EMT-B Test 2

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Anonymous
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10322
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EMT-B Test 2
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2010-03-14 21:15:22
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EMT-B Test 2 - Assessment
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  1. What are the four senses used in doing a patient assessment. List two observations from each sense.
    • Smell: Drugs, alcohol, fruity breath for diabetics - fruity breath
    • Sight: Rashes, vomiting, external bleeding, seizures, deformities, sweating, color
    • Sound: Breath sounds, lung sounds, patient explanations, blood pressure
    • Touch: Swelling, pain, palpation, temperature, skin condition, position of trachea, vertebrae, trapped air
  2. What are the steps of patient assessment?
    • Scene Size Up
    • Initial Assessment
    • Focused Medical
    • Focused Trauma
    • Detailed Assessment
    • Ongoing Assessment
  3. What are the steps of initial assessments?
    • General Impression: Sick or not sick
    • L.O.C: Level of conscientiousness, AAOx4
    • A: Airway
    • B: Breathing
    • C: Circulation
    • Priority: Emergent, urgent, non-urgent
  4. What is general impression?
    • Sick or not sick
    • Across the room assessment
    • Sick patients require fast attention
    • Based on three main areas
    • -Airway
    • -Breathing
    • -Circulation
  5. What determines L.O.C.?
    • Altered versus decreased mental status
    • AAOx4
    • A.V.P.U.
    • GCS
  6. What do you look for when assessing airway?
    • Patency
    • Sounds
    • Color
    • Phonation
    • Mentation
    • Position
  7. What do you look for when assessing breathing?
    • Rate
    • Color
    • Mentation
    • Phonation
    • Effort
    • Sounds
  8. What do you look for when assessing circulation?
    • Central vs peripheral
    • Rate
    • Strength
    • Quality
    • Color
    • Mentation
    • Temperature
    • Bleeding
  9. What are the three levels of priority?
    • 1: Emergent
    • 2: Urgent
    • 3: Non-urgent
  10. What is done a primary survey?
    • Rapid assessment to find and treat all immediate, life threatening conditions
    • -Find and fix
    • -Treat as you go
    • Decide if the patient is a load and go or requires additional on-scene assessment and treatment
  11. What is done during a secondary survey?
    • Discover medical conditions and/or injuries not identified in the primary survery
    • Physical examination
    • Vital signs
    • Reassess changes and trends in the patient's condition
    • Determine: chief complaint, history of illness, pertinent past medical history
  12. What are the requirements for a primary survey?
    • Must be performed on: Every patient
    • It begins after: The scene is safe and patient access is obtained
    • Appropriate protection: PPE, gown, gloves, mask, eye protection
  13. What are the specific parts of a primary survey?
    • General Impression: Sick or not sick
    • Airway: Level of responsiveness/cervical spine protection
    • Breathing: Ventilation
    • Circulation: Perfusion, bleeding control
    • Disability: Mini-neurological examination
    • Expose: For proper examinations
    • Identification of priority
  14. When doing a general impression, what should be noted about the eyes?
    • Patient's eyes should be open
    • Patient's eyes should track movement
    • Approach a slow to react, agitated, limp, sleeping patient immediately
  15. When doing a general impression, what should be noted about the patient's breathing?
    • Both sides of the chest rise and fall equally
    • Normal breathing is quiet, painless, effortless, and at a regular rate
    • Things to look for include:
    • 1) A patient who is struggling to breath
    • 2) A patient with noisy breathing (gurgles, snoring, wheezing)
    • 3) A slow or fast breath rate
    • 4) Abnormal chest movement
  16. When doing a general impression, what should be noted about the patient's circulation?
    • Normal skin color
    • Strong pulse, bilaterally
    • Central and peripheral
  17. When opening a patient's airway, what are the two methods used and when do you use them?
    • Head tilt chin lift: Unresponsive patient who is not suspected of trauma
    • Jaw thrust: Unresponsive patient who has suspected trauma
  18. What is A.V.P.U? What is it used for?
    • A: Alert
    • V: Verbal
    • P: Painful
    • U: Unresponsive

    AVPU is used to determine a patient's responsiveness
  19. Cervical spine protection
    • In-line spinal protection is required
    • Anatomically linear
    • Do not move head or neck
  20. What are techniques that can be used in order to help improve a patient's airway?
    • Spinal stabilization
    • Head tilt chin lift
    • Jaw thrust
    • Suctioning
    • Repositioning
    • Removal of a foreign object
    • Insertion of an NPA or OPA
  21. What are signs of adequate breathing?
    • Breathing effort is quiet, relaxed, effortless
    • Breathing rate is normal
    • Breathing pattern is regular
    • Equal rise and fall of chest
    • Depth is adequate
    • Skin color is normal
    • Warm, pink, dry
  22. What are signs of inadequate breathing?
    • Anxious appearance
    • Confusion, restlessness
    • Breathing rate is too fast or too slow
    • Breathing pattern is irregular
    • Breathing depth is deep or shallow
    • Noisy breathing (snoring, gurgling, wheezing)
  23. If a patient is unresponsive but breathing adequately
    • Maintain an open airway
    • Use adjuncts if needed (NPA and OPA)
    • Give oxygen with an NRB
    • Recovery position if no spinal injuries or other contraindications
  24. If a patient is breathing and is responsive
    Let the patient rest in a comfortable position
  25. If the patient is unresponsive and breathing is inadequate, or the patient is not breathing
    • Begin positive pressure ventilation
    • Watch the patient's chest while giving positive pressure
    • -Chest rise
  26. What are some emergency care techniques that may be utilized for a breathing problem in a patient?
    • Give oxygen
    • Suction
    • Reposition
    • Remove any foreign objects
    • Insert NPA or OPA
    • Positive pressure ventilation
  27. Proper circulation assessment involves
    • Signs of obvious bleeding
    • Central and peripheral pulses
    • Skin color, temperature, condition
    • Capillary refill
  28. List two central pulses and four peripheral pulses
    • Central: carotid, femoral
    • Peripheral: Brachial, radial, dorsalis pedis, posterior tibial
  29. What are the five skin colors, and two causes of each
    • Pale: Poor perfusion, shock, fright, anxiety, blood loss
    • Cyanotic: Low levels of oxygen (hypoxia), shock
    • Mottled: Shock, hyperthermia, cardiac arrest
    • Jaundice: Liver problems, gallbladder problems
    • Flushed: Heat exposure, high blood pressure, allergic reaction, alcohol, CO poisoning
  30. What are the skin conditions associated with circulation and causes of each?
    • Warm: Normal
    • Hot: Heat exposure, fever
    • Cool: Inadequate circulation, exposure to cold
    • Cold: Extreme exposure to cold or shock
    • Clammy: Shock
  31. Capillary refill
    • Normal: <2 seconds
    • Delayed: 3-5 seconds - poor perfusion, exposure to cool temperatures
    • Markedly delayed: >5s - shock
  32. Emergency procedures to help assist with circulation include:
    • Giving oxygen
    • Patient positioning
    • Chest compressions and CPR
    • Control of bleeding
  33. Glascow Coma Score explanation
    • Assesses three categories
    • Eyes 1-4
    • Verbal 1-5
    • Motor 1-6
  34. Glascow Coma Score in depth
    • Eyes:
    • 4) Open
    • 3) Open to verbal command
    • 2) Open to painful stimulus
    • 1) No response

    • Verbal:
    • 5) Oriented
    • 4) Confused, but able to answer questions
    • 3) Answers questions with inappropriate words
    • 2) Incomprehensible sounds
    • 1) No response

    • Motor:
    • 6) Obeys commands
    • 5) Responds to pain
    • 4) Withdraws from pain
    • 3) Abnormal flexxion (decorticate) - straight
    • 2) Abnormal extension (decerebrate) - curled
    • 1) No response
  35. Secondary surveys are performed
    • Head-to-toe
    • Performed only after life threatening complications have been performed
    • Physical examination
    • Rapid trauma
    • Rapid medical
    • Focused physical
    • Look, listen, feel
  36. What is DCAPBTLS
    • D: Deformities
    • C: Contusions (bruises)
    • A: Abrasions (scrapes)
    • P: Puncture / Penetration
    • B: Burns
    • T: Tenderness
    • L: Lacerations
    • S: Swelling
  37. Vital Signs
    • Breathing (respirations)
    • Pulse
    • Blood pressure
    • Pupils
    • Skin (Warm pink dry)
    • Oximetry
    • Two complete sets
  38. SAMPLE
    • S: Signs and symptoms
    • A: Allergies
    • M: Medications
    • P: Pertinent past medical history
    • L: Last oral intake and last menses
    • E: Events leading up to the problem
  39. Patient history
    • Direct, open-ended questions
    • Pertinent positives and negatives
  40. OPQRST
    • O: Onset - When did it start?
    • P: Palliation and provocation - What makes it better (palliation) and what makes it worse (provocation)
    • Q: Quality - What kind of pain
    • R: Region and radiation
    • S: Severity - 0-10 scale
    • T: Time - How long has it been like this?
  41. Rapid trauma assessment
    • Reassess mental status
    • Assess
    • -Head
    • -Neck
    • -Chest
    • -Abdomen
    • -Pelvis
    • -Lower extremities
    • -Upper extremities
    • -Back
    • Compare sides of the body
  42. Ongoing assessment
    • Repeat unstable every 5 minutes
    • Repeat stable every 15 minutes
    • Reassess mental status and maintain airway
    • Repeat physical examination
    • Check the treatments to make sure they are working
    • Monitor trends

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