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107 Cards in this Set

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What's the most important part of patient assessment?
The chief complaint.
In what situation do you skip taking a SAMPLE history?
When the patient is too severely injured for you to take a break from trying to save his/her life.
During what stage of patient assessment would you take a SAMPLE history from a patient?
During the stage called "focused history and physical exam," which comes after the initial assessment.
Define "vital signs."
Outward signs of what is going on inside the body. These include respiration, pulse, skin (color, temperature, condition), pupils, blood pressure.
In what order do you assess vitalsigns?
1) Breathing
2) Pulse
3) Skin (color, temperature, condition)
4) Pupils
5) Blood pressure
What additional step do you take when taking vitals of a child or infant?
You check capillary refill time along when you assess the patient's skin color, temperature, and condition.
What important sign isn't considered a "vital sign," but must be assessed while you're taking a patient's vitals?
Mental status
What two factors do you assess when taking a pulse?
Rate and quality.
Define "pulse."
The rhythmic beats felt as the heart pumps blood through the arteries.
Define "pulse rate."
The number of pulse beats per minute.
What do you do when you're trying to take the respiratory rate of a patient and he or she won't stop talking?
1) Assess the ease with which the patient talks. If he or she is easily delivering sentences of six words or more, they are in minimal distress.

2) You could also tell the patient that they need to be quiet so that you can check his lung sounds or heartbeat -- when you put the stethoscope on, you can then assess both respiration rate and pulse rate.
What do you do when you're about to take a patient's blood pressure, but he stops you because he has a shunt in his arm, and you can't reach his other arm?
Wait until you've got the patient onto a carrying device to take blood pressure. Breathing, pulse, skin (color, temperature, condition), and pupils will give you a relatively complete picture of the situation until then.
What do you do when you're on a call responding to an 80-year-old man with mild abdominal pain, and when you ask him if he has any medical conditions he says "no," though you clearly see at least 5 or 6 prescription bottles on the table?
1) Ask him specifically about the medication bottles you see. You could have somebody visually verify the name of the patient printed on the labels.

2) Ask the question several ways if necessary. If you can't get any more information out of the patient, use your best judgment based on what you see.
What do you do when the patient is an unconscious 32-year-old female who was thrown from a car when it flipped over and you can't find her radial pulse?
This is a severe trauma situation and you should check the carotid pulse first. If this was a responsive patient you would check the other wrist.
What's the normal pulse rate range for an adult?
60-100
What's the normal pulse rate range for an adolescent (11-14 years)?
60-105
What's the normal pulse rate range for a school-age patient (7-10 years)?
70-110
What's the normal pulse rate range for a preschooler (3-5 years)?
80-120
What's the normal pulse rate range for a toddler (1-3 years)?
80-130
What's the normal pulse rate range for an infant (6-12 months)?
80-140
What's the normal pulse rate range for an infant (0-5 months)?
90-140
What's the normal pulse rate range for a newborn?
120-160
What are possible causes of or indications given by a rapid, regular, and full pulse?
1) Exertion
2) Fright
3) Fever
4) High blood pressure
5) First stage of blood loss
What are possible causes of or indications given by a rapid, regular, and weak pulse?
1) Shock
2) Later stages of blood loss
What are possible causes of or indications given by no pulse at all?
Cardiac arrest AKA clinical death
What's of greater concern when assessing a child or an infant: low pulse or high pulse?
Low pulse is a greater concern, because it may indicate imminent cardiac arrest.
Define "tachycardia."
Rapid pulse -- any pulse rate greater than 100
Define "bradycardia."
A slow pulse -- any pulse rate below 60 beats per minute.
Define "pulse quality."
The rhythm (regular or irregular) and force (strong or weak) of the pulse.
Define "thready" when used in a clinical setting.
Used to describe force of pulse. A "thready pulse" is very fine and scarcely perceptible.
Define "radial pulse."
Pulse taken at the wrist -- the first pulse checked on an alert adult patient.
Define "brachial pulse."
The pulse felt in the upper arm -- the first pulse checked on infants.
Define "carotid pulse."
Pulse read at the neck. This is where you would try to read the pulse if there was no perceptible radial pulse on an adult patient. In severe trauma cases or unresponsive patient situations, check the carotid pulse first.
Children of what age should have their brachial pulse taken rather than a radial pulse?
Children one year and younger.
Why must you be careful when reading the carotid pulse?
Because too much pressure can slow the heart rate, especially in older patients. NEVER palpate carotid pulse on both sides simultaneously.
What are the first measurements that you take during patient assessment?
Baseline vital signs.
How do you read a patient's pulse?
Palpate at the proper site, time pulse rate over 30 seconds and multiply by 2 (or time pulse rate over 15 seconds and multiply by 4).
Define "respiration."
The act of breathing in and out.
Define "respiratory rate."
The number of breaths taken in one minute.
Define "respiratory quality."
The normal or abnormal character of breathing. Characterized as "shallow, normal, labored, or noisy."
What are the four categories of respiratory quality?
1) Normal
2) Shallow
3) Labored
4) Noisy
Why shouldn't you use your thumb to palpate a pulse?
Your thumb can generate a pulse and throw you off
When palpating a carotid pulse, what side of the neck should you palpate?
The side you're on. Don't reach.
What are four abnormal skin colors?
1) Pale
2) Cyanotic
3) Flushed
4) Jaundiced
What are three abnormal skin temperatures?
1) Hot
2) Cool
3) Cold
What are two abnormal skin conditions?
1) Wet/clammy
2) Very dry
How do you assess a patient's pupils?
Shine a light in the patient's eye and look for reactions. Keep an eye out for constricted, dilated, or unequal pupils.
What two readings do you take when measuring blood pressure?
Systolic BP and Diastolic BP

