Ad & I - Patient Assessment & Vitals

Front 1

Describe the components of a thorough scene assessment?

Back 1

PHSSPERM - PPE - Hazards (look listen smell) - Scene Safety (can I approach) Scene Time - Number of Patients - Environment (inside and outside) Resources I Need - Mechanism of Injury or Nature of Illness

Front 2

What is the difference between a primary trauma assessment and a primary medical assessment?

Back 2

With a medical primary you get a partner to take a set of vitals. With a trauma primary you get them to perform interventions then load and go. Medications are also done on scene.

Front 3

Describe the physiology of blood pressure?

Back 3

Blood pressure is the measurement of the force exerted against the walls of the blood vessels.

Front 4

What is systolic blood pressure?

Back 4

The systolic BP is the pressure created by the left ventricle when it is contracting (in systole)

Front 5

What is diastolic BP?

Back 5

The result of residual pressure in the system while the left ventricle is relaxing.

Front 6

What is the normal blood pressure range for an adult?

Back 6

Between 120/80 and 90/60 is the ideal range for blood pressure.
120/80 up to 140/90 is considered pre-hypertension
140/90 and above is considered hypertension
Below 90/60 is hypotension

Front 7

Treat the patient?

Back 7

Regardless of blood pressure if the patient is showing signs of poor perfusion you have problems! Ask questions - some peoples BP can be high or low!!!

Front 8

What is the normal blood pressure range for children

Back 8

Varies, the easiest way to work out the minimum is to take the following sum

70 + (2 x age) = minimum BP

Again treat the symptoms if poor perfusion then there is a problem somewhere.

Front 9

How is blood pressure measured in infants?

Back 9

In Infants and children up to about age 5 it is very reliable to go on capilliary refill. If the Cap refill is greater than 2 seconds there there is a problem with the Blood Pressure.

Front 10

What are the popular pulse points?

Back 10

Carotid, Femoral, Brachial, Radial, Femoral, Posterior Tibial and Dorsalis Pedis.

Front 11

Where is the Carotid pulse point?

Back 11

Front 12

Where is the Brachial Pulse point?

Back 12

Front 13

Where is the radial pulse point?

Back 13

Front 14

Where is the femoral pulse point?

Back 14

Front 15

Where is the posterior tibial pulse point?

Back 15

Front 16

How is the respiratory rate measured?

Back 16

Inspection of the patients chest. Also visualizing portions of the abdominal wall, neck face and accessory muscle use.

Front 17

What is just as important as respiration rate?

Back 17

The depth and quality of respiration rate.

Front 18

What should you learn to recognise?

Back 18

Pathologic respiration patterns such as tachypnea, kussmaul, cheyne stokes and biot breathing. Also positioning such as tripoding and accessory muscle use.

Front 19

How is temperature measured?

Back 19

Can use a range of measures including tympanic.

Front 20

What are extrinsic factors that can increase or decrease body temperature readings via a tympanic thermometer?

Back 20

Dirt and debris, Technique (must be directed at the tympanic membrane) Size of the ear canal, Outside temperature (-30 will give a falsely low reading)

Front 21

How does the pulse oximiter work?

Back 21

The device emits two wavelengths of light one of which is blocked by oxygen saturated hemogolobin. This is registered as a percentage.

Front 22

What are some drawbacks to the pulse oximiter?

Back 22

The device measures the saturation of blood not the amount of blood. A patient can bleed out still with a 100% Sp02.

Front 23

What happens with CO?

Back 23

The patient will show a 100% Sp02 even though they are about to die as CO has a higher affinity for hemoglobin than O2. The o2 will be pushed out of the way by CO

Front 24

What else can interfere with a SpO2 reading?

Back 24

Bright ambient light, Patient motion, Poor perfusion (shock, cardiac arrest, hypothermia) Nail polish, venous pulsations (patients with right sided heart failure)

Front 25

What should you always do with SpO2?

Back 25

Look at the patient and treat them not the machine.

Front 26

What are you looking for when you assess the pulse?

Back 26

Rate rhythm and quality

IE Fast, Regular and Strong
OR Slow, Regular and Weak etc

Front 27

How can the pulse be used to estimate blood pressure?

Back 27

The pulse should be palpated at the most distal point first and then to more central locations. This allows an estimation of blood pressure. For example a radial pulse generally means the systolic BP is at least 80. If the carotid pulse is palpable then 60-70 mgHg. Femoral is 70-80 mgHg

Front 28

When checking the pulse why should you check the respiratory rate?

Back 28

Patients often try and regulate their breathing if they think you are checking for it. This technique avoids such problems.

Front 29

What is the General Impression?

Back 29

The general impression is formed as you approach the scene. It is a quick look at the environment in which the patient is found and helps to answer the question sick or not sick.

