65 terms

Outdoor Emergency Care (5th Edition): Chapter 7

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Assessment
Determine the nature of a patient's injury/illness
Primary Assessment
Determine major injuries/symptoms of illnesses that the patient is experiencing, and correct them when possible. 30-60 seconds
Secondary Assessment
Take a patient's vitals, conduct a head-to-toe assessment
MOI
Mechanism of injury, what caused the injury?
NOI
Nature of illness, what illness is a patient experiencing?
Chief Complaint
The first and foremost complaint made by a patient
Steps of Primary Assessment
Check for response by patient (tap on shoulder, speak to them); Open airway (if they respond and can talk, it's fine), check for breathing, check for carotid pulse
If breathing normally
Continue with primary assessment
If no pulse
CPR
If pulse but no breathing
Rescue breaths
ABCD
Airway Breathing Circulation Disability
ABCD | A
Airway, make sure the airway is open. If patient is speaking normally, airway is open, patent, and intact. Vomit, blood, bleeding, broken teeth imply compromised airway.
ABCD | B
Breathing, make sure patient is breathing so oxygen gets to tissues.
ABCD | C
Circulation, make sure blood is flowing normally
ABCD | D
Disability, make sure patient has normal mental status, and has normal neurological function. Spine injury is considered abnormal neurological function.
Head-tilt chin-lift
A means of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin. Used when no trauma, or injury, is suspected.
Jaw-thrust
1. Place one hand on each side of the victim's head, resting your elbows on the surface on which the victim is lying.
2. Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw foreward.
3. If the lips close, push the lower lip with your thumb to open lips.
Look, Listen, Feel
Look for evidence of breathing, watch to see if the chest rises and falls with every breath
Listen for the sound of breath moving in and out, listen for anything unusual
Feel for chest wall movements when taking a breath
Normal respiration rate for adult/teen
12-20 breaths per minute
Normal respiration rate for infant
20-30 breaths per minute
Tripod position
a posture that uses three points of support, typically used by patients with pulmonary problems as they lean forward, use their arms for support, and lift the chest to increase breathing capacity
Arterial pulse/radial pulse check
Checking for pulse at the wrist
Carotid pulse
the pulse felt along the large carotid artery on either side of the neck
Brachial pulse
beating or throbbing felt over the brachial artery, usually palpated in the antecubital space
Circulation perfusion
Observe color, temperature, and condition of skin
Capillary refill
A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure.
AVPU
Alert, Verbal, Pain, Unresponsive, four stages of a patient's mental status.
AVPU | A
Alert, patient is awake, opens eyes without prompting, can speak to you. Aware and responsive.
AVPU | V
Verbal, patient does not open eyes spontaneously, responds to voice by reacting in some meaningful way
AVPU | P
Pain, patient does not open eyes or respond to sound, but responds to a painful stimulus
AVPU | U
Unresponsive, does not respond to any form of stimulus
Glascow-Coma Scale
EYE OPENING
4 - spontaneous
3 - open to speech
2 - open to pain
1 - no response
VERBAL
5 - alert and oriented
4 - disoriented conversation
3 - inappropriate words
2 - nonsensical sounds
1 - no response
MOTOR
6 - spontaneous
5 - localizes pain
4 - withdraws to pain
3 - decorticate posturing
2 - decerebrate posturing
1 - no movement
Decorticate posturing
characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.
Decerebrate posturing
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
Paresthesia
abnormal sensation of numbness and tingling without objective cause
Paralysis
temporary or permanent loss of motor control
Managing life-threatening conditions
Do what you can, get them out of there somehow
SAMPLE
Symtoms, Allergies, Medications, Previous history, Last oral intake, Events leading into
Hypoperfusion
inadequate perfusion of the cells and tissues of the body caused by insufficient flow of blood through the capillaries
Edema
puffy swelling of tissue from the accumulation of fluid
Symptom
subjective evidence of a disease, such as pain or a headache. Only the patient can feel it
OPQRST
Onset, Provocation, Quality, Radiation, Severity, Time
DCAP-BTLS
Deformity, Contusion, Abrasion/Avulsions, Punctures/Penetrations - Burn/Bruising/Bleeding, Tenderness, Laceration, Swelling
EOMI
Extra ocular movement intact
PERRL
Pupils equal, round, and responsive to light
Assessing the eyes
Establish PERRL, use a penlight to check for proper eye reactions (eyes should enlarge as light nears the eye), do this on each eye
Assessing the neck
Stabilize the neck and spine, look for bleeding/tenderness
Assessing abdomen
Is it flat/distended? Pale or discolored?
Assessing chest
Look for trauma, color, tenderness. Look for breathing
Assessing pelvis
Place hands on iliac crests, squeeze bones inward, note any instability
Assessing back
Look for abnormalities, palpitate the back, is there tenderness? Palpitate the spine
Assessing extremities
Look for weird ends, ask if there is bleeding. Check tenderness, pulse
Vital signs
Measurements of the body's most basic functions and useful in detecting or monitoring medical problems.
LOR
Level of responsiveness
Respiration
Act of breathing in/out
Blood pressure
Pressure of blood on interior walls
Systolic pressure
Pressure within arteries when ventricles contract
Diastolic pressure
Pressure within arteries when heart at rest
Body temperature
Maintains homeostasis, average at 36-38 degrees Celsius, 98.6-100.4 degrees Fahrenheit
Oxygen Saturation level
How much oxygen is in blood (percent)
Orthostatic Blood Pressure
Check for sudden drop in blood pressure
Causes of Orthostatic Hypotension
Hypovolemia from dehydration; medications; or neurological disease
Oxygenation
Oxygen added to body tissue
When to take complete set of vitals
Start and end of secondary assessment
When to get a good impression of the scene
Before primary assessment
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