CH 11 Patient Assessment

What is the first step in determining a patient's condition?

Qualify whether the patient is sick or not sick.

What should you do if the scene is unsafe?

Take necessary actions to make it safe.

What is the first priority in patient assessment?

Your own safety and the safety of other EMS team members.

What should you treat all patients as?

Potentially infectious.

What indicates an open and patent airway?

Crying or talking from the patient.

What should you assess regarding breathing?

Breathing rate, work of breathing, chest rise and fall, and lung sounds.

What should you look for during circulation assessment?

Major hemorrhage or life-threatening injury.

What indicates a weak pulse?

A thready pulse.

What does a bounding pulse indicate?

Hypertension.

What should you assess to evaluate perfusion?

Skin color, temperature, and condition.

What should you do if a patient has inadequate circulation?

Restore or improve circulation and control severe bleeding.

What should you do if you cannot feel a pulse?

Begin CPR until an AED or manual defibrillator is available.

What is a key technique for dealing with sensitive topics?

Talk to the patient in private.

What is required by law in cases of physical abuse or sexual assault?

You are required to report it.

What should you do if a patient becomes seductive?

Firmly make it clear that the relationship is professional.

What should you consider when gathering information from third parties?

The further from the primary source, the greater the chance of inaccuracies.

What should you consider regarding dietary practices in cultural competence?

Consider dietary practices when providing care.

What does social history encompass in a medical context?

It includes the patient's occupation, lifestyle, and chronic exposures.

What should you consider when assessing geriatric patients?

They may present a variety of medical and traumatic conditions and often have multiple problems.

What is a life-threatening mechanism of injury (MOI) for trauma patients?

Falls greater than 20 feet for adults or greater than 10 feet for children.

What is a high-priority MOI for infants or children?

Falls from more than 2-3 times the child's height.

What should you determine in a motor vehicle crash (MVC)?

Whether seat belts and/or air bags were involved.

What general symptoms should be assessed?

Fever, chills, malaise, fatigue, night sweats, and weight variations.

What skin-related symptoms should be inquired about?

Rash, itching, hives, or sweating.

What musculoskeletal symptoms should be evaluated?

Joint pain, loss of range of motion (ROM), swelling, redness, erythema, localized heat, or deformity.

What symptoms are associated with the head and neck?

Severe headache or loss of consciousness.

What eye symptoms should be assessed?

Visual acuity, blurred vision, diplopia, photophobia, pain, and flashes of light.

What ear symptoms should be evaluated?

Hearing loss, pain, discharge, tinnitus, and vertigo.

What nasal symptoms should be inquired about?

Sense of smell, rhinorrhea, obstruction, epistaxis, postnasal discharge, and sinus pain.

What throat and mouth symptoms should be assessed?

Sore throat, bleeding, pain, dental problems, ulcers, and changes to taste sensation.

What endocrine symptoms should be evaluated?

Enlargement of the thyroid gland, temperature intolerance, skin changes, swelling of hands and feet, weight changes, polyuria, polydipsia, polyphagia, and changes in body and facial hair.

What chest and lung symptoms should be assessed?

Dyspnea, chest pain, coughing, wheezing, hemoptysis, and tuberculosis status.

What hematology and lymph node symptoms should be evaluated?

Anemia, bruising, fatigue, and tender or enlarged lymph nodes.

What gastrointestinal symptoms should be inquired about?

Appetite, digestion, food allergies, heartburn, nausea, vomiting, diarrhea, hematemesis, bowel irregularity, changes in stool, flatulence, jaundice, and past GI evaluations.

What genitourinary symptoms should be assessed in women?

Menstrual cycle regularity, last period, dysmenorrhea, last sexual intercourse, number of partners, contraception use, and pregnancy history.

What genitourinary symptoms should be assessed in men?

Erectile dysfunction, fluid discharge, testicular pain, last sexual encounter, condom use, and characteristics of discharge or lesions.

What neurologic symptoms should be evaluated?

Seizures, syncope, loss of sensation, weakness, paralysis, loss of coordination or memory, muscle twitches, and facial asymmetry.

What psychiatric symptoms should be assessed?

Depression, mood changes, difficulty concentrating, anxiety, irritability, sleep disturbances, fatigue, and suicidal or homicidal tendencies.

What should be assessed when measuring pulse?

Rate, presence, location, quality, and regularity.

What should be checked in unresponsive patients?

Check for central pulse.

What are signs that indicate respiratory distress?

Tripod positioning, accessory muscle use, and retractions.

What is blood pressure a product of?

Cardiac output and peripheral vascular resistance.

What does pallor indicate?

Poor red blood cell perfusion to the capillary beds.

What does cyanosis indicate?

Low arterial oxygen saturation.

What is ecchymosis?

Localized bruising or blood collection within or under the skin.

What should be inspected on the head?

Deformity, asymmetry, tenderness, and shape.

What should be evaluated in the eyes?

Visual acuity, pupil reaction, and muscle movement.

What should be looked for during a nasal assessment?

Asymmetry, deformity, wounds, foreign bodies, discharge or bleeding, tenderness, and evidence of respiratory distress.

What should be assessed in the neck?

Symmetry, masses, venous distention, carotid pulses, and suprasternal notch.

What are indications for spinal immobilization?

Tenderness on palpation, complaint of pain, altered mental status, inability to communicate, GCS less than 15, distracting injury, paralysis, or neurologic deficit.

What should be done if pain or tenderness occurs during cervical spine examination?

Stop the examination.

What are the three phases of a chest exam?

Chest wall exam, pulmonary evaluation, and cardiovascular assessment.

What signs should be checked during a chest assessment?

Signs of abnormal breathing, ventilatory fatigue, accessory muscle use, and chest deformities.

What should be palpated during a chest examination?

Abnormal areas of the chest wall.

What types of breath sounds should be auscultated?

Normal, tracheal, bronchial, bronchovesicular, vesicular, and adventitious sounds.

What are Korotkoff sounds related to?

Blood pressure measurement.

What does Phase I of Korotkoff sounds indicate?

Clear, faint, tapping sounds correlating to systolic contraction.

What does Phase V of Korotkoff sounds indicate?

All sounds disappear, correlating to diastolic pressure.

What is a bruit?

An abnormal 'whooshing' sound due to turbulent blood flow through a narrowed artery.

What is a murmur?

An abnormal 'whooshing' sound due to turbulent blood flow around a cardiac valve.

What should be assessed regarding arterial pulses?

They are an expression of systolic blood pressure and should be palpable where the artery crosses a bony prominence.

What does jugular venous distention (JVD) indicate?

May indicate cardiac tamponade with penetrating left chest trauma or heart failure with pedal edema.

What factors may compromise an older patient's ability to compensate for cardiovascular insult?

Arterial atherosclerosis, diabetes, and medications for high blood pressure.

What should be done with arterial pulses during assessment?

Pay attention to them, obtain blood pressure, and repeat the measurement.

What should be palpated and auscultated during cardiovascular assessment?

Carotid arteries.

What are the key assessments for a suspected heart problem?

Pulse, skin, breath sounds, baseline vital signs, extremities.

How is the abdomen divided for assessment?

The abdomen can be divided into quadrants or ninths.

What organs are contained in the abdomen?

Almost all organs of digestion, organs of the GU system, and significant neurovascular structures.

What is the peritoneum?

A well-defined layer of fascia made up of parietal and visceral peritoneum.

What are the three basic mechanisms that produce abdominal pain?

Visceral pain, inflammation, and referred pain.

What is the purpose of orthostatic vital signs?

To determine the extent of volume depletion by measuring blood pressure and pulse in different positions.

What indicates a positive orthostatic vital sign test?

Decrease in systolic pressure, increase in diastolic pressure of 10 mm Hg, and increase in pulse rate by 20 beats/min.

How can the abdomen be described during inspection?

Flat, rounded, protuberant, scaphoid, or pulsatile.

What is ascites?

Fluid within the peritoneal cavity, which may cause abdominal distension.

What signs may indicate ruptured ectopic pregnancy or acute pancreatitis?

Cullen sign or Grey Turner sign.

What is the utility of auscultation in abdominal assessment?

To note the presence or absence of bowel sounds and detect bruits.

What should be palpated during abdominal assessment?

Each quadrant gently but firmly, noting guarding, rebound tenderness, and localized tenderness.

What is the technique to palpate the liver?

Place left hand behind the patient, right hand on the abdomen below the rib cage, and ask the patient to take a deep breath.

What indicates possible inflammation when palpating the gallbladder?

Pain response when the patient takes a deep breath.

How should the spleen be palpated?

Reach over with the left hand and press forward on the lower left rib cage while pressing with the right hand below the costal margin.

What is an aortic aneurysm?

A pulsating mass seen in the upper midline of the abdomen; do not palpate an obvious pulsatile mass.

What are the reasons for examining female genitalia?

Life-threatening hemorrhage and imminent delivery in childbirth.

What are possible reasons for pain on palpation of female genitalia?

Ectopic pregnancy, complications of third trimester pregnancy, nonpregnant ovarian problems, pelvic infections.

What should be assessed in male genitalia?

Bleeding, injury, fracture, inflammation, discharge, swelling, lesions, and signs of priapism.

What is the significance of examining the anus?

To assess for bleeding control or other interventions, especially in conjunction with genitalia examination.

What are the components of the musculoskeletal system?

Joints, skeletal muscles, and associated structures.

What are common injuries in the musculoskeletal system?

Fractures, sprains, strains, dislocations, contusions, hematomas, and open wounds.

What should be noted during musculoskeletal assessment?

Structure and function, limitations or pain in range of motion, bony crepitus, inflammation, obvious deformity, diminished strength, atrophy, asymmetry, and pain.

What should be assessed in the shoulders during musculoskeletal examination?

Posture, sternoclavicular joint, acromioclavicular joint, subacromial area, and bicipital groove.

What is the range of motion assessment for the elbows?

Flex and extend passively and actively, and pronate the forearms while flexed.

What should be assessed in the hands and wrists?

Palpation of the hands and carpal bones, and range of motion including making fists and extending fingers.

What is the technique for assessing knees and hips?

Ask the patient to bend each knee and raise toward the chest, and assess for rotation and abduction.

What is the purpose of palpating the pelvis?

To assess for abnormalities or injuries.

What should be assessed when evaluating the ankles and feet?

Range of motion, including plantar flexion, dorsiflexion, inversion, and eversion.

What does the peripheral vascular system comprise?

Aspects of the circulatory system and the lymphatic system.

What are the five Ps of acute arterial insufficiency?

Pain, Pallor, Paresthesia, Paresis, Pulselessness.

What should be noted during the assessment of lower extremities?

Temperature of feet and legs, palpation of edema, and palpation of superficial inguinal lymph nodes.

What are the three types of spinal deformities to inspect?

Lordosis, Kyphosis, Scoliosis.

What should be done if pain or tingling is elicited during spine evaluation?

Stop the exam and immobilize the spine.

What are the two divisions of the nervous system?

Voluntary nervous system and involuntary (autonomic) nervous system.