Front 30

What are you looking for?

Back 30

Signs of significant stress such as mental state changes, anxiousness, laboured breathing, difficulty speaking, diaphoresis, obvious pain, obvious deformity, guarding or splinting of an injured area.

Front 31

What else might you notice?

Back 31

Dress hygiene, expression, size, posture, untoward odors and overall state of health.

Front 32

What is the quickest and most reliable initial way to determine health.

Back 32

Examine the skin condition. Pallor, Cyanosis and Ecchymosis all are indicators.

Front 33

How is mental status evaluated?

Back 33

Using the AVPU scale.
Alert - Responds to questions about Person, Place, Time and Event
Verbal - Responds to being shouted at
Painful - Responds to being pinched on the nail bed
Unresponsive - Does not respond to verbal or tactile stimuli

Front 34

How is skin condition evaluated?

Back 34

Examination of the skin involves both inspection and palpation.

Front 35

What are you paying attention for?

Back 35

The skin colour, moisture, temperature, texture, turgor and any significant lesions. Look for evidence of diminished perfusion, evaluate for pallor and cyanosis and be wary of diaphoresis.

Front 36

What can reddened or pink skin mean?

Back 36

It can be seen in a variety of normal states but also evident in states of relative vasodilation (flushing). Flushed skin is usually apparent in patients with fever and it may be seen in patients experiencing an allergic process. Should also be considered in the context of superficial burns.

Front 37

Where is skin best examined for changes in perfusion?

Back 37

In areas where the epidermis is thinnest such as the fingernails lips and conjunctivae. Sometimes also useful to examine the palms and the soles.

Front 38

What does pale skin mean?

Back 38

It is a relatively common finding in the seriously ill patient and may indicate severe vasoconstriction as seen in profound anemia, acute cardiovascular events, other shock like states and hypothermia.

Front 39

What are local areas of blanched cool white skin are typical of?

Back 39

Frostbite

Front 40

What is mottling a sign of?

Back 40

A typical finding in states of severe hypoperfusion and shock and readily evident in pediatric patients.

Front 41

What is Turgor?

Back 41

Turgor relates directly to hydration status. Poor skin turgidity is an expression of poorly hydrated skin with associated tenting evident in extreme cases particularly young children

Front 42

What can skin lesions and ecchymosis be signs of?

Back 42

Severe internal injuries and bleeding. Be aware of palpable crepitus (fractures) and open wounds.

Front 43

What are these and what do they mean?

Back 43

Beau's lines - systemic illness, severe infection or nail injury

Front 44

What is this and what can it mean?

Back 44

Clubbing - This is associated with chronic respiratory disease.

Front 45

What is this and what does it signify?

Back 45

Splinter Hemorrhages - Bacterial endocarditis or trichinosis.

Front 46

What is this and what does it signify?

Back 46

Cirrhosis

Front 47

How is the head examined?

Back 47

Visually inspect the head looking for any obvious DCAP-BTLS

Palpate the top and back of head to locate and subtle abnormalities. Be systematic front to back ensure nothing is missed.

Part the hair and note the condition of the scalp

Note any pain caused during this process

Palpate the structure of the face looking for any obvious DCAP-BTLS - pay attention to the shape of the face and condition of the skin.

Front 48

How are the Eyes examined?

Back 48

Examine the exterior portion of the eye. Look for obvious trauma or deformity.

Ask the patient about any pain, altered vision, discharge or sensitivity to light

Measure visual acuity by counting fingers at 2m, 1m and 30 cm. Perform on each eye independently

Examine pupils for shape size and symmetry - should be equal

Test pupils for reaction to light

Test cranial nerve function ask patient to follow fingers in Z or H

Inspect for evidence of trauma foreign bodies or discharge

Front 49

How is the ear examined?

Back 49

Look for any obvious trauma or wounds.

Look for drainage of fluids either CSF, pus, blood

Look for battles sign

Check for any problems with hearing in both ears.

Front 50

How is the nose examined?

Back 50

Look for evidence of asymmetry

Deformity

Wounds

Foreign bodies

Discharge (CSF) or bleeding

Tenderness

Evidence of respiratory distress such as nostril flaring

Front 51

How is the throat examined?

Back 51

Begin with the lips which should be pink and free of edema or surface irregularities

Confirm that the mouth is symmetrical. The gums should be pink with no lesions or edema.

Visualize the tongue noting colour, size and moisture. The tongue should be located midline without swelling and moist.

Examine the oropharynx, identify any discoloration or pustules that may indicate an infection.

Note any unusual odours on the breath. Inspect the uvula for edema and redness

Take precautions to protect the cervical spine.

Palpate the neck for structural abnormalities or subcutaneous air. Ensure the trachea is midline.

