EMT Ch. 10- Patient Assessment

symptom

subjective condition felt & told by pt

sign

objective condition observed or measured

mechanism of injury (MOI)

trauma; type, amount, duration, location of force

nature of illness (NOI)

medical; general type of illness experienced by pt

blunt trauma

force of injury occurs over broad area; skin may be broken; tissues/organs underneath area of impact may be damaged

penetrating trauma

injury occurs at specific point of contact between skin & object; creates open wound that carries high potential for infection

when there are multiple pts:

• use incident command system

• establish command

• identify number of pts

• begin triage

determine if additional resources are required:

• does the scene pose a threat to you, pt, others?

• how many pts are there?

• do we have the resources to respond to their conditions?

primary assessment

identify & begin to treat immediate/imminent life threats; not in-depth physical exam or assessment of vitals

AVPU scale

assesses LOC, neurological/physiological status

AVPU- A

awake & alert; pt’s eyes spontaneous open as you approach; aware of you; responsive to environment; appears to follow commands; eyes track people & objects

AVPU-V

responsive to verbal stimuli; pt is not alert/awake; eyes to not open spontaneously but open when spoken to or respond in some meaningful way when spoken to (moaning, speaking, moving); does not respond to normal speaking volume but loud speaking volume

AVPU-P

responsive to pain; pt does not respond to questions but moves/cries in response to painful stimuli

AVPU-U

unresponsive; pt does not respond spontaneously or to verbal/painful stimuli; usually have no cough/gag reflex

orientation

tests pt’s mental status by checking memory/thinking ability

orientation test

• person- name

• place- current location

• time- current year, month, DOTW

• event- describe what happened (MOI/NOI)

if all can be stated, pt is A&Ox4

altered mental status

any deviation from alert/oriented to person, place, time, event, or normal baseline

indications for spinal immobilization- blunt or penetrating trauma

• pain/tenderness on palpation of neck/spine

• pt report of pain in neck/back

• paralysis/neurologic complaint (numbness, tingling, partial paralysis of legs/arms)

indications for spinal immobilization- blunt trauma

• altered mental status

• intoxication w/ alcohol or drugs

• difficulty or inability to communicate

distracting injury

any injury that distracts pt/provider’s attention from other more severe injuries they may have

with an unresponsive pt or pt with decreased LOC, immediately assess:

patency of airway

signs of airway obstruction in unconscious pts:

• obvious trauma, blood, other obstruction

• noisy breathing (snoring, bubbling, gurgling, crowing, stridor, other abnormal sounds)

• extremely shallow/absent breathing

goal for SPO2 for most pts:

>94%

signs of respiratory distress

• agitation, anxiety, restlessness

• stridor, wheezing

• accessory muscle use (intercostal retractions, neck muscle use)

• tachypnea

• mild tachycardia

• nasal flaring, seesaw breathing, head bobbing

signs of respiratory failure

• lethargy, difficult to rouse

• tachypnea with periods of bradypnea/agonal respirations

• inadequate chest rise/poor excursion

• inadequate respiratory rate/effort

• bradycardia

• diminished muscle tone

if pt has a pulse but is not breathing, provide ventilations at rate of:

10-12 breaths/min for adults

12-20 breaths/min for infants/children

in pts with darker skin tone, tone changes may only be apparent in:

• fingernail beds

• mucous membranes in mouth

• lips

• underside of arm/palm

• conjunctiva of eyes

in infants, skin tone changes should be assessed in:

palms & soles

with adequate perfusion, capillary refill should be restored within:

2 seconds

DCAP-BTLS

• deformity- misshapen body part

• contusions- bruising

• abrasions- damage to surface of skin from rubbing/scraping

• punctures- small penetration through skin into soft tissue

• burns- redness, blisters, white areas of skin

• tenderness- pain when area is palpated

• lacerations- deep cut in skin

• swelling- raised/enlarged area of soft tissue

pts with any of the following conditions are high-priority & should be transported immediately:

• unresponsive

• difficulty breathing

• uncontrolled bleeding

• altered LOC

• severe chest pain

• signs of poor perfusion/shock

• complicated childbirth

• severe pain in any area of body

golden hour/period

time from injury to definitive care to maximize pt’s chance of survival

history taking includes documenting:

• date of incident

• pt’s age

• pt’s sex

• pt’s race

• past medical history including pertinent info regarding pt’s current condition (medical problems, traumatic injuries, surgeries)

• pt’s current health status (diet, meds, drug use, living environment/hazards, physician visits, family history)

OPQRST

gathering additional info/history; mostly used for pain

• onset- what were you doing when symptoms began?

• provocation/palliation- does anything make the symptoms better/worse? how are you most comfortable

• quality- what does the symptom feel like?

• region/radiation- where do you feel the symptom? does it move?

• severity- on a scale of 0-10, rate the pain

• timing- how long have you had the symptom? when did it start?

pertinent negatives

signs/symptoms pt does not have

SAMPLE history

• signs/symptoms- what signs/symptoms occurred at the onset of the incident?

