EMTB - Ch 10

Symptom

Subjective findings that the patient feels but that can be identified only by the patient.

Sign

Objective finding that can be seen, heard, felt, smelled, or measured.

Field Impression

The conclusion about the cause of the patient’s condition after considering the situation, history, and examination findings.

Scene size-up

A step within the patient assessment process that involves a quick assessment of the scene and the surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care.

Situational awareness

Knowledge and understandings of one’s surroundings and the abilith

Mechanism of Injury (MOI)

The forces, or energy transmission, applied to the body that cause injury.

Nature of Illness (NOI)

The general type of illness a patient is experiencing.

Chief Complaint

The reason a patient called for help; also, the patient’s response to questions such as “What’s wrong?” or “What happened?”

Personal Protective Equipment

Protective equipment that blocks exposure to a pathogen or a hazardous material.

Standard precautions

Protective measures that have traditionally been developed by the Centers for Disease Control and Prevention (CDC) for use in dealing with objects, blood, body fluids, and other potential exposure risks of communicable disease.

Incident Command System

A system implemented to manage disasters and mass-casualty incidents in which section chiefs, including finance/administration, logistics, operations, and planning, report to the incident commander.

Triage

The process of establishing treatment and transportation priorities according to severity of injury and medical need.

Primary Assessment

A step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats.

Vital Signs

The key signs that are used to evaluate the patient’s overall condition, including respirations, pulse, blood pressure, level of consciousness, and skin characteristics

General Impression

the overall initial impression that determines the priority for patient care; based on the patient’s surroundings, the mechanism of injury, signs and symptoms, and the chief complaint.

AVPU Scale

A method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally early in the assessment process.

Responsiveness

The way in which a patient responds to external stimuli, including verbal stimuli (sound), tactile stimuli (touch), and painful stimuli

Orientation

The mental status of a patient as measured by memory of person (name), place (current location), time (current year, month and approximate date), and event (what happened)

Altered Mental Status

A change in the way a person thinks and behaves that may signal disease in the central nervous system or elsewhere in the body.

Distracting Injusry

Any injury that prevents the patient from noticing other injuries he or she may have, even severe injuries; for example, a painful femur or tibia fracture that prevents the patient from noticing back pain associated with a spinal fracture.

Indications for spinal immobilization

Either blunt or penetrating trauma with any of the following:

• Pain or tenderness on palpation of the neck or spine

• Patient report of pain in neck or back

• Paralysis or neurologic complaint (numbness, tingling, partial paralysis of the legs or arms)

Blunt trauma with any of the following:

• Altered mental status

• Intoxication (alcohol or drugs)

• Difficulty or inability to communicate

Spontaneous respirations

Breathing that occurs without assistance

Shallow respirations

Respirations characterized by little movement of the chest wall (reduced tidal volume) or poor chest excursion

Retractions

Movements in which the skin pulls in around the ribs during inspiration

Accessory Muscles

The secondary muscles of respiration. They include the neck muscles (sternocleidomastoids), the chest pectoralis major muscles, and the abdominal muscles

Nasal Flaring

Widening of the nostrils, indicating that there is an airway obstruction

Two to three word dyspnea

A severe breathing problem in which a patient can only speak two to three words at a time without pausing to take a breath

Tripod Position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward

Sniffing Position

An upright position in which the patient’s head and chin are thrust slightly forward to keep the airway open

Labored Breathing

The use of muscles of the chest, back, and abdomen to assist in expanding the chest; occurs when air movement is impaired

Respiratory Distress:

Agitation, anxiety, restlessness

Respiratory Failure:

Lethargy, difficult to rouse

Respiratory Distress:

Stridor, wheezing

Respiratory Failure:

Tachypnea with periods of bradypnea or agonal respirations

Respiratory Distress:

Accessory muscle use; intercostal retractions, neck muscle use (sternomastoid)

Respiratory Failure:

Inadequate chest rise/poor excursion

Respiratory Distress:

Mild tachycardia

Respiratory Failure:

Bradycardia

Respiratory Distress:

Nasal flaring, seesaw breathing, head bobbing

Respiratory Failure:

Diminished muscle tone

Pulse

The wave of pressure created as the heart contracts and forces blood out the left ventricle and into the major arteries

Palpate

To examine by touch

Conjunctiva

The delicate membrane that lines the eyelids and covers the exposed surface of the eye

Cyanosis

A blue skin discoloration that is caused by a reduced level of oxygen in the blood. Although paleness, or a decrease in blood flow, can be difficult to detect in dark-skinned people, it may be observed by examining mucous membranes inside the inner lower eyelid and capillary refill. On general observation, the patient ay appear ashen or gray.

Jaundice

Yellow skin or sclera that is caused by liver disease or dysfunction

Sclera

The tough, fibrous, white portion of the eye that protects the more delicate inner structures.

Diaphoretic

Characterized by light or profuse sweating

Capillary refill

A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure

Hypothermia

A condition in which the internal body temperature falls below 95 degrees F (35 degrees C)

Frostbite

Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten.

Vasoconstriction

Narrowing of a blood vessel

DCAP-BTLS

A mnemonic for assessment in which each area of the body is evaluated for Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, and Swelling

Crepitus

A grating or grinding sensation or sound caused by fractured bone ends or joints rubbing together

Golden Hour

The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is the best; also called the Golden Period.

History Taking

A step within the patient assessment process that provides details about the patient’s chief complaint and an account of the patient’s signs and symptoms.

OPQRST

A mnemonic used in evaluating a patient’s pain: Onset, Provocation/palliation, Quality, Region/radiation, Severity, and Timing

Pertinent Negatives

Negative findings that warrant no care or intervention.

SAMPLE history

A brief history of a patient’s condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness.

Secondary Assessment

A step within the patient assessment process in which a systematic physical examination of the patient is performed. The examination may be a systematic exam or an assessment that focuses on a certain area or region of the body, often determined through the chief complaint.

Auscultate

To listen to sounds within an organ with a stethoscope

Focused Assessment

A type of physical assessment typically performed on patients who have sustained nonsignificant mechanisms of injury or on nonresponsive medical patients. This type of examination is based on the chief complaint and focuses on one body system or part.

Stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

Breath Sounds

An indication of air movement in the lungs, usually assessed with a stethoscope.

Normal Respiration Range (in breaths/min) for Adults

12 to 20

Normal Respiration Range (in breaths/min) for Adolescents (13 to 18 years)

12 to 16

Normal Respiration Range (in breaths/min) for School-aged children (6 to 12 years)

18 to 30

Normal Respiration Range (in breaths/min) for Preschoolers (4 to 5 years)

22 to 34

Normal Respiration Range (in breaths/min) for Toddlers (1 to 3 years)

24 to 40

Normal Respiration Range (in breaths/min) for Infants

30 to 60

Tidal volume

The amount of air (in milliliters) that is moved into or out of the lungs during one breath

Wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis

Crackles

Crackling, rattling breath sounds that signal fluid in the air spaces of the lungs

Ronchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

Tachycardia

A rapid heart rate, more than 100 beats/min

Bradycardia

A slow heart rate, less than 60 beats/min

Blood Pressure

The pressure that the blood exerts against the walls of the arteries as it passes through them.

For which of the following patients is spinal immobilization clearly indicated?