24 | Primary Assessment

primary assessment

identifying and immediately correct life-threatening conditions of the pt's airway, breathing, or circulation

general imperssion

first, intuitive evaluation of the patient

AVPU

mental status assessment acronym

alert

AVPU - A

verbal stimuli

AVPU - V

painful stimuli

AVPU - P

unresponsive

AVPU - U

person, place, time, situation

people can be oriented to …

alert

pts whose eyes are open and who appear to be awake are categorized as …

responsive to verbal stimuli

patients who appear to be sleeping but responding when spoken to are considered …

responsive to painful stimuli

patients who are not responsive when spoken to, but responsive when a pain response is stimulated are considered …

purposeful or nonpurposeful

note the type of motor response to the painful stimuli: is it … ?

decorticate posturing

arms flexed, legs extendeddec

decerebrate posturing

arms and legs extendedde

serious brain injury

decorticate or decerebrate posturing is nonpurposeful and suggests a …

flick the soles of the feet

for the infant, … and expect crying as the appropriate response

unresponsive

a patient who is comatose and fails to respond to any noxious stimuli

emergent or already serious problem

any alteration or deterioration in mental status can indicate an …

patent

if the pt is responsive and can speak clearly, assume the airway is …

tongue

the supine unconscious pt's … often obstructs the upper airway

jaw-thrust maneuver

Which airway-opening maneuver should be used when a cervical spine injury is suspected?

head-tilt/chin-lift maneuver

Which airway-opening maneuver should be used when cervical spine injury is not suspected?

head-tilt/chin-lift maneuver

Which airway-opening maneuver should be used if a jaw thrust fails to open the airway?

gentle head extension

How should the airway be opened in an infant or young child?

look, listen, and feel

How should airway patency be assessed after opening the airway?

snoring

What airway sound indicates the tongue is partially obstructing the upper airway?

reposition the head and neck

What should be done first if snoring is heard during airway assessment?

gurgling

What airway sound indicates blood, secretions, vomit, or gastric contents are obstructing the airway?

aggressive suctioning

What intervention should be used to remove blood, vomit, secretions, and other fluids from the airway?

stridor

What high-pitched inspiratory sound indicates a life-threatening upper airway obstruction?

foreign body obstruction

What is the most common cause of sudden-onset stridor while eating?

abdominal thrusts

What intervention should be performed for a conscious patient with severe foreign body airway obstruction and poor air movement?

back blows and chest thrusts

What intervention should be used instead of abdominal thrusts for an infant with foreign body airway obstruction?

Magill forceps

What instrument is used under direct laryngoscopy to remove a foreign body from the airway?

croup

Which upper airway infection causing stridor may be treated with vaporized epinephrine?

epiglottitis

Which upper airway infection causing stridor is associated with fever, drooling, and inability to swallow?

respiratory burns

Which cause of stridor requires rapid endotracheal intubation because of airway swelling?

anaphylaxis

Which cause of stridor requires vasoconstrictor medications to decrease airway swelling?

wheezing

What expiratory airway sound is caused by constricted bronchioles?

albuterol and ipratropium

Which aerosolized medications are commonly used to treat wheezing caused by bronchospasm?

respiratory arrest

What condition is present when a patient has a pulse but is not breathing?

bag-valve mask ventilation

What should be initiated immediately for a patient in respiratory arrest?

10-12 breaths/min

What is the recommended ventilation rate for adults receiving rescue breathing?

12-20 breaths/min

What is the recommended ventilation rate for children receiving rescue breathing?

complete airway obstruction

What should be suspected if repositioning the head and neck still does not produce air movement during ventilation?

mouth-to-mouth ventilation

Which infant ventilation technique requires pinching the nose closed?

mouth-to-nose ventilation

Which infant ventilation technique requires closing the mouth?

oropharyngeal airway

Which airway adjunct should be used in an unconscious patient without a gag reflex?

nasopharyngeal airway

Which airway adjunct is preferred for patients with an intact gag reflex or significant orofacial trauma?

basilar skull fracture

Which injury is a contraindication or major precaution for nasopharyngeal airway insertion?

endotracheal intubation

Which advanced airway technique provides definitive airway control?

