Chapter 10 Patient Assement

What is the basis for all EMT treatment?

Patient assessment.

What are the five main parts of patient assessment?

Scene size-up, primary assessment, history taking, secondary assessment, reassessment

What is a symptom?

A subjective condition the patient feels and tells you about

What is a sign?

An objective condition you can observe.

What is a field impression?

The apparent cause of the patient's condition based on the situation, history, and examination findings

SYMPTOM

Says it.

SIGN

See it

What is scene size-up?

Evaluation of the conditions in which you will treat your patient

When does scene size-up begin?

Before patient contact

What information contributes to scene size-up

Pre-response information, dispatch information, and your observations of the scene

What should you maintain throughout the call

Situational awareness.

Should an EMT enter an unsafe scene

No

What should you do if violence is suspected

Stage in a safe location until law enforcement says the scene is safe

Why must scene safety be continuously reassessed

An emergency scene is dynamic and can change

What environmental factors should you consider

Traffic, weather, hazards, violence, and anything that could harm rescuers, patients, or bystanders

What does MOI stand for

Mechanism of injury.

What does NOI stand for

Nature of illness.

MOI is primarily associated with what type of patient

Trauma

NOI is primarily associated with what type of patient?

Medical

What is blunt trauma

Injury caused by force applied without penetrating the body

What is penetrating trauma

Injury produced when an object penetrates body tissues

What should MOI make you consider in an unresponsive trauma patient

Whether spinal motion restriction and manual cervical stabilization are necessary

What is the chief complaint

The patient's most serious sign or symptom

What is the chief concern

The condition requiring the most urgent intervention as determined by the clinician

Multiple patients with similar unexplained symptoms may indicate what

An unsafe scene or common exposure

When should standard precautions be taken

Before patient contact, often before leaving the response vehicle

Standard precautions assume what about blood and body fluids

That they may pose an infection risk, except sweat

What minimum PPE does the chapter specify before patient contact

Gloves and eye protection

What may provide protection from some airborne diseases

A Mask

Why determine the number of patients during scene size-up

To determine whether additional resources are needed

What should be used when there are multiple patients

The incident command system and triage

Examples of specialized resources

ALS, air medical support, fire/rescue, hazmat, technical rescue, and law enforcement

What three questions help determine whether additional resources are needed

Is there a threat? How many patients? Do we have enough resources

When does the primary assessment begin?

When you greet the patient.

What is the purpose of the primary assessment

Identify and begin treating immediate or imminent life threats

What major items are evaluated during the primary assessment

LOC, airway, breathing, and circulation

What sequence is normally used

ABC

When is XABC used?

When there is obvious life-threatening external bleeding

What does the X represent in XABC

Immediate control of exsanguinating/severe external hemorrhage

What airway problem may cause sudden death?

Airway obstruction

What respiratory problems may cause sudden death?

Respiratory failure and respiratory arrest.

What circulatory problems may cause sudden death

Shock, severe bleeding, and cardiac arrest

What neurologic event can cause sudden death

An acute intracranial event such as hemorrhage

Why do you form a general impression

To determine the priority of care

What basic characteristics are observed

Age, sex, race, level of distress, and overall appearance

What can the patient's response to your introduction tell you

Information about LOC, airway patency, breathing, and circulation

What senses help form your initial general impression?

What you see, hear, and smell

Can cyanosis be detected during general impression

Yes

Can gurgling respirations be detected during general impression

Yes

Can severe bleeding be detected during general impression?

Yes

Can tachycardia usually be identified just from general impression

No, it requires pulse assessment

What should you do if uncontrolled external bleeding is found

: Control it before continuing the assessment

What pattern typically indicates arterial bleeding

Spurting blood.

What is an initial method of bleeding control

Direct pressure.

What should be applied when direct pressure is not rapidly successful for severe extremity hemorrhage

A tourniquet

What does LOC stand for

: Level of consciousness

What does AVPU stand for

Alert, Verbal, Pain, Unresponsive

What does A mean in AVPU?

Awake and alert

AVPU What does V mean?

Responds to verbal stimuli

AVPU What does P mean

Responds to painful stimuli

AVPU What does U mean?

Unresponsive

Patient withdraws or moans after painful stimulus = ?

P - responsive to pain.

Patient remains flaccid, silent, and does not move = ?

Unresponsive.

What four things are checked when determining orientation

Person, place, time, and event

A patient who is talking or crying has what?

An open airway

A conscious patient unable to speak or cry may have what?

A severe airway obstruction.

What do you do if you identify an airway problem?

Stop the normal assessment sequence and correct the airway problem

Which airway maneuver is preferred if trauma is suspected

Jaw-thrust maneuver.

Which maneuver is used in a nontrauma patient?

Head tilt-chin lift

If jaw thrust cannot open a trauma patient's airway, what may be necessary?

Head tilt-chin lift

What airway sounds may indicate obstruction?

Snoring, bubbling, gurgling, crowing, or other abnormal sounds

Other signs of obstruction in an unconscious patient?

Blood, obvious trauma, foreign material, or extremely shallow/absent breathing

What three major characteristics of breathing should be assessed?

Rate, rhythm, and quality.

What should also be assessed when evaluating breathing?

Signs of hypoxia.

When are positive-pressure ventilations indicated?

When breathing is absent, too slow, or too shallow.

If breathing is adequate but the patient is hypoxic, what should you administer?

Oxygen

What oxygen saturation goal does the chapter give for most patients?

Greater than 94%.

What does smooth speech without pauses suggest

Breathing is likely adequate.

What indicates shallow respirations?

Little chest movement or poor chest excursion

How long does a typical inhalation/exhalation cycle take according to the chapter?

About 1-2 seconds for each inhalation and exhalation, with a short pause

Signs of increased work of breathing

Retractions, accessory muscle use, nasal flaring, tripod position, sniffing position, and labored breathing.

What is respiratory distress

Increased difficulty breathing with abnormal effort or rate

What is respiratory failure

Inadequate oxygenation or ventilation to meet the body's demands

What may respiratory failure progress to if not corrected?

Respiratory arrest

Patient can speak only 2-3 words before taking a breath = ?

Two- to three-word dyspnea.

Is two- to three-word dyspnea serious?

Yes, it indicates severe breathing difficulty

What three major factors are used to assess circulation?

Mental status, pulse, and skin condition.

If an unresponsive patient has no palpable pulse, what should you do?

Begin CPR.

What aspects of skin are assessed?

Color, temperature, moisture, and capillary refill

What does pale, white, ashen, or gray skin suggest?

Poor circulation.

What is cyanosis?

Blue coloration associated with inadequately oxygenated blood

What may cause flushed/red skin

High blood pressure, heatstroke, or burns.

Yellow skin and sclera is called what?

Jaundice

Jaundice can indicate dysfunction of what organ?

The liver

What is normal skin temperature

Warm

What is normal skin moisture

Dry

What does capillary refill evaluate?

The circulatory system's ability to restore blood to the capillary bed.

What does PAT stand for?

Pediatric Assessment Triangle

What is the purpose of PAT

Rapidly determine whether a pediatric patient appears sick or not sick.

How quickly can PAT be performed

In less than 30 seconds