Systolic goes over diastolic
How do you palpate a patient's blood pressure?
Find a radial pulse. Pump up the cuff. Keep pumping until you lose the pulse. Count the systolic measurement as about 15 pounds of pressure above the reading at the point when you lost the pulse. Make sure you notate that it's palpated (if you get a measurement of 118 systolic, write "118/P")
How is the blood pressure of a female different from that of a male?
It's 8-10 points lower.
How do you calculate a child's proper systolic BP (1-10 yrs)?
(Child's age x 2) + 80 mmHg
How many blood pressure cuff sizes will you usually find on an ambulance?
5 -- for children, small adults, adults, large adults, and thigh cuffs
How should you read blood pressure?
1) First try auscultating
2) Second try palpating
3) If all else fails, assume it's very low and measure with a non-invasive machine
Define "pulse oximetry."
Measurement of the oxygen levels circulating in the blood.
How do you read the results from a pulse oximiter?
Normal: 96-100%
Hypoxia: 91-95%
Significant hypoxia: 86-90%
Severe hypoxia: less than 85%
In what cases is a pulse oximiter inaccurate?
1) COPD patients (pulse oximetry is usually lower than normal patient -- 91-95%)

2) Patients who have inhaled carbon monoxide (since CO attaches to a red blood cell, it can't be differentiated from oxygen).

3) When a patient moves

4) When a patient has nail polish on

5) When the oximiter's batteries are low
When is a pulse oximiter reading unnecessary?
When a patient is obviously in bad shape -- weak pulse, irregular pulse, pale skin, sweating, inadequate breathing, etc.
If the oximiter reads normal and a patient seems to be in respiratory distress, what do you do?
Give them oxygen!!
How often do you reassess a stable patient? An unstable patient?
Stable: Every 15 minutes (unless they're having chest pains)

Unstable: Every 5 minutes
What are the components of SAMPLE history?
Signs/Symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading to injury or illness
When you're on a call and discover that a patient takes prescription drugs, what must you do?
If they have a list of medications and dosages they take, get that. If they have a family member that can provide or produce that, have them do it!

If they don't, grab all their prescription bottles and take them along.
Define "sign."
An indication of a patient's condition that is objective, or can be observed by another person; an indication that can be seen, heard, smelled, or felt by an EMT or others.
Define "symptom."
An indication of a patient's condition that cannot be observed by another person but rather is subjective, or felt and reported by the patient.
Should you only ask about prescription medications when obtaining a sample history?
No -- ask about over-the-counter meds they might be taking as well.

Also, be ready to count pills!
What's a "vial of life?"
It's a small vial stuck to a fridge with a sticker. It's got all the patient's necessary information. Often found in homes of elderly patients.
What are some important patient interview strategies?
1) Position yourself appropriately

2) Identify yourself

3) Speak in a normal voice

4) Use your patient's name (and title!)

