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47 Cards in this Set

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Problem-oriented evaluation of patient and establishment of priorities based on existing and potential threats to human life.
Patient assessment
Components of Patient Assessment
- Scene size up
- Initial assessment
- Focused history and physical exam
- Ongoing assessment
- Detailed physical exam
Life-support activities that go beyond basic procedures to include adjunctive equipment and invasive procedures.
Advanced life support (ALS)
Components of Scene Size-Up
- Body substance isolation
- Scene safety
- Location of all patients
- Mechanism of injury
- Nature of the ilness
Doing everything possible to ensure a safe environment.
Scene safety
Order of Priorities for Scene Safety
1. You
2. Your crew
3. Other responding personnel
4. Your patient
5. Bystanders
Minimum Rescue Operation Equipment
- Four-point suspension helmets
- Eye goggles or industrial safety glasses
- High-quality hearing protection
- Leather work gloves
- High-top steel-toed boots
- Insulated coveralls
- Turnout gear
Minimum Patient Safety Equipment
- Construction-type hard hats
- Eye goggles
- Hearing and respiratory
- Protective blankets
- Protective shielding
Combined strength, direction, and nature of forces that injured your patient.
Mechanism of injury
Your anticipation of possible injuries based on your analysis of the event.
Index of suspicion
Prehospital process designed to identify and correct life-threatening airway, breathing, and circulation problems.
Initial assessment
Steps of Initial Assessment
1. Form general impression
2. Stabilize cervical spine as needed
3. Assess baseline level of response
4. Assess airway
5. Assess breathing
6. Assess circulation
7. Assign priority
Your initial, intuitive evaluation of your patient.
General impression
AVPU
- Alert
- Verbal stimuli
- Painful stimuli
- Unresponsive
Arms flexed, legs extended.
Decorticate
Arms and legs extended.
Decerebrate
Signs of Inadequate Breathing
- Altered mental status
- Shortness of breath
- Retractions
- Asymmetric chest wall movement
- Accessory muscle use
- Cyanosis
- Audible sounds
- Abnormal rate or pattern
- Nasal flaring
Evaluating the pulse and skin and controlling hemorrhage.
Circulation assessment
Top Priority Patients
- Poor general impression
- Unresponsive
- Responsive but cannot follow commands
- Airway compromise
- Difficult breathing
- Signs and symptoms of hypoperfusion
- Multiple injuries
- Complicated childbirth
- Chest pain and blood pressure below 100 systolic
- Uncontrolled bleeding
- Severe pain
Problem-oriented assessment process based on initial assessment and chief complaint.
Focused history and physical exam
Types of Patients
- Trauma patient with significant mechanism of injury or altered mental status
- Trauma patient with isolated injury
- Responsive medical patient
- Unresponsive medical patient
Person who has suffered significant mechanism of injury.
Major trauma patient
Order of Focused History and Physical Exam for Major Trauma Patients
- Initial assessment
- Rapid trauma assessment
- Packaging
- Rapid transport and ongoing assessment
Predictors of Serious Internal Injury
- Ejection from vehicle
- Death in same passenger compartment
- Fall from higher than 20 feet
- Rollover of vehicle
- High-speed vehicle collision
- Vehicle-pedestrian collision
- Motorcycle crash
- Penetration of head, chest, or abdomen
Additional Predictors of Serious Internal Injury for Infants and Children
- Fall from higher than ten feet
- Bicycle collision
- Medium-speed vehicle collision
Quick check for signs and serious injury.
Rapid trauma assessment
DCAP-BTLS
- Deformities
- Contusions
- Abrasions
- Penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
Sitting up at 45 degrees.
Semi-Fowler's position
Crackling sensation caused by air just underneath the skin.
Subcutaneous emphysema
Bruising over the umbilicus.
Cullen's sign
Bruising over the flanks.
Grey Turner's sign
Baseline Vital Signs
- Pulse rate and quality
- Blood pressure
- Respiration rate and quality
- Skin temperature and condition
Sample History
- Symptoms
- Allergies
- Medications
- Pertinent past medical history
- Last oral intake
- Events leading up to the incident
The pain, discomfort, or dysfunction that caused your patient to request help.
Chief complaint
History for the Responsive Medical Patient
- Chief complaint
- History of present illness
- Past history
- Current health status
OPQRST-ASPN
- Onset
- Provocation/Palliation
- Quality
- Region/Radiation
- Severity
- Time
- Associated Symptoms
- Pertinent Negatives
Past Medical History
- General state of health
- Childhood and adult diseases
- Psychiatric illnesses
- Accidents and injuries
- Surgeries and hospitalizations
Current Health Status
- Current medications
- Allergies
- Tobacco use
- Alcohol/substance abuse
- Diet
- Screening exams
- Immunizations
- Sleep patterns
- Exercise/leisure activities
- Environmental hazards
- Use of safety measures
- Family history
- Social history
Additional Assessment Techniques
- Pulse oximetry
- Capnography
- Cardiac monitoring
- Blood glucose determination
Assessing the Unresponsive Medical Patient
- Initial assessment
- Rapid medical assessment
- Brief history
Careful, thorough process of eliciting the history and conducting a physical exam.
Detailed physical exam
Black and blue discoloration surrounding the eye sockets.
Periorbital ecchymosis
Black and blue discoloration over the mastoid process.
Battle's sign
Areas of Nervous System Exam
- Mental status and speech
- Cranial nerves
- Motor system
- Reflexes
- Sensory system
Reflex Tests
- Biceps
- Triceps
- Brachioradialis
- Quadriceps
- Achilles
- Abdominal
- Plantar
Sensory System Tests
- Pain
- Light touch
- Temperature
- Position
- Vibration
- Discriminative
Ongoing Assessment
- Detects trends
- Determines changes
- Assesses interventions' effects