CRITI CARE EMS - PRIMARY CARE PARAMEDIC Performance Checklist

Flashcards covering pupil assessment, Glasgow Coma Scale (GCS), AVPU Scale, and levels of consciousness for Primary Care Paramedic training.

Pupil Assessment

The evaluation of pupil size, symmetry, and reactivity to light by a Primary Care Paramedic.

Unusually small pupils

May indicate narcotic effects or bleeding within the pons.

Unusually large pupils

May indicate alcohol ingestion.

Fixed and dilated pupils

Suggest brain death.

Pupil size measurement

Measured in millimeters (mm).

Unequal pupils

May indicate pathologies such as brain lesions, meningitis, drug poisoning, third-nerve paralysis, and increasing intracranial pressure, though normal in 20% of patients.

Direct response (pupils)

When pupils react to light equally, observed by shining a light into one eye and observing its response.

Consensual response (pupils)

Observed by shining a light into one eye and observing the other eye's reaction.

Bilaterally sluggish pupils

Usually suggest decreased blood flow to the brain and hypoxia.

PERL

Acronym for 'Pupils Equal and Reactive to Light'.

Glasgow Coma Scale (GCS)

A scale used to assess a patient's level of consciousness, independently measuring Motor Responsiveness, Verbal Response, and Eye Opening.

GCS - Eye Opening: Spontaneous

Eyes open without stimuli, scored as 4.

GCS - Eye Opening: Speech

Eyes open in response to verbal stimuli, scored as 3.

GCS - Eye Opening: Pain

Eyes open in response to painful stimuli (e.g., fingertip pressure, trapezius squeeze), scored as 2.

GCS - Eye Opening: No Response

Eyes do not open to speech or pain, scored as 1.

GCS - Verbal Response: Alert & Oriented

Patient is engaged in conversation and oriented, scored as 5.

GCS - Verbal Response: Confused/Disorientated Conversation

Patient is confused or disoriented during conversation, scored as 4.

GCS - Verbal Response: Inappropriate Words / Nonsensical Speech

Patient uses inappropriate words or nonsensical speech, scored as 3.

GCS - Verbal Response: Incomprehensible Sounds

Patient makes incomprehensible sounds, scored as 2.

GCS - Verbal Response: No Response

Patient has no verbal response, scored as 1.

GCS - Motor Response: Obeys Commands

Patient performs requested actions (e.g., 'Lift your right arm off the bed and make a fist'), scored as 6.

GCS - Motor Response: Locals to Pain

Patient moves to painful stimulus, scored as 5.

GCS - Motor Response: Withdraws from Pain

Patient pulls away from painful stimulus, scored as 4.

GCS - Motor Response: Abnormal Flexion

Patient exhibits abnormal flexion to painful stimulus, scored as 3.

GCS - Motor Response: Abnormal Extension

Patient exhibits abnormal extension to painful stimulus, scored as 2.

GCS - Motor Response: No Response

Patient has no motor response, scored as 1.

Adjusted GCS

A modified Glasgow Coma Scale score specifically for infants and children.

AVPU Scale

A method of assessing a patient's mental status based on four determinants of response: Alert, Verbal Response, Painful Response, and Unresponsive.

AVPU - Alert

Patient is aware of the responder, can respond to the environment, obey commands, spontaneously open eyes, and follow objects.

AVPU - Verbal Response

Patient's eyes are not spontaneously open but open in response to a direct verbal stimulus, and they react meaningfully to it.

AVPU - Painful Response

Patient's eyes are not spontaneously open but respond to a painful stimulus (e.g., moaning, crying, or moving) applied by a responder.

AVPU - Unresponsive

Patient does not respond spontaneously and does not respond to verbal or painful stimuli.

Normal consciousness

Persons are alert, awake, aware of both self and environment, and respond to external stimuli.

Drowsiness or Obtundation

Consciousness is clouded, attentiveness impaired, thinking is slower, spontaneous movement diminished, responsive to stimuli but tending to fall asleep afterward.

Stupor or Stuporous

Marked reduction in mental and physical activity; vigorous stimuli like pain are needed to elicit reduced, slowed, inadequate, or absent responses (with reflex activity preserved).

Coma

Complete unconsciousness; cannot be aroused even by painful stimuli, no voluntary movements; reflex activity may be preserved in light coma but lost in deep coma.

Delirium

Involves level of consciousness but is classified separately due to additional characteristics; does not fit neatly on the consciousness continuum.

Trapezius squeeze

A painful stimulus applied by squeezing one of the patient's trapezius muscles, used in GCS and AVPU assessments.

Coma (GCS Score)

Applies when a patient's total Glasgow Coma Scale score is 7 or lower.