5) Try to judge what your patient is like at first glance, and try to make them comfortable, physically and emotionally
What are a few abnormal respiratory sounds and their interventions?
1) Snoring -- airway blocked -- open airway and give prompt transport

2) Wheezing -- Medical problem such as asthma -- assist patient in taking medications, and give prompt transport

3) Gurgling -- Fluids in airway -- suction airway and give prompt transport

4) Crowing (harsh sound when inhaling) -- Medical problem that cannot be treated on the scene -- expedite tranport
What's the proper respiratory rate for an adult?
12-20 (under 10 or above 24 is serious)
What's the proper respiratory rate for a newborn?
30-50
What's the proper respiratory rate for an infant 0-5 months old?
25-40
What's the proper respiratory rate for an infant 6-12 months old?
20-30
What's the proper respiratory rate for a toddler 1-3 yrs old?
20-30
What's the proper respiratory rate for a preschooler 3-5 yrs old?
20-30
What's the proper respiratory rate for a school age child 6-10 yrs old?
15-30
What's the proper respiratory rate for adults and adolescents?
12-20
Define "respiratory rhythm."
The regular or irregular spacing of breaths.
What are signs of labored breathing?
1) Increase in the work of breathing

2) Use of accessory muscles

3) Nasal flaring

4) Retractions above collarbones or ribs

5) Stridor

6) Grunting

7) Gasping
What are breathing sounds one should be concerned about?
1) Snoring

2) Wheezing

3) Gurgling

4) Crowing
When should you observe respiratory rhythm?
When assessing an unconscious patient.
Where are the best places to assess skin color in adults?
1) Nail beds

2) Inside of cheek

3) Inside of lower eyelids
Where are the best places to observe changes of skin color in children and infants?
1) Palms of hands

2) Soles of feet
What does cyanotic skin indicate?
Insufficient oxygen reaching red blood cells.
What does pale skin indicate?
Poor circulation of blood
What does jaundice indicate?
Liver abnormalities
What uncommon skin coloration might you see that indicates shock?
Mottling, or a blotchy appearance, especially in children or the elderly.
What are some possible causes of pale skin?
1) Blood loss

2) Shock

3) Hypotension

4) Emotional distress
What are some possible causes of red skin?
1) Exposure to heat

2) Emotional excitement
What does cool, clammy skin indicate?
Shock or anxiety
What does cold, moist skin indicate?
Body is losing heat
What does cold, dry skin indicate?
Exposure to cold
What might hot, dry skin indicate?
1) Heat exposure

2) High fever
What might hot, moist skin indicate?
1) Heat exposure

2) High fever
What might goosebumps, chattering teeth, blue lips, and pale skin indicate?
1) Chills

2) Communicable disease

3) Exposure to cold

4) Pain

5) Fear
How do you assess a patient's skin temperature?
Put the back of your hand up against their forehead. If they feel cold there, also hold the back of your hand against their abdomen, under the clothing.
What might a warm abdomen but a cold arm on a patient indicate?
Circulation problems with that arm.
Define "pupil."
The black center of the eye
Define "dilate"
Get larger
Define "constrict."
Get smaller
Define "reactivity."
In the pupils of the eyes, reacting to light by changing size.
How can you determine if a patient's eyes are dilated?
The pupils are huge, often making it difficult to even determine the color of their eyes.
What do nonreactive pupils NOT do?
They don't constrict when light shines into them.
How do you assess a patient's pupils?
1) Note starting pupil size

2) Cover one eye and shine penlight into other eye

3) Assess pupil reaction, repeat on other side.

4) In case you're under bright sunlight, use the sun as your penlight. Cover the eyes for a while, and note their reaction when uncovered.
Very generally speaking, what might dilated, constricted, uneven, or nonreactive pupils indicate?
1) Drug influence

2) Head injury

3) Eye injury
Specifically, what might dilated pupils indicate?
1) Fright

2) Blood loss

3) Drugs

4) Use of eye-drops
Specifically, what might constricted pupils indicate?
1) Drugs

2) Use of eye drops
Specifically, what might unequal pupils indicate?
1) Stroke

2) Head injury

3) Eye injury

4) Artificial eye
Specifically, what might nonreactive pupils indicate?
1) Drugs

2) Lack of oxygen to brain