Assess the lymph nodes

Assess the jugular veins for distension.

Front 52

How is the cervical spine examined?

Back 52

Evaluate the patient first for MOI and then for the presence of pain.

Is their significant MOI or are there serious distracting injuries or circumstance to make assessment difficult?

With any complaints of neck pain in patients who have suffered a significant MOI immediate stabilization of the head and neck is essential.

Front 53

How is the Chest examined?

Back 53

Inspect chest for DCAP-BTLS

Any Open wounds should be dressed appropriately

Note the shape of the chest as it can give clues as to the underlying medical conditions such as emphysema or bronchitis

Look for surgical scars that may be from a pacemaker or a midline zipper indicating previous heart surgery.

Auscultate the lung fields noting any abnormal lung sounds

Use percussion to detect any abnormalities

Auscultate for heart tones

Repeat the appropriate portions for the posterior aspect of the thorax

Compare the two sides of the chest wall for symmetry note any paradoxical movement, subcutaneous air

Front 54

How should the heart be examined?

Back 54

Place the patient in one of these positions to bring the heart closer to the left anterior chest wall - Sitting up leaning slightly forward, Supine, Left lateral recumbent position

Place stethoscope at the fifth intercostal space over the apex of the heart

To appreciate the S1 sound ask the patient to breathe normally and hold the breath on expiration.

To appreciate the S2 sound ask the patient to breathe normally and hold the breath on inhalation

Auscultate the the area above the left nipple to listen for S3 and S4 heart sounds.

Front 55

How should the abdomen be examined?

Back 55

Inspect the abdomen for DCAP-BTLS

Auscultate the abdomen for bowel sounds

Palpate the four quadrants of the abdomen in a systematic pattern beginning with the quadrant farthest from the patients complaint.

Note any distention, tenderness or rigidity

Front 56

How should the female genitalia be examined?

Back 56

Limit the examination to visual inspection. Should be limited and discreet. Reasons to examine include concern over life threatening hemorrhage or imminent delivery in childbirth.

Ensure that the patient is appropriately draped during examination

If a crime or potential crime try to preserve garments

Front 57

How should the male genitalia be examined?

Back 57

Ensure that partner is present and perform exam in limited and discreet fashion. Note any inflammation, discharge, swelling or lesions

Front 58

How is the Anus examined?

Back 58

Often evaluated at the same time as the genitalia. Examined only in a limited number of circumstances.

Front 59

How is the Musculoskeletal system examined?

Back 59

Inspect the skin overlying the muscles bones and joints for soft tissue damage

Check for adequate distal pulse and motor sensation to each extremity.

Ask the patient to flex and extend the joints of the fingers hands and wrist to establish range of motion.

Ask the patient to turn the hand from the palm down position to the palm up position and back again.

Inspect and palpate the shoulders.

Inspect and palpate the bony structures.

Ask the patient to point and bend the toes to establish range of motion.

Ask the patient to rotate the ankle checking for pain or restricted range of motion

Inspect and palpate the knee joints and patella. Ask patient to bend and straighten both to establish range of motion

Check for integrity of the pelvis by applying gentle pressure to the iliac crests and pushing in and then down

Ask the patient to lift both legs bending at the hip and then turning the legs inward and outward.

Front 60

How do you examine the peripheral vascular system?

Back 60

Note any abnormalities in the radial pulse, skin colour or condition

If abnormalities are noted in the distal pulse then work way proximally checking pulse points and noting findings

Palpate the epitrochlear and brachial nodes of the lymphatic system noting any swelling or tenderness

Examine the lower extremities noting any abnormalities in the size and symmetry of the legs

Inspect the skin colour and condition noting abnormal venous patterns or enlargement

Check distal pulses

Palpate the inguinal nodes for swelling or tenderness

Evaluate for pitting edema in the legs and feet

Front 61

How should the spine be examined?

Back 61

Inspect the cervical, thoracic and lumbar curves for abnormalities

Evaluate the heights of the shoulders and the iliac crests

Palpate the posterior portion of the cervical spine noting any point tenderness or structural abnormalities

In the non trauma patient and in the absence of reported pain ask the patient to move the head forward and then from side to side

Palpate each vertebra with the thumbs

In the absence of pain ask the patient to bend at the waist in each direction to establish the range of motion.

Front 62

How should a neurological assessment be performed?

Back 62

Assess the patients mental status using the AVPU mnemonic

Note the patients posture

Evaluate Cranial Nerve function

Evaluate the patients neuromuscular status by checking muscle strength against resistance.

Evaluate the patients coordination by performing the finger-to-nose test using alternating hands

If appropriate have the patient walk head to toe

Perform the pronator drift test

Evaluate the sensory function checking responses to gross and light touch

If appropriate check for deep tendon reflexes.