basic clinical skills lab exam 2

Scene size up

done while approaching patient

• Ppe 

• Scene safety 

• # of patients

• Additional resources → security, physicians, PAs, EMS

Primary assessment

identify immediate life threats to your patient

• General impression

• Mechanism of injury/nature of illness → source of injury/illness

• Responsiveness (LOC)

  • Alert

  • Verbal

  • Painful

  • Unresponsive 

ABC’S

• Airway

• Breathing

• Circulation

• Skin:

Airway

is it patent (clear of obstruction)? Is there swelling? Are they responsive?

Breathing

are they breathing? Is the breathing adequate? Do they require immediate treatment?

Circulation

do they have a pulse? Is it too fast/slow? Critical bleeding?

Skin

• color? Temperature? Condition (diaphoretic, dry)?

• Skin does not lie

• Autonomic nervous system → involuntary

• For darker skinned patients: Check under eyes, Check inner lip 

Glasgow coma score

3-15

Deficits

abnormal function of a body area 

Secondary assessment

• related to the specific problem with the patient 

• Patient history

• Physical examination

• Vital signs

• Diagnostic tests 

Chief complaint

•  what is bothering the patient the most; what brought them in today 

• Only one chief complaint 

• Subjective to patient, could be different than what you think is the bigger issue

Working (differential) Diagnosis

• what your assessment leads you to believe is wrong with your patient 

• Not the same as as an official diagnosis 

• Be flexible 

• Work from most-to-least likely 

• Differential lists of possible diagnoses 

Diagnosis

A label for a condition based on your assessment, patient history, physical exam, and vital signs

Trauma vs. Medical?

• Example. Someone driving a car has heart attack and hits a tree 

• Medical issue becomes a trauma issue 

Trauma Assessments

• D = deformities

  • Musculoskeletal problems 

• C = contusions

  • Bruising 

• A = abrasions

  • Rashes, rug burns

  • Top layer removed

• P = punctures/penetrations

  • Ie. gunshot wound

• B = Burns

  • Second degree = blistering

  • Third degree = charing

• T = tenderness

• L = Lacerations 

• S = swelling/symmetry

myocardial infarction (heart attack)

• Cell death of the heart muscle caused by complete loss of blood flow to area of cardiac muscle

• Fatty deposits in the artery limit the flow of blood (narrows the artery)

• Decreased blood flow leads to chest pain when demand increases

• Full or large occlusions can lead to myocardial infarction

• Dead cells become scar tissue

• Ischemia 

myocardial infarction (heart attack) Signs and symptoms

• Chest pain radiating to jaw and left arm

• shortness of breath

• Syncope (fainting spells)

• Cool,pale, moist or diaphoretic

• Altered mental status

myocardial infarction (heart attack) Differences in women, diabetics, and the elderly

• Nausea

• Vomiting

• Pain in either arm

• Abdominal pain 

• Back pain

• Impending sense of doom

myocardial infarction (heart attack) treatment

• Fibrinolytics = breaks up the clot

•  Percutaneous coronary intervention (PCI) = putting a catheter into the radial artery, stent inserted, opens up the artery, prevents another clot 

heart failure

• Damage, age, or other problems weaken myocardium

• Heart unable to pump effectively

• Fluid backs up into body or lungs → leads to further damage

• Edema symptoms (lower extremity edema, sputum production)

• Left sided heart failure causes pulmonary conditions (pulmonary edema)

• Right sided heart failure causes systemic hypertension (pedal edema)

Atrial fibrillation

• Quivering of the atria du to chaotic electrical activity

• Atrial contractions less effective

• Areas of stagnant blood

• Increases risk for clot formation

• Clots pumped into various parts of the body

• Blocks blood flow to that area

• Brain = stroke

• Lungs = pulmonary embolism

Congestive heart failure

Usually referencing Left sided heart failure episode where the backup is into the lungs

Asthma

• Reactive airway disease 

• A trigger causes constriction and blockage of lower airways

• Episodic disease → asthmatics can lead normal lives with proper care

• Acute asthma attacks can be some of the quickest patients to deteriorate

Asthma Signs and symptoms

• Shortness of breath/respiratory distress

• Wheezing → tends to start on exhalation but can progress to both inhalation and exhalation

• Chest tightness and coughing

• tripoding , accessory muscle use and retractions

• Anxiety, panicking, and fatigue  

Asthma Treatment

• Coach patient through breathing (goal is slow to allow time to exhale)

• If patient appears hypoxic ot in distress gie supplemental oxygen

• Augent oxygen with nebulized breathing treatment (albuterol)

• If patient needs additional support trial CPAP

• If patient is fatigued assist ventilations 

COPD

• Progressive disease and currently has no cure → treatment is aimed at quality 

• Alveolar sacs lose elasticity 

Allergic reactions

• Urticaria → raised bumps, form of edema

• Overreaction

• Exaggerated immune response to a foreign substance

•  Vasodilation 

Treatment

• Epi-pens 

Diabetes

• Normal blood sugar = 70-139 mg.dL

• Hypoglycemia <70 mg/dL

• Hyperglycemia >140 mg/dL

• Clinically significant hyperglycemia >300 mg/dL

Seizures

• Grand mal = jerking movement of body-rigid/tense and then relaxed

• Petit mal = loss of awareness with no other signs 

• Febrile seizures = seizure due to elevated body temp, usually in pediatrics, usually tonic-clonic, usually no big deal

• Status epilepticus = a seizure that “doesn’t stop”, duration over 5 minutes 

Dressing

what you put on the wound

Bandage

what secures and sticks the dressing to the wound

R.I.C.E.S

R = rest; prevents further injury

I = ice; reduces swelling, bleeding, inflammation

C = compression; reduces swelling and bleeding

E = elevation; decrease blood flow and controls edema

S = stabilization; reduces muscle spasm in the injured area by relaxing associated muscles

HbA1C test

A test to see the average blood sugar level of a patient over the past 3 months and is used to see how well a diabetic is managing their blood sugar

normal HbA1C level

below 5.7%

Pre-diabetic HbA1C

5.7%-6.4%

Diabetes HbA1C

6.5% or higher

normal blood glucose range

70-140 mg/dL