multilumen airways

Which advanced airway devices are not appropriate for use in children?

cricothyrotomy

Which emergency airway procedure creates a surgical airway through the neck?

supplemental oxygen

What should be administered if pulse oximetry is below 95%?

altered mental status

What neurologic finding is an early sign of inadequate breathing?

retractions

What visible sign of increased work of breathing occurs when accessory muscles pull the chest inward?

accessory muscle use

What physical finding indicates increased work of breathing?

cyanosis

What skin color change suggests hypoxia?

nasal flaring

What breathing sign is commonly seen in respiratory distress, especially in children?

tachypnea

What term describes an abnormally rapid respiratory rate?

hyperpnea

What term describes deep respirations that compensate for metabolic acidosis?

Kussmaul respirations

What breathing pattern consists of deep, rapid respirations often accompanied by a fruity breath odor in diabetic ketoacidosis?

Cheyne-Stokes respirations

What breathing pattern consists of progressively increasing and decreasing respirations followed by apnea?

Biot respirations

What breathing pattern consists of irregular gasping respirations and suggests severe brain injury?

CPAP

Which respiratory device provides continuous positive airway pressure to keep lower airways open?

sucking chest wound

What chest injury should immediately be covered with an occlusive dressing taped on three sides?

occlusive dressing taped on three sides

What dressing should be applied to an open pneumothorax?

tension pneumothorax

Which life-threatening chest injury presents with absent breath sounds on one side, distended neck veins, and unequal chest expansion?

needle decompression

What emergency procedure is performed for a tension pneumothorax?

second intercostal space, midclavicular line

Where should needle decompression traditionally be performed for a tension pneumothorax?

flail chest

Which chest injury with paradoxical movement may require positive-pressure ventilation?

pulse oximetry

Which monitoring device measures oxygen saturation?

continuous waveform capnography

Which monitoring device evaluates ventilation and provides information about circulation?

radial pulse

Which pulse should be assessed first in adults during the circulation assessment?

carotid pulse

Which pulse should be checked if the radial pulse is absent?

brachial pulse

Which pulse is preferred for circulation assessment in infants?

chest compressions

What should be started immediately if a patient is pulseless?

tachycardia

What term describes an abnormally fast heart rate?

bradycardia

What term describes an abnormally slow heart rate?

synchronized cardioversion

What intervention is indicated for an unstable patient with tachycardia?

atropine

Which medication is commonly administered for symptomatic bradycardia?

external cardiac pacing

What intervention may be required if symptomatic bradycardia does not respond appropriately?

irregular pulse

What pulse quality may indicate a cardiac arrhythmia?

bounding pulse

What pulse quality is commonly associated with head injury, heat stroke, or hypertension?

thready pulse

What pulse quality usually indicates poor perfusion?

direct pressure

What is the first method used to control external hemorrhage?

tourniquet

What device should be applied if severe extremity bleeding cannot be controlled with direct pressure?

hemostatic agents

What should be used to control bleeding in areas where a tourniquet cannot be applied?

internal bleeding

What type of hemorrhage cannot usually be controlled in the prehospital setting and requires rapid transport?

cool, clammy skin

What skin finding commonly indicates shock and peripheral vasoconstriction?

mottled skin

What blotchy skin appearance suggests poor peripheral perfusion?

capillary refill

What is a reliable indicator of circulatory function in infants and young children?

primary assessment

What assessment is performed to identify and immediately correct life-threatening conditions?

less than 1 minute

How long should a systematic primary assessment typically take?

rapid head-to-toe assessment

What assessment should immediately follow the primary assessment if a serious illness or injury is suspected?

Glasgow Coma Scale <14

According to CDC field triage guidelines, what GCS score indicates transport to the highest-level trauma center?

systolic blood pressure <90 mmHg

According to CDC field triage guidelines, what blood pressure indicates transport to the highest-level trauma center?

respiratory rate <10 or >29 breaths/min

According to CDC field triage guidelines, what adult respiratory rates require transport to the highest-level trauma center?

penetrating injuries to the head, neck, torso, or proximal extremities

Which penetrating injuries meet Step 2 trauma triage criteria?

pelvic fracture

Which skeletal injury automatically meets Step 2 trauma triage criteria?