8-12 Primary, history, vitals, physical exam

5 people I must consider in SSU- in order

Me

Partner

Other responders

PT

Bystanders

steps in primary assessment

1. General impression

2. C-spine if applicable

3. Patient status- CC

4. LOC

5. Airway

6. breathing

7. Circulation

8. Disability- GCS and AVPU if not already done.

9. Prioritization

10. Resuscitation

what would a patient supine or lateral with bent knees possibly mean?

Abdominal pain

describe decorticate and decerebrate posturing and what they indicate

decorticate- arms flexed, fists clenched, legs extended. Indicates increased ICP, cerebral cortex, and mid brain injury

decerebrate- arms and legs rigidly extended and pronated. Also indicates increased ICP but with extension of injury to the brain stem. More serious

Opisthotonos- what is it and what causes it

neck bridging- back arched with only occiput touching the bed

PCP OD, meningitis, severe tetanus, strychnine poisoning

torticollis

AKA wry neck

unilateral sternocleidomastoid muscle spasm- phenothiazines and PCP, congenital

jaundice causes and other name

AKA- icterus

liver failure, anemia, various drugs, bile duct issues, yellow fever, TB, malaria

what causes grunting

dyspnea requiring increased expiratory pressure (basically a form of PEEP)

indicators of of inadequate respirations

rate >24 or <8

rhythm

rise

what is belly breathing- specifically when its bad

diaphragm breathing only- cervical cord injury

what is the term “time critical diagnosis” and some examples

a field working impression where the morbidity or mortality of the pt outcome is time dependent

CVA, STEMI, critical trauma, acute surgical emergencies (internal bleeding)

if you check cap refill, where should you check

central (chest) and peripheral

ideally same with pulses…

where do you listen to heart sounds`

apical heart tones: over apex, 5th ICS MCL

what is a pulse deficit and what can cause it

when there is a difference between apical and peripheral HR

abnormal heart rhythms or contractions are too week to make it to peripheral arteries

ex.

Apical- 100

peripheral- 75

Pulse deficit- 25

Pulsus parodoxus what is it and causes

Difference in pulse strength during respirations, stronger with exhalation and weaker with inhalation

asthma, COPD, tension pneumo, cardiac tamponade (most noticable)

basically the pressure of the lungs causes the pressure to drop

heart sounds

S1: closing of AV valves- low pitched and dull- start of systole

S2: closing of semilunar valves- higher pitched and louder- start of diastole

S3: dullest of all 3- normal in children and young adults. Beyond those ages it is caused by vibration of ventricular walls by rapid ventricular filling. Often associated with CHF (makes heart more weak so kinda bounces off wall and makes sound). At the end of ventricular diastole. “ken-tuch-Y”

what can cause crackles

CHF, pneumonia

what can cause wheezing

asthma, anaphylaxis, COPD, pneumonia, HEART FAILURE

What can cause rhonchi

COPD, pneumonia, aspiration, Opioid overdose (secretions and vomit), cholinergic OD (increased secretions)

what can cause pleural friction rub

pleurisy, viral infection, TB, PE

cheyne stokes causes and description

repeated pattern lasting 30 seconds to 1 min

progressively getting deeper and sometimes faster then gradual decrease and period of apnea

damage to respiratory centers causes O2 and Co2 Partial pressure changes

ataxic causes and description

complete irregularity of breathing. Damage to medulla oblongata from CVA or trauma`

Biots causes and description

irregularity with pauses- damage to pons due to strokes trauma, opioid OD, or by pressure on pons

apneustic causes and description

deep gasping inspiration pausing at full inspiration with brief insufficient exhalation

almost like agonal but a bit faster

CVA, head injury,

some accompanying S/S include posturing, fixed, dilated pupils, coma, absent gag reflex.

agonal causes and description

occasional respirations, reflexes only, respiratory arrest iminent

what should you never classify someone as on a report? What do you want to ask them/their family

They are “normal”

ask what is normal for them

at what age would a lack of concern for strangers indicate AMS

9-12 months

what can cause a widened pulse pressure

narrowed?

wide- cushings triad- increased ICP

narrowed- becks triad- cardiac tamponade

what is the main cause for orthostatic hypotension?

fluid loss

normal pupil size in dark and bright light

2-4mm in bright

4-8 in dark

dilated pupils causes

hypoxia, barbiturate OD, atropine, cocaine

deviated conjugate gaze causes and description

head injury, CVA

eyes stuck to one side

dysconjugate gaze description and cause

one eye is not aligned with the other

orbital fracture

nystagmus causes and description

eye twitching…

alcohol, valium, PCP, seizure

Dolls eye reflex

when the eyes move with the head in an abnormal way

normally if i look at something and move my head, my eyes move

tenting causes and description

when the skin stays pulled up

dehydration

mottled

shock, cold exposure, vascular emergencies, end of life

normal BGL

80-120

what types of thermometers are most vs least accurate

most acurate to least accurate

esophageal and rectal- oral- tympanic- temporal- axiallry

normal body temp

97.5-100.2

37 C

98.6 F

temp #s for hypothermia, fever, hyperthermia (heat stroke)

hypo- <97.7

fever- 100.3-104

hyperthermia- > 104

What medical history should you ask about

Diabetes, Respiratory, Heart, htn, Stroke, seizures, Surgeries

DRHHSSS

pertinent positive and negative

positive-present on assessment that support your field impression

negative- findings that are not found that help narrow down your DD

pertinent findings are are relevant to the field impression or are something that are completely new or unexpected.

in a rapid trauma assessment what are you looking for

life threats and major bleeding and fractures.

what side of stethoscope for what things

bell- low frequency sounds (heart)

diaphragm- high pitched (breath)

what is hyper resonance and what does it indicate

tension pneumothorax- sounds like hitting a drum

when does positive JVD actually clinically mean something

when HOB is greater than or equal to 45 degrees

cullens sign

bruising around umbilicus

bleeding in abdomen

Grey-Turner’s sign

bruising in flank area- retroperitoneal bleading

Kehr’s sign

Refered pain to the shoulder (usually left)

blood, air, or GI contents in abd cavity irritating inferior side of diaphragm.