EMT Assessment, Reassessment, and Communication (12-17)

Action when patient stops responding during physical exam

Repeat the primary assessment.

First step in the reassessment process

Primary assessment

Information excluded from medical radio report

Address at which the patient was located

Narrative

The free-text section of the Patient Care Report describing patient presentation and treatment.

Patient information not to relay on open radio

Patient's name

Auscultation

Listening to characteristic sounds using a stethoscope.

Blood Pressure

The force of blood against the walls of the blood vessels.

Blood Pressure Monitor

A machine that automatically inflates a cuff and measures blood pressure.

Brachial Artery

The major artery of the arm.

Brachial Pulse

The pulse felt in the upper arm.

Bradycardia

A slow pulse; any pulse rate below 60 beats per minute.

Carotid Pulse

The pulse felt along the large carotid artery in the neck.

Constrict

To get smaller.

Diastolic Blood Pressure

The pressure remaining in arteries when the left ventricle is relaxed.

Dilate

To get larger.

Oxygen Saturation (SpO2)

The ratio of oxygen in blood to amount possible, as a percentage.

Palpation

Touching or feeling with fingertips, such as taking a pulse.

Pulse

Rhythmic beats felt as the heart pumps blood through arteries.

Pulse Oximeter

Electronic device measuring oxygen saturation (SpO2) in the blood.

Pulse Quality

The rhythm (regular/irregular) and force (strong/weak) of the pulse.

Pulse Rate

The number of pulse beats per minute.

Pupil

The black center of the eye.

Radial Pulse

The pulse felt at the wrist.

Reactivity

Pupils changing size in response to light.

Respiration

The act of breathing in and breathing out.

Respiratory Quality

The character of breathing (normal, shallow, labored, or noisy).

Respiratory Rate

The number of breaths taken in one minute.

Respiratory Rhythm

The regular or irregular spacing of breaths.

Sphygmomanometer

The cuff and gauge used to measure blood pressure.

Systolic Blood Pressure

The pressure created when the heart contracts and forces blood out.

Tachycardia

A rapid pulse; any pulse rate above 100 beats per minute.

Vital Signs

Respiration, pulse, skin condition, pupils, blood pressure, and pulse oximetry.

Capnography

Graphical measurement of how much CO2 a patient is exhaling.

Capnometry

Numeric-only measurement of exhaled CO2.

Normal Blood Glucose Level

70 to 100 mg/dL.

Normal O2 Saturation %

96% to 100%.

Mild Hypoxia O2 Saturation

91% to 95%.

Significant/Moderate Hypoxia O2 Saturation

86% to 90%.

Severe Hypoxia O2 Saturation

85% or less.

Cautions for Pulse Ox Readings

Inaccurate in shock, hypothermia, carbon monoxide, motion, anemia, or nail polish.

Temperature Locations for EMS

Oral, axillary, and rectal.

Normal Blood Pressure (Adults)

120/80 mmHg.

Hypertension (Adults)

Systolic of 140 mmHg or diastolic of 90 mmHg or more.

Serious Low Blood Pressure

Systolic less than 90 mmHg.

Causes for Unreactive Pupils

Drugs or lack of oxygen to the brain.

Causes for Unequal Pupils

Stroke, head/eye injury, prescription drops, or artificial eye.

Causes for Constricted Pupils

Narcotics/drugs or prescription eye drops.

Causes for Dilated Pupils

Fright, blood loss, drugs, or prescription eye drops.

Causes for Hypertension

Medical conditions, exertion, fright, distress, or excitement.

Causes for Hypotension

Athletic training, baseline low BP, blood loss, or shock.

Cause for No BP in a Conscious Patient

Ventricular assist device (VAD) in the chest.

Skin Condition: Cool, Clammy

Sign of shock or anxiety.

Skin Condition: Cold, Moist

The body is losing heat.

Skin Condition: Cold, Dry

Exposure to cold.

Skin Condition: Hot, Dry

Exposure to heat or high fever.

Skin Condition: Hot, Moist

Exposure to heat or high fever.

Skin Condition: Goose Pimples with Chills

Cold exposure, communicable disease, pain, or fear.

Skin Color: Pink

Normal perfusion in light skin, inner eyelids, lips, or nail beds.

Skin Color: Pale

Constricted vessels from shock, blood loss, hypotension, or emotional distress.

Skin Color: Cyanotic

Lack of oxygen in tissues (respiratory or circulatory issue).

Skin Color: Flushed

Heat exposure or emotional excitement.

Skin Color: Jaundiced

Liver dysfunction.

Skin Color: Mottled

Blotchy skin, occasionally seen in shock.

Skin Color Check: Infants & Children

Check palms of hands or soles of feet.

Respiratory Sound: Stridor

High-pitched, harsh inhalation sound indicating upper airway obstruction.

Respiratory Sound: Snoring

Upper airway obstruction (typically tongue); requires opening airway.

Respiratory Sound: Wheezing

Lower airway constriction (e.g., asthma); requires prompt transport.

Respiratory Sound: Gurgling

Fluid in upper airway; requires immediate suctioning.

Respiratory Sound: Crowing

Noisy, harsh inhalation sound; requires prompt transport.

Normal Adult Respiratory Rate

12 to 20 breaths per minute.

Serious High Adult Respiratory Rate

Above 24 breaths per minute.

Serious Low Adult Respiratory Rate

Below 10 breaths per minute.

The 6 Vital Signs

Pulse, BP, respiration, pupils, skin (color/temp/condition), and pulse ox.

Normal Pulse Rate: Adult/Adolescent

60 to 100 beats per minute.

Normal Pulse Rate: School Age

65 to 120 beats per minute.

Normal Pulse Rate: Preschooler

70 to 120 beats per minute.

Normal Pulse Rate: Toddler

80 to 140 beats per minute.

Normal Pulse Rate: Infant

90 to 160 beats per minute.

Normal Pulse Rate: Newborn

100 to 170 beats per minute.

Pulse Quality: Rapid, Regular, Full

Exertion, fright, fever, hypertension, or early blood loss.

Pulse Quality: Rapid, Regular, Thready

Shock, late-stage blood loss, or abnormal heart rhythm.

Pulse Quality: Irregular

Abnormal electrical activity in the heart.

Pulse Quality: Slow

Head injury, drugs, poisons, heart problems, or pediatric hypoxia.

Pulse Quality: Absent

Cardiac arrest, or ventricular assist device (VAD) in awake patient.

A-B-C's

Airway, breathing, circulation

AVPU

Memory aid for level of responsiveness: Alert, Verbal, Painful, Unresponsive

Chief complaint

The reason EMS was called, usually in the patient's own words.

General impression

First-approach impression based on environment, chief complaint, and appearance.

Interventions

Actions taken to correct or manage a patient's problems.

Manual stabilization

Using hands to prevent head/neck movement until a cervical collar is applied.

Mental status

Level of responsiveness.

Primary Assessment

First assessment element to discover and treat life-threatening problems.

Six parts of Primary Assessment

General impression, mental status, airway, breathing, circulation, and transport priority.

Priority

Decision regarding immediate transport versus further assessment/care at the scene.

Spinal motion restriction (SMR)

Procedure for limiting movement of head, neck, and spine when injury is suspected.

When does SMR take place?

During the scene size-up.

The LOOK test

Feeling from environmental observations combined with first look at patient.

Levine's sign

A fist clenched over the chest; the global position of a heart attack.

Acronym used when assessing mental status

AVPU

Skin assessment in the circulation stage of ABCs

Good circulation: warm, pink, dry. Shock: pale, clammy.