• allergies- meds, foods, other substances; reactions

• meds- prescription, OTC, herbal, recreational, dosage, frequency

• pertinent past medical history- medical, surgical, trauma occurrences; family history

• last oral intake/menstrual cycle- when did pt last eat/drink?

• events leading up to injury/illness- key events leading up to incident; what occurred between onset of incident & EMS arrival?

questions to ask female pts of childbearing age reporting lower abdominal pain regarding sexual history:

• when was your last menstrual period?

• (if pt is bleeding) how many sanitary pads/tampons have you used?

• do you have urinary frequency/burning?

• what is the severity of cramping?

• are there any foul odors?

• is there a possibility you may be pregnant?

• are you using any form of birth control?

questions to ask male pts regarding urinary symptoms/sexual history:

• is there pain associated with urination?

• do you have discharge, sores, or increase in urination?

• do you have burning/difficulty voiding?

• has there been any trauma?

normal breath sounds

clear/relatively quiet; air moves into/out of lungs without obstruction

snoring breath sounds

indicates simple but potentially dangerous upper airway obstruction usually caused by tongue or foreign object; does not require stethoscope to be heard

stridor

brassy, crowing sound more prominent on inspiration; indicates airway obstruction in neck/upper part of chest; does not require stethoscope to be heard

wheezing

high-pitched whistling sound most prominent on expiration; indicates obstruction/narrowing of lower airways; typically heard through ausculation

crackles

wet, crackling breath sounds on both inspiration/expiration; may indicate fluid in lungs; heard through ausculation

rhonchi

low-pitched, noisy sounds most prominent on expiration; similar to blowing bubbles underwater; may indicate presence of mucus/fluid in lungs

normal respirations

breathing is neither shallow/deep; appears effortless; bilateral chest rise/fall; no use of accessory muscles

shallow respirations

decreased chest/abdominal wall motion

labored respirations

increased breathing effort; use of accessory muscles; possible gasping; nasal flaring, supraclavicular, & intercostal retractions in infants/children

noisy respirations

increase in sound of breathing

glasgow coma scale- eye opening- 1

no eye opening

glasgow coma scale- eye opening- 2

eye opening in response to pressure

glasgow coma scale- eye opening- 3

eye opening in response to sound

glasgow coma scale- eye opening- 4

eye opening spontaneously

glasgow coma scale- best verbal response- 1

no verbal response

glasgow coma scale- best verbal response- 2

verbal response consisting of incomprehensible sounds

glasgow coma scale- best verbal response- 3

verbal response consisting of inappropriate words

glasgow coma scale- best verbal response- 4

confused conversation

glasgow coma scale- best verbal response- 5

oriented conversation

glasgow coma scale- best motor response- 1

no motor response

glasgow coma scale- best motor response- 2

motor response consisting of abnormal extension

glasgow coma scale- best motor response- 3

motor response consisting of abnormal flexion

glasgow coma scale- best motor response- 4

motor response withdrawing from pressure

glasgow coma scale- best motor response- 5

motor response localizing to pressure

glasgow coma scale- best motor response- 6

motor response obeys commands

aniscoria

normally unequal pupils

indications of altered brain function as a result of CNS depression/injury in pupils:

• become fixated (dilated/constricted) w/ no reaction to light

• dilate with bright light & constrict when light is removed

• react sluggishly instead of briskly

• become unequal in size when bright light introduced/removed from one eye

reassess pts in stable condition:

every 15 min

reassess pts in unstable condition:

every 5 min

Which of the following statements regarding the mechanism of injury (MOI) is correct?

The MOI may allow you to predict the severity of a patient's injuries

Which of the following patients has signs of an altered mental status?

A patient with a head injury who is slow to answer questions

Supplemental oxygen without assisted ventilation would MOST likely be administered to patients:

with difficulty breathing & adequate tidal volume

During the primary assessment, circulation is evaluated by assessing:

pulse quality, external bleeding, & skin condition

Normal skin color, temperature, & condition should be:

pink, warm, & dry

A 71-year-old female slipped on a rug & fell. She is conscious but confused & complains of severe pelvic pain. Her respirations are 22 breaths/min & her heart rate is 120 beats/min. What should you do?

Treat her for possible shock

Which of the following statements regarding the secondary assessment is correct?

The secondary assessment should focus on a certain area or region of the body as determined by the chief complaint

Which of the following statements regarding the secondary assessment is correct?

You may not have time to perform a secondary assessment if you must continually manage life threats that were identified during the primary assessment

Which of the following assessments would be the MOST useful in determining the possible cause of a patient's altered mental status?

Blood glucose level

When performing the secondary assessment on a trauma patient, you note the presence of Battle sign. This is defined as:

bruising behind the ear

A decrease in blood pressure may indicate:

a loss in vascular tone

A blood pressure cuff that is too small for a patient's arm will give a:

falsely high systolic & diastolic reading

Which of the following statements regarding the blood pressure is correct?

Blood pressure is usually not measured in children younger than 3 years of age