kin 220 exam 2

consent

a person who is alert, rational and capable of making informed descions has a legal right to refuse care, a child cannot give…

informed consent

oral consent from the patient or guardian

expressed consent

patient does something to comply with consent like rolling up sleeves..can be verbal or actions

implied consent

when a patient is not capable of giving consent (ill and consent) when situation is urgent

refusal of care

when a patient refuses treatment, transportation or leaves a health care facility against the recommended, clearly documents the events and info provided to he patient 

Good samaritan laws 

protect HCPs and other emergency personnel from being sued because of providing help to a victim an emergency situation

What are the five elements of good samaritan law

1. incident must be an emergency 

2. act of rendering care must be voluntary 

3. person receiving care must be accepting of it (expressed or implied)

4. care provider must be a good faith effort to help 

5. provider must not receive reimbursement for any of the care provided 

to obtain consent one must 

state name, state level of training, ask if you may need help, explain what you plan to do, 

vital signs are 

temperature, respiration, pulse, skin, pupils, blood pressure, pulse oximetry

respiration rate for adults

-for adults the normal range is 12-20 breaths per minute

-respiratory rated that are <8 or >24 are of concern

vital signs where to find pulse

pressure waves generated by the contraction of the left ventricle

-locations are: carotid, femoral, brachial, popliteal, posterior tibial, dorsalis pedis

vital signs-temperature

normal is 98 degrees F

• changes in temp can be reflected in skin temp, digital oral thermometers are also accurate 

• lower temp is often accompanied by chills, teeth chattering, blue lips, goose bumps, and pale skin

what to look for in skin- vital signs 

assess the appearance and condition of the skin looking for color, temp, condition, capillary refill 

skin conditions vital signs

normally skin is dry, but moist skin may indicate shock poisoning or heat-related cardiac, diabetic emergency

-skin that is cool and moist is often described as clammy 

diaphoresis

profuse sweating

capillary refill

the time it takes for compressed capillaries to fill up again with blood

three seconds for females, four seconds in the elderly, 2 secs for infants children and male adults 

how do pupils react

constricted pupils may indicate use of a depressant drugs, dilated pupils may indicate head injury, shock or use of stimulant, response is more important then size 

what is blood pressure

blood pressure is the force of blood against arterial walls, females are usually 8 to 10mmHg less 

systolic blood pressure 

the higher-pressure present during contraction of the left ventricle

diastolic blood pressure

reflects vascular resistance and blood volume, the pressure present during relaxation of the left ventricle

pulse oximeter

is the blood oxygen saturation assessment (amount of oxygen circulating in blood) indications for pulse oximetry)should be a standard measure in patients along with respiration, pulse, skin, pupils, and blood pressure

limitations of the pulse oximeter 

conditions that interfere with blood flowing to the area where the probe is attached may produce an erroneous reading 

if the oximeter is also not accurately reading the blood flow and oxygen saturation 

when would an oximeter reading be in accurate

shock, hypothermia, excessive patient movement, nail polish, carbon-monoxide exposure, anemia 

pain scale 

several scales exist like the visual analogous scale, and wrong-baker faces scale

-0, 2, 4, 6, 8, 10 

how to reduce patients anxiety when taking patient history

introduce yourself

gain patients consent 

position yourself at eye level and use communication

use touch when appropriate 

obtaining history from patient

typically begins with determining the cheif complaint and associated signs and symptoms

obtain info about the demographic info, present illness, significant past medical history, and current health status 

taking history demographic info 

you’ll need date, time, patients identify data, their current health status, current medication, tobacco use, allergies/medication

Current health status

alchohol, drugs, and related substances, diet, recent screening tests, immunizations, environmental hazards, use of safety equipment, family history, 

technique for patient history

note-taking; document the info the patient provides as accurately as possible. Types of questions; open ended questions can yield more info, close ended questions are also useful 

facilitation; active listening technique

use phrases such as i’m listening or go on

reflection

repeating a patients words back to them

empathetic responses

use phrases such as I understand or I see how that would be difficult

confrontation  

if patients are being untruthful; you said you have never been to the doctor…

interpretation

Next level of confrontation  “Are you afraid your
current medical condition is worsening, and you might have
to be admitted to the hospital?”

taking the history SAMPLE

commonly used in emergency medicine and used when time is a factor or non-specific concerns

S-signs and symptoms

A-allergies

M-medication

P-past medical history 

L-last oral intake 

E-events leading to

assessing patient complaints: OPQRST

the mnemonic helps you evaluate the signs an symptoms, used for specific issues, differentiating causes, or focused exams

O-onset

P-rovocation

Q-uality

R-adiation 

S-everity

T-iming

Sample

sample pros: quick, broad, useful for emergencies, flexible

Sample Cons: does not explore a symptom in detail, may miss nuances of pain

OPQRST

OPQRST Pros: focused, more detailed for clarity, structured

Cons: Narrow scope, Patient must be conscious

what to do when asking sensitive topics

remain non judgmental and ask only questions that pertain directly to the medical history or patient care and respect their privacy

special challenges

silence, overly talkative patients, patients with multiple symptoms, anxious patients, angry patients, intoxication, crying patients

steps for sizing up the scene

1. evaluate scene hazards and ensure scene safety

2. take necessary standard pre causations

3. form an initial impression by looking for signs of life-threating emergency

4. determine the mechanism injury or nature of illness 

5. establish the number of patients 

6. identify the need for additional resources  

Primary assessment

performed initially to establish presence of life-threatening condition

airway, breathing, circulation, shock, and severe breathing, used to correct life-threatening conditions contact EMS 

Secondary assessment

Life-threatening condition ruled out, gather specific info about illness or injury, assess vital signs and perform more detailed evaluations of conditions that do not pose life-threatening consequences 

the first step in primary assessment is form a general impression of patient what should be done

develop a general impression of the patients condition as you approach and determine if they are stable or unstable 

1-5 chart of forming an assessment of a patient 

1. does the victim appear sick? is skin abnormal 

2. is the victim awake and moving

3. is the victim unresponsive 

4. determine whether the patient is a trauma or medical patient 

5. is the victim bleeding?

injured or ill?: if injured

penetrating trauma is a force that pierces the skin and body issues

blunt trauma is caused by a force that impacts the boy but doesn’t penetrate it

Injured or Ill: Illness

the environment may offer clues that he patient is suffering from a medical problem

obtain the chief complaint

the chief complaint is a concise statement about the main problem, trauma patients may have an observable chief complaint

immediate life threats include

• An airway that is compromised by blood, vomit, secretions, the tongue, bone, teeth, etc objects

• obvious open wounds to the chest 

• paradoxical movement of a segment of the chest..inward movement on inhalation and outward movements  

• major bleeding..steady flow or spurting 

• unresponsive with no breathing or no normal breathing agonal or gasping breaths 

assess level of consciousness

A-ALERT

V-VERBAL STIMULUS

P-PAINFUL SIMULUS

U-UNRESPONSIVE

alertness and orientation

if the patients eyes are open and they can speak as you approach them, you might assume that the patient is alert 

responsiveness to verbal stimuli

patient opens his eyes and responds or attempts to respond to your voice, if the patient does not speak, see if he will follow a command 

responsiveness to a painful stimulus

If the patient doesn’t respond to verbal stimuli, try a painful
stimulus.
• Methods of applying painful stimuli include:
• Trapezius or armpit pinch
• Supraorbital pressure
• Sternal rub or earlobe pinch
• Nail-bed pressure
• Pinch the webbing between the thumb and index finger

unresponsiveness 

a patient who does not respond to verbal stimuli is unresponsive, they are high priority for emergency care and transport 

altered mental status

the patient who is not alert but responds to either verbal or painful stimuli, they are not completely unresponsive but like the unresponsive patient, may be prone to airway compromise

documenting level of responsiveness 

be specific in documenting level of responsiveness to establish a baseline for later comparison 

-the AVPU check is performed to quickly establish a baseline for mental status 

asses life hreatning external bleeding

assessment should be completed quickly before addressing airway or breathing because significant blood loss can occur, shock or death

manual stabilization-cervical spine

hold patients head firmly with both hands, support the lower jaw, maintain position until patient is secured to a backboard

what scales do you use when assessing responsiveness

AVPU or glasgow coma scale

Glascow coma scale GCS

i assesses level of impaired consciousness in acute medical and trauma patients

-eye opening 1 to 4=open spontaneously

-verbal stimulus 1=none to 5=oriented

-motor stimulus 1 to 6=obey commands

assess the airway determine airway status

an occluded airway is an immediate threat to life, a patient who is alert and talking without signs of distress has sufficient airflow passing through the respiratory system  and use AVPU to gather info

signs and symptoms of complete airway obstruction

unable to breathe or speak, agitated and distressed, grips the throat, cyanosis, loss of consciousness

additional sounds that may indicate partial airway obstruction

snoring-rough sounds of inspiration or exhalation

gurgling-a sound similar to air rushing through water on inspiration and exhalation liquid in the airway

crowing- a sound like a crawing crow on inspiration swelling or muscle spasm of the airway

stridor-harsh, high-pitched whistling sound on inspiration

wheezing- high pitches whistling sound on inspiration

checking an unresponsive paients airways

head tilt, chin lift technique, only use if no head, neck or spinal injury, jaw thrust maneuver, use if suspect neck or spinal injury 

airway 

maintain an open airway, using suction or oral or nasal airway, if necessary, administer high-concentration oxygen 10-15L/min using a face mask with oxygen reservoir, treat critical chest injury

breathing & Circulation

look, listen, and feel no more than 10 seconds , look for chest to rise and fall, listen and feel for air escaping through mouth and nose

primary assessment of circulation 

1. assess for presence or absence of pulse 

2. assess for possible major bleeding 

3. assess skin color, temperature and condition 

4. assess capillary refill 

the main purpose for checking circulation are to determine whether the heart is beating, any severe bleeding, and whether blood is circulating adequately 

unresponsive and adequate breathing

place the patient in the recovery position if they are

-unresponsive, but breathing adequately, not suspected of having a spinal injury

-gather all info and establish priority and status of each patient

determine priority of patient care and transport CUPS call 911

C- critical

U- unstable

P- potentially unstable

S- stable

what parts are in the upper airways

nasopharynx: nasal cavity and soft palate, pharynx, mouth

what parts are in the lower airway

larynx; houses vocal cords, trachea; extends from larynx, bronchioles, and alveoli 

alveoli

tiny air sacs of lungs(gas exhange)

bronchioles

small air passageway

order of anatomy of lungs

pharynx—larynx—-trachea—-bronchi—-bronchioles—-alveoli

what’s needed for effective breathing

-cells need oxygen to survive, o2 reaches the cells through breathing and circulation, occurs in he lungs between alveoli and capillaries

progression of respiratory emergencies 

respiratory distress—respiratory failure—respiratory arrest 

respiratory distress

patient is compensating breathing is difficult, administer oxygen to maintain an 94% or higher

common causes of respiratory distress

narrowing of the bronchioles from inflammation, swelling, or bronchoconstriction(illness,asthma)

-injuries to the head, neck, face, spine, chest, or abdomen, cardiac compromise, hyperventilation

clinical presentation of respiratory distress

inadequate breathing leads to hypoxia SpO2<94%, slow or rapid breathing, unusually deep or shallow breathing, dizzines, drowsiness, changes in levels of consciousness, increased heart rate, chest pain

hypoxia

body and tissues do not have enough oxygen, develops quickly in people who are not breathing adequately

symptoms: restlessness, anxiety, tachycardia

respiratory failure

rate, tidal volume(amount of air that moves in/out of the lungs in each cycle) or both are inadequate

may deteriorate to respiratory arrest 

common causes of respiratory failure

• conditions affecting nerves/muscles:muscular dystrophy, ALS, spinal cord injuries and stroke

• damage to tissues and ribs around lungs, injuries/trauma to chest

• drug or alchohol overdose 

• lung disease COPD, pneumonia

what to do when suffering from respiratory failure

if the tidal volume decreases or the respiratory rate increases or decreases significantly, you must provide immediate positive pressure, ventilaion and oxygenation with a bag-valve mask device, supplemental oxygen must be delievered through ventilation device 

clinical presentation of respiratory failure

shortness of breath, rapid breathing, accessory muscle use, air hungry, cyanosis of skin lips and fingernail tips, confusion, seizures, sleepiness and loss of consciousness

resipratory arrest

cessation of respiratory effort, leads to cardiac arrest in minutes, immediately interven with a bag-valve mask ventilations and supplement oxygen

Asthma

chronic airways obstrucion inflammation of airways, bronchospasms

common triggers of asthma

exercise, allergens, pollen, cold or dry skin, chemicals, stress and anxiety

signs and symptoms of asthma

shortness of breath, dyspnea, wheezing, dry cough, productive cough

exercise-induced bronchospasm

aerobic exercise can trigger airway hyperactivity with symptoms occurring within 10-15minute activity 

treatment of exercise induced bronchospasm

inhaled beta-agonist 15-30mins prior to exercise onset, pre warm up burst of physical activity at 80-90% max, nebulizer

what is hyperventilation

increased respiratory rate leading to decreased blood carbon dioxide

predisposing factors of hyperventilation

anxiety, increased activity, poor conditioning, fear, sometimes used as pre-race strategy

symptoms and signs of hyperventelation

symptoms: lightheadedness, numbness, tingling, air hunger

Signs: extremely anxious/panicked appearing, increased respiratory rate, shallow breathing, may have stridorous, increased heart rate

what are examples of viral respiratory infections 

colds, the flu, SARS-Covid and bronchiolitis, usually mild but significant infections can occur and asses for treatment both hypoxia and respiratory distress, symptoms of viral infections

Treatment of Viral Respiratory infections

supplemental oxygen as needed (maintain 94% or greater ) contact EMS for medication administration in patients with potential deterioration 

Bronchitis 

Chronic or acute inflammatory condition of the bronchial passages, acute bronchitis is caused by self-limited viral infections, but can come from bacterial sources in smokers and those chronic obstructive pulmonary disease

signs and symptoms of bronchitis

upper respiratory tract infection, productive cough with clear/yellow sputum, mild shortness of breath, chest tightness, lung sounds of crackles or rhonchi

pneumonia

any condition that result in the inflammation of the lung parenchyma from viral, bacterial, or fungal pathogens 

signs and symptoms of pneumonia 

short/labored breathing, chest pain, productive cough, dark discolored sputum, abnormal breath sounds 

pulse oximeter ranges

-normal: 95%-100% no device needed

-mild hypoxia: 91%-94% need nasala canuula

-Mild-moerate hypoxia: 88%-92% simple oxygen mask

-moderate hypoxia: 86%-90% non-rebreather mask or bag-valve mask

-severe Hypoxia: <85% non-breather mask or bag-valve