carotid pulse
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What are priority patients
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unresponsive
cannot follow commands difficulty breathing hypoperfusion complicated childbirth chest pain and BP below 100 uncontrolled bleeding Severe Pain Multiple injuries |
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Cranial Nerve
I |
normally not done
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Cranial Nerve
II, III |
response to light
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Cranial Nerve
III, VI IV |
H test for extraocular movements
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Cranial Nerve
V |
Clench teeth test sensory to forehead, cheek and chin
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Cranial Nerve
VII |
show teeth
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Cranial Nerve
IX, X |
say ahhhhhh..watch uvula, gag reflex
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XII
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Stick out tongue
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Cranial Nerve
VIII |
Test balance
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Cranial Nerve
XI |
shrug shoulders, turn head
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What consists of the ongoing assessment
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Reassess ABC
Take vitals again Perform focused assessment again Evaluate intervention effects |
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Where are the sites for cardiac auscultation
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aortic
pulmonic mitral tricuspid |
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Asthma
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affects 4-5% of population
airway becomes hyper responsive trigger causeing histamine release, bronchoconstriciton, and bronchial edema |
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What happens after an asthma attack
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6-8 hours later the immune cells invade the brochial mucosa and cuase additional swelling
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Symptoms
1-2 word dyspnea accessory muscle use cough tachycardia pulsus paradoxus |
Asthma
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Treatment Goals for asthma
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Correct hypoxia
reverse bronchospasm reduce inflammation maintain airway High flow O2 |
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What is status asthmaticus
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severe prolonged attack that cannot be broken by bronchodilators
greatly diminished breath sounds respiratory arrest imminent |
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A chronic lung condition in which alveoli are destroyed, damagedm cllapsed, stretched
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Emphysema
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S&S
shortness f breath productive cough fatigue, anxiety barrel chest pink skin pursed lip breathing |
Emphysema
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Affects 20% of adult males
CLinically productive cough over production of mucus due to goblet cells Usually due to hx of heavy smoking Overwight Rhonchi on expiratory JVD Blue bloater |
Chronic Bronchitis
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5th leading cause of death in US
a group of infections fever, chiils, weakness, deep productive cough tachypnea, tachycardia, decreased air movement in affected lung |
Pnuemonia
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S&S
Sudden onset of sever dyspnea and pain Blood tinged cough signs of heart failure, JVD, hypotension Warm swollen extremeties recent surgery, oral contraceptive use |
Pulmonary Embolism
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Occurs 18 per 100,000
young males thin smokers history of copd |
spontaneous pnuemothorax
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shortness of breath
sudden chest pain pallor diaphoresis altered mentaion tachy subQ emphysema |
spontaneous pnuemothorax
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Is not a disease but a pathophysiological condition
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Pulmonary Edema
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2 causes of PE
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cardiogenic - High pressure
non-cardiogenic - High permeability |
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Acute myocardial infarction
Chronic hypertension Myocarditis |
Cardiogenic PE
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Acute hypoxemia
Near Drowning Post cardiac arrest Post shock ARDS |
Non-Cardiogenic PE
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What is a near drowning
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Suffocation in water tat does not result n death in 24 hours
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No water in lungs
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dry drowning
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Water in lungs
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wet drowning
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What happens in salt water drowning
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Salt water is more hypertonic than blood
Intrvascular fluid moves into lungs PE occurs |
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What happens in fresh water drowining
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Fresh water is more hypotonic
water enters intravascular space electroyte imbalance cardiac arrythmias |
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What is significant about a cold wateer drowning
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patient is not dead until warm and dead
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Steps for drowning patient
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remove pt from water
inititate ventilations in water suspect head and neck injury protect pt from heat loss Eval ABC Begin CPR and Defib |
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ARDS=
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Adult respiratory Distress Syndrome
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ARDS effects what
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disprupts dffusion and perfusion
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Pupil Reactions
slight enequality gross inequalities dilated unresponsive |
normal
increased ICP deep brain insult, anoxia |
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Arms flexed
legs extended |
Decorticate posturing
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Stiff and extended
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Decerebrate
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Loss of memory
from chronic alcoholism diet deficient in thiamine inapropriate eye movement |
Wernicke's Syndrome
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Potential permanant psychosis
disorientation delerium painful extremeties bilateral foot drop wrist drop |
Karsakoff'sSyndrome
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A resolved stroke is also known as
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TIA
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caused by the occlusion of a cerebral artery
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occlusive stroke
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What are teo types of occlusive strokes
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Embolic
Thrombolic (blood clot) |
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A rupture of blood vessels in the brain
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Hemorrhagic Stroke
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S&S
sudden onset of sever headache facial drooping monitor blood glucose leves |
Hemorrhagic Stroke
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S&S
problems with thought shuffling gait muscle stiffness |
Alzheimer's Disease
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A progressive degeneration od nerve cells that control voluntary movement
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Lou Gehrig's disease
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An exaggerated response of the immune system to a foriegn substance
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Allergic reaction
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An unusual or exaggerated allergic reaction
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Anaphalaxis
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disease of inadequate isulin production
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Diabeted Mellitus
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Normal blood Sugar levels
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80-100 fasting
120-140 after meal |
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Hypoglycemic Blood Level reading
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Less thn 80
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S&S
Hypergycemia Polyuria, Pulydispnea polyphagia fruity breath deep and fast resp |
Diabetic Ketoacidosis
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Juvenile Onset Diabetes
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Type I Diabetes Mellitus
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What is the greatest risk factor of type 1 Diabetes
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Heredity
along with viral infections and autoimmune disorders |
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Type I leads to:
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Heart disease, strokes, blindeness
kidney failure, distal tisssue necrosis |
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Type II Diabetes aka
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Non Insulin Dependent Diabetes
Most common form of Diabetes |
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Type II Diabetes controlled by
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hypoglycemic agents, diet and exercise
greatest risk factors heredity and obesity |
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What causes Diabetic Ketoacidosis
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Missed insulin injections
Stress-catecholemine release Binge eating |
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Insulin shock aka
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Hypoglycemia
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Causes of insulin Shock
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Excessive admin of insulin
Overexertion resulting in low glucose level |
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S&S
Weak rapid pulse Normal blood pressure Cool clammy skin Weakness Headache Irritable agitated rapid Onset |
Hypoglycemia
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Tx for hypoglycemia
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50% Dextrose= 25 grams
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Diabetic Emergency
Hot & Dry __________ Cold and Clammy__________ |
Sugars High
needs some Candy |
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S&S
Agitation emotional changeability poor heat tolerance weight loss weakness dyspnea Protrusuion of eyeballs |
Grave's Disease
Thyroid Disorder |
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S&S
High fever above 106 Increse of sympathetic ns irritability tachycardia and hypotension vomiting diahhrea |
Thyrotoxic Storm
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Thyrotoxic Storm resuts when
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thyroid hormone moves from bound state to free state within blood
associated with severe stress or overdose of thyroid hormone |
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Leading killer of persons under 44
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Traumatic injuries
150K annually 44K from MVC 38K from GSW |
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Serious life threatening problems occur in less than ______ of all trauma
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10%
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Serious trauma is a treatable condition
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NO, it is a surgical disease and needs surgical intervention
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Criteria for Triage
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START
Transport to nearest appropriate facility |
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The best survivability from indient to surgery is how long?
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1 hour
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Scene time should be limited to?
and is known as? |
10 minutes
Platinum 10 minutes |
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What are the criteria for adult trauma
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>20'fall
Ped/bicycle vs auto Motorcycle impact > 20 mph Ejected from auto Severe vehicle impact >40 mph >12" intrusion >20" vehicle deformity Serious Rollover Death of another vehicle occupant Extrication time > 20 mins |
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What are the criteria for pedi/infant trauma
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>10'fall
Bicycle collision vehicle collision at medium speed any vehicle collision wiht unrestrained child |
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Trauma Physical Findings
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Trauma score <11
Pediatric Score <9 GCS <14 BP <90 respiratory rate <10 >29 |
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Trauma Physical Findings
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>2 proximal long bone fractures
Flail Chest Pelvic Fracture Limb Paralysis >15% burn face or airway burn penetrating trauma |
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Most common cause of trauma death
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Blunt trauma
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What is inertia
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A body in motion will stay in motion unless ated upon by an outside force
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What si kinetic energy
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Energy in motion
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Kinetic energy formula
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mass x velocity divided by 2
double weight = double energy Double speed is quadruple energy |
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Force formula
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Forece=Mass x Acceleration
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What type of impact occurs most?
least? |
Most = rotational
least = rollover |
