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Chapter 13: Patient Assessment (MEMS)
Terms in this set (47)
What are the components of the patient assessment?
scene size-up, primary assessment, secondary assessment, reassessment
What are the steps of the scene size-up?
1. Take necessary Standard Precautions
2. Evaluate scene hazards & ensure scene safety
(a) personal protection
(b) protection of patient
(c) protetion of bystanders
3. Determine mechanism of injury (MOI) or nature of illness (NOI)--trauma or medical patient
5. Additional Resources
6. Stabilization of spine
What is the main purpose of the primary assessment?
identify & manage immediately life-threatening conditions to the airway, breathing, oxygenation, or circulation
What must be done if a life-threatening injury is found during the primary assessment?
any life-threatening condition identified must be treated immediately as found--before moving on to the next portion of the primary assessment
What should you do if you notice a compound fracture of the patient's humerus (bone protruding from skin) during your primary assessment?
Continue your primary assessment. The compound fracture is dramatic, but not life-threatening and therefore should not delay the primary assessment
What should you do if you notice clotted blood around a patient's mouth during your primary assessment?
Check to see if it is in danger of obstructing the airway. If so, address this immediately; it is now a life-threatening condition that warrants immediate attention, even though it is not necessarily dramatic.
What are the components of the primary assessment?
1. form GENERAL IMPRESSION of the patient
2. assess LEVEL OF CONSCIOUSNESS (LOC) (mental status)
3. assess AIRWAY
4. assess BREATHING
5. assess OXYGENATION
6. assess CIRCULATION
7. establish PATIENT PRIORITIES (triage)
Should you ever divert from the appropriate sequence of actions in the primary assessment?
Yes. Whenever a life-threatening condition requires immediate attention.
For example, if you a approach a patient with a spurting arterial bleed, you will proceed immediately to controlling the immediate life threat to the circulation before assessing the ABCs. Once direct pressure is applied to the bleeding artery, you will go back to assessment of the airway, breathing, oxygenation, and circulation.
How long should the primary assessment take?
No longer than 60 seconds (unless confronted with a life-threatening injury)
When should you begin you general assessment?
immediately upon arrival. You will instantly notice things like the patient's age, sex, signs of illness, ability to speak, etc. Your initial general assessment may change as you continue gathering information
What are parts of forming a general impression of a patient?
1. estimate patient's AGE
2. note patient's SEX
3. determine if patient is TRAUMA OR MEDICAL
4. obtain CHIEF COMPLAINT
5. identify (and manage) immediate LIFE-THREATS
What are the two types of trauma?
penetrating and blunt-force
What is the chief complaint?
The patient's answer to the question: "Why did you call EMS today?"
If a patient is unable to answer questions about his chief complaint, how do you proceed?
chief complaint can come from the family member that called, or what you infer from observation. If you happen upon an unresponsive patient with no addition information, your chief complaint would be "unresponsive".
Should you stick with whatever the patient says is the chief complaint?
not necessarily. You might havean injured patient who later comments, "my chest is killing me." Medical conditions rarely offer obvious signs, so obtaining the chief complaint from a medical patient is extremely important.
What is the chief complaint for unresponsive patients?
Chief complaint (CC) may be established from family/friends/bystanders at sceneor from the environment itself. Ask, "was the patient complaining of anything before going unconscious" or "canyou tell me what happened?".
How are obvious immediate life threats defined?
those threats that you identify as you approach the patient--without having to look or feel for the problem.
What are 5 examples of immediate life threats obvious during the general impression?
1. airway compromised by blood, vomitus, secretions, the tongue, bone, teeth, or other substances or objects
2. obvious open wounds to the CHEST
3. PARADOXICAL MOVEMENT of a segment of the CHEST (inward movement on inhalation & outward movement on exhalation)
4. major BLEEDING (steady flow or spurting)
5. unresponsive w/no breathing or no normal breathing (agonal or gasping breaths)
What is agonal breathing?
gasping-type respirations that have no pattern & occur very infrequently; a sign of impending cardiac or respiratory arrest.
Upon recognition of cardiac arrest, how must resuscitation efforts begin?
CHEST COMPRESSIONS immediately
If you suspect a patient has been injured, what is one of hte first things you should assess about the MOI?
is the spine injured. If so, stabilize it. Even medical patients (for instance, a passed out diabetic)
What is the in-line stabilization procedure for suspected spinal injuries?
1. place one hand on each side of the patient's head.
2. gently bring head into a position in which the NOSE is in line w/NAVAL (umbilicus, or "belly-button")
3. position head neutrally so head not extened (tipped backward) or flexed (tipped forward)
Once manual in-line stabilization is established, how long should it be maintained?
Until the patient is completely immobilized to a backboard with backboard straps & a head immobilization device.
("Manual in-line stabilization...must be maintained, veneafter a cervical spinal immobilization collar (CSIC) is applied, until the patient is completely immobilized to a backboard w/backboard straps..")
What should you do if you find a patient laying prone?
quickly log roll her into a supine position.
It is not possible to properly assess the airway &breathign with the patient prone.
What should you do just before log rolling a prone patient?
quickly assess the posterior thorax & lumbar regions, vertebral column, buttocks, & posterior aspects of lower extremities by inspecting & palpatign for any major bleeding, deformities, open wounds, bruises, burns, tenderness, or swelling.
How should you proceed if an open wound to the posterior thorax is found upon assessment just prior to rolling a prone patient?
quickly occlude the wound w/nonporous or occlusive dresing taped on 3 sides
If a spinal injury is suspected in a patient found lying prone, what should be done prior to log rolling him into supine position?
When is it ok to assess level of consciousness (LOC) in a trauma patient?
only after taking manual in-line stabilization
to avoid any unnecessary movements by the patient
What must you quickly determine when assessing LOC?
if patient is awake, responds to a stimulus, or is unresponsive.
What does AVPU stand for and how is it used?
A- Alertness & Orientation
V- Verbal stimulus
P- responsiveness to Painful stimulus
Use AVPU to rapidly assess the patient's level of responsiveness.
How would you assess altertness & orientation?
if pateint's eyes are open and he is able to speak as you approach him, he's alert. If not alert, proceed to check his response to verbal stimulus.
If the patient doesn't respond to your verbal stimulus, how should you proceed?
quickly check if he will obey commands. tell to "squeeze my fingers" or "wiggle your toes".
If no response to verbal stimulus, how proceed?
Painful stimulus. can be central or peripheral painful stimulus
What are 5 examples of a central painful stimulus?
1. Trapezius pinch
2. Supraorbital pressure
3. Sternal rub (no longer used)
4. Earlobe pinch
5. Armpit pinch
What are 3 examples of peripheral painful stimulus?
1. Nail bed pressure
2. pinch to web b/w thumb& index finger
3. pinch to finger, toe, hand, or foot
What should you watch for when determine if a patient is responding to pain?
distinguish between purposeful and nonpurposeful movements.
*Purposeful movements are attempts by patient to remove stimulus or avoid pain, and = FAKING PAIN.
*Nonpurposeful movements: just reflexes, genuine
What are the 2 nonpurposeful movements?
Decorticate and Decerebrate posturing
DeCORTICATE posturing is (flexion/extension)?
DeCEREBRATE posturing is (flexion/extension)?
When is a patient considered unresponsive?
when not respond to verbal or painful stimulus. Unresponsive patients lose cough & gag reflex.
What are some sounds that indicate partial airway occlusion?
snoring, gurgling, crowing & stridor
What does snoring indicate?
tongue and likely epiglotis partially blocking the airway. use head-tilt, chin-lift (if no spine injury). If still no luck, use OPA
What does gurgling indicate?
liquid substance in airway. use suction.
What do crowing & stridor indicate?
swelling or muscle spasms that result from conditions such as: airway infxns, allergic rxns, or burns to upper airway.
How should you treat a patient with stridor/crowing sounds?
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