Volume 2 Chapter 3A/B

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amerelman
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19905
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Volume 2 Chapter 3A/B
Updated:
2010-05-19 12:16:22
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Volume Chapter 3A
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Volume 2 Chapter 3A/B
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  1. Patient Assessment
    Problem-oriented evaluation of patient and establishment of priorities based on existing and potential threats to human life.
  2. Components of Patient Assessment
    • Scene size-up
    • Initial assessment
    • Focused history and physical exam
    • Ongoing assessment
    • Detailed physical exam
  3. Advanced Life Support (ALS)
    Life-support activities that go beyond basic procedures to include adjunctive equipment and invasive procedures
  4. Compnents of Scene Size-Up
    • Standard precautions
    • Scene safety
    • Location of all patients
    • Mechanism of injury/Nature of illness
  5. Standard Precautions
    Strict form of infection control that is based on the assumption that all body fluids are infectious
  6. Personal Protective Equipment (PPE)
    Equipment designed to protect against infection.
  7. Scene Safety
    Doing everything possible to ensure a safe environment
  8. Order of Priorities for Scene Safety
    • 1. Self
    • 2. Crew
    • 3. Other responders
    • 4. Patient
    • 5. Bystanders
  9. Minimum Rescue Operation Equipment
    • Four point suspension helmets
    • Eye goggles/safety glasses
    • Hearing protection
    • Leather work gloves
    • Steel toed boots
    • Insulated coveralls
    • Turnout gear
  10. Minimum Patient Safety Equipment
    • Hard hats
    • Eye goggles
    • Hearing/respiratory protection
    • Protective blankets
    • Protective shielding
  11. Mechanism of Injury
    Combined stregnth, direction and nature of forces that injured the patient
  12. Index of Suspicion
    Your anticipation of possible injuries based on analysis of the event
  13. Initial Assessment
    Prehospital process designed to identify and correct life-threatening airway, breathing, and circulation problems
  14. Steps of the Initial Assessment
    • General impression
    • C-spine considerations
    • AVPU response level
    • Airway
    • Breathing
    • Circulation
    • Priority
  15. General Impression
    Your initial, intuitive evaluation of your patient
  16. AVPU
    • Alert
    • Verbal stimuli
    • Painful stimuli
    • Unresponsive
  17. Decorticate Posturing
    Arms flexed, legs extended
  18. Decerebrate Posturing
    Arms and legs extende
  19. Signs of Inadequate Breathing
    • Altered mental status
    • Shortness of breath
    • Retractions
    • Asymmetric chest wall movement
    • Accessory muscle use
    • Cyanosis
    • Audible sounds
    • Abnormal rate or pattern
    • Nasal flaring
  20. Circulation Assessment
    Evaluating the pulse and skin and controlling major hemorrhage
  21. Top Priority Patients
    • Poor general impression
    • Unresponsive
    • Responsive but cannot follow commands
    • Airway compromise
    • Difficult breathing
    • Signs and symptoms of hypoperfusion
    • Multiple injuries
    • Complicated childbirth
    • Chest pain and BP below 100 systolic
    • Uncontrolled bleeding
    • Severe pain
  22. Focuses History and Physical Exam
    Problem-oriented assessment process based on initial assessment and chief complaint
  23. Types of Patients
    • Trauma patients, significant mechanism or AMS
    • Trauma patients, isolated injury
    • Medical patients, responsive
    • Medical patients, unresponsive
  24. Major Trauma Patient
    Person who has suffered significant mechanism of injury
  25. Order of Focused History and Physical Exam for Major Trauma Patients
    • Initial assessment
    • Rapid trauma assessment
    • Packaging
    • Rapid transport and ongoing assessment
  26. Predictors of Serious Internal Injury
    • Ejection from vehicle
    • Death in same passenger compartment
    • Fall from higher than 20 ft
    • Rollover of vehicle
    • High-speed vehicle collision
    • Vehicle vs pedestrian
    • Motorcycle crash
    • Penetration of head, chest or abdomen
  27. Predictors of Serious Internal Injuries for Infants and Children
    • All adult predictiors plus:
    • Fall from higher than 10 ft
    • Bicycle collision
    • Medium-speed vehicle collision
  28. Rapid Trauma Assessment
    Check for signs of serious injury
  29. DCAP-BTLS
    • Deformities
    • Contusions
    • Abrasions
    • Penetrations
    • Burns
    • Tenderness
    • Lacerations
    • Swelling
  30. Semi-Fowler's Positions
    45 degrees up
  31. Subcutaneous Emphysema
    Crackling sensation caused by air just underneath the skin
  32. Cullen's Sign
    Bruising over the umbilicus
  33. Grey Turner's Sign
    Bruising over the flanks
  34. Baseline Vitals
    • Pulse rate/quality
    • BP
    • RR and quality
    • Skin temp and condition
  35. SAMPLE History
    • Signs/Symptoms
    • Allergies
    • Medications
    • Pertinent past medical history
    • Last oral intake
    • Events leading to the incident
  36. Chief Complaint
    The pain, discomfort or dysfunction that caused the patient to call the ambulance
  37. History for the Responsive Medical Patient
    • CC
    • History of present illness (OPQRST-ASPN)
    • Past history
    • Current health status
  38. OPQRST-ASPN
    • Onset
    • Provocation/Palliation
    • Quality
    • Region, radiation
    • Severity
    • Time
    • Associated symptoms
    • Pertinent negatives
  39. Past Medical History
    • General state of health
    • Childhood or adult diseases
    • Psychiatric illness
    • Accidents or injuries
    • Surgeries/hospitalizations
  40. Current Health Status
    • Current medications
    • Allergies
    • Tobacco/alcohol/substance abuse
    • Diet
    • Screening exams
    • Immunizations
    • Sleep patterns
    • Excercise/leisure activity
    • Environmental hazards
    • Use of safety measures
    • Family history
    • Social history
  41. One-Minute Cranial Nerve Test
    • I: Not done
    • II, III: Direct response to light
    • III, IV, VI: "H" test for extraocular movement
    • V: Clench teeth, palpate jawline
    • VII: Show teeth
    • IX, X: Say "ah", watch uvula movement, test gag reflex
    • XII: Stick out tongue
    • VIII: Test balance (romberg test) and hearing
    • XI: Shrug shoulders, turn head
  42. Additional Assessment Techniques
    • Pulse oximetry
    • Capnography
    • Cardiac monitoring
    • Blood glucose determination
  43. Assessing Unresponsive Medical Patient
    • Initial assessment
    • Rapid medical assessment
    • Brief history
  44. Detailed Physical Exam
    Careful, thorough process of eliciting the history and conducting a physical exam
  45. Periorbital Ecchymosis
    Black and blue discoloration surrounding eye sockets. Can indicate skull fracture
  46. Battle's Sign
    Black and blue discoloration over the mastoid process, just behind the ears. Can indicate skull fracture
  47. Areas of Nervous System Exam
    • Mental status and speech
    • Cranial nerves
    • Motor system
    • Reflexes
    • Sensory system
  48. Reflex Tests
    • Biceps
    • Triceps
    • Brachioradialis
    • Quadriceps
    • Achilles
    • Abdominal
    • Plantar
  49. Sensory System Tests
    • Pain
    • Light touch
    • Temperature
    • Position
    • Vibration
    • Discriminative
  50. Ongoing Assessment
    • Detects trends
    • Determines changes
    • Assesses interventions

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