HFD PATIENT ASSESSMENT
Terms
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- WHAT ARE THE COMPONENTS OF PATIENT ASSESSMENT
- SCENE SIZE UP, INITIAL ASSESSMENT, FOCUSED HISTORY AND PHYSICAL EXAM, RAPID HEAD TO TOE, VITALS, DETAILED PHYSICAL EXAM, ONGOING ASSESSMENT
- WHAT IS THE ESSENTIAL FIRST STEP AT ANY MERGENCY
- SCENE SIZE-UP
- WHAT ARE THE PRIORITIES FOR SCENE SAFETY
- YOU, THE CREW, OTHER RESPONDING PERSONNEL, YOUR PATIENT
- WHAT DO YOU DO IF YOU ROLL UP ON AN OVERWHELMING SCENE
- CALL FOR ASSISTANCE, ONE PERSON IS INCIDENT COMMANDER, THE OTHER IS TRIAGE OFFICER AND STARTS PRIORITIZING PATIENTS
- START
- SIMPLE TRIAGE AND RAPID TRANSPORT
- HOW LONG SHOULD TRIAGE TAKE AT AN MCI
- PATIENTS SHOULD BE TRIAGED IN LESS THAN 60 SEC. THEN TAGED
- WICH PATIENT STATUS IS ASSESSED FIRST AT MCI
- RESPIRATORY, IF ADEQUATE - GO TO NEXT ASSESSMENT, IF INADEQUATE TRY TO FIX WITH BASICS, IF IT WORKS TAG RED, IF IT DOES NOT WORK TAG BLACK
- WICH PATIENT STATUS IS CHECKED SECOND AT MCI
- PULSE/PERFUSION, CHECK FOR RADIAL PULSE ONLY, IF PRESENT IT IS PROBABLY 80
- WHAT IS THE THIRD PATIENT STATUS CHECKED AT MCI
- MENTAL STATUS
- WHEN IS DETAILED ASSESSMENT PERFORMED
- AFTER PATIENTS ARE MOVED TO TREATMENT SECTOR
- HOW BIG IS DANGER ZONE IF THERE IS NO APPARENT HAZARDS
- 50 FEET IN ALL DIRECTIONS
- HOW BIG IS DANGER ZONE FOR A FUEL SPILL OR VEHICLE FIRE
- 100 FEET
- HOW FAR SHOULD BOX BE PARKED IF THERE IS DOWNED POWERLINES
- PARK ONE FULL SPAN OF WIRES FROM POLE THAT BROKEN WIRES ATTACH TO
- WHO DO YOU CONTACT FOR DANGER ZONE FOR HAZ-MAT SPILL
- NORTH AMERICAN EMERGENCY RESPONSE GUIDE, CHEMTREC, DZ COULD BE 50-2000 FEET
- WHAT ARE THE THREE R'S OF REACTING
- RETREAT, RADIO, REEVALUATE
- WHAT ARE CONSIDERED SEPERATE EVENTS OF MVA
- VEHICLE COLLISION, BODY COLLISION, ORGAN COLLISION, SECONDARY COLLISION, ADDITIONAL IMPACTS
- WHAT IS MOI FOR HEAD-ON COLLISION
- UP AND OVER - LOOK FOR HEAD, NECK, CHEST, ABDOMIN, PELVIS INJURIES, DOWN AND UNDER - LOOK FOR PELVIS AND LOWER EXTRIMITIES
- WHAT IS MOI FOR REAR-END COLLISION
- WHIPLASH, LOOK FOR HEAD, NECK, CHEST, ABDOMEN, PELVIS, THIGH INJURIES
- WHAT MOI DO YOU LOOK FOR AT ROLLOVER
- ANY AND ALL TYPES OF INJURIES FROM MANY DIRECTIONS
- WHAT IS MOI FOR ROTATIONAL INJURIES
- MULTIPLE INJURIES, EXPECT THE WORST
- WHAT IS MORTALITY RATE IF PATIENT WAS EJECTED
- 25 TIMES
- WHAT DO YOU NEED TO FIND OUT IF PATIENT WAS INVOLVED IN A FALL
- SURFACE, HEIGHT, INTERRUPTIONS DURRING FALL, WHAT PART OF BODY STRUCK SURFACE
- LOW VELOCITY WEAPONS
- PROPELED BY HAND, INJURY LIMITED TO PENETRATED AREA, CAN BE EXTENSIVE
- MEDIUM VELOCITY WOUNDS
- HAND GUNS, SHOT GUNS, ARROWS, DAMAGE CAN BE MINIMAL OR EXTENSIVE
- HIGH VELOCITY WOUNDS
- HIGH POWERED
- WHAT DOES BULLET DAMAGE DEPEND ON
- SIZE, TYPE, PATH, IF TI FRAGMENTED, IF IT DEFLECTED OF BONE OR TISSUE
- WHAT ARE PRESSURE RELATED DAMAGE FROM BULLET
- VELOCITY FROM BULLET CREATES PRESSURE WAVE, THIS CREATES A CAVITY LARGER THAN THE BULLET, EXIT WOUND IS USUALY LARGER
- BLUNT FORCE TRAUMA
- INJURY CAUSED BY BLOW THAT STRIKES THE BODY, SKIN AND ORGANS ARE NOT PANETRATED, INTERNAL VESSELS CAN BE RUPTURED, THIS LEADS TO SERIOUS BLEEDING, SPILLAGE OF HOLLOW ORGAN CONTENT
- WHAT IS GOAL OF INITIAL ASSESSMENT
- IDENTIFY AND CORRECT ANY LIFE THREATENING CONDITIONS OF AIRWAY, BREATHING OR CIRCULATION
- WHAT IS IN THE INITIAL ASSESSMENT
- GENERAL IMPRESSION, C-SPINE, MENTAL STATUS, ABC'S, DETERMINE PRIORITIES
- HOW IS BASELINE MENTAL STATUS ASSESSED
- AVPU, ALERT, VERBAL, PIANFUL, UNRESPONSIVE
- AAOX3
- AWAKE, ALERT, ORIENTED TO TIME, ORIENTED TI PLACE, ORIENTED TO THIRD PERSON, ORIENTED TO SELF
- WHAT IS PERPOSEFUL RESPONSE TO PAIN
- LOCALIZES TO PAIN, MOVES AWAY FROM PAIN
- WHAT IS NON-PURPOSEFUL RESPONSE TO PAIN
- WITHDRAWS TO PAIN, DECORTICATE- ARMS FLEXED, LEGS EXTENDED, DECEREBRATE- ARMS AND LEGS EXTENDED
- WHAT DOES LOCALIZING/WITHDRAWING TO PAIN MEAN
- THE RESPONSE IS COMING FROM THE CEREBRUM/CEREBRAL CORTEX
- WHAT DOES FLEXION/EXTENSION RESPONSE TO PAIN MEAN
- RESPONSE IS COMING FROM BRAIN STEM, NOT A GOOD SIGN, EXTENSION IS WORSE THAN FLEXION
- LESS THAN 8 OVER 24 PROBLEMS
- OVER 24 AND ALERT=NRBM, LESS THAN 8=BVM, OVER 24 W/LOC CHANGES=BVM, RESPIRATORY ARREST=BVM
- HOW IS CIRCULATION ASSESSED
- PULSE RATES, PULSE QUALITY, EXTERNAL BLEEDING, SKIN TEMP., COLOR, CONDITION, CAP. REFILL
- WHAT PULSE SHOULD BE CHECKED FIRST ON PATIENTS OVER ONE YEAR
- RADIAL, IF NOT FOUND CHECK CAROTID, CHECK APICAL PULSE IF NEEDED
- WHAT IS PULSE PRESSURE AT RADIAL, FEMORAL, CAROTID
- RADIAL=80, FEMORAL=70-80, CAROTID=60
- WHERE IS COLOR CHECKED
- NAIL BEDS, INSIDE OF CHEEK, CONJUNCTIVA, LIPS, PALMS, SOLES OF FEET(ON PEDI)
- WHAT DOES SHOCK CAUSE SKIN TO BECOME
- MOTTLED, CYANOTIC, PALE OR ASHEN(DUE TO VASOCONSTRICTION), COOL, MOIST, DIAPHORETIC(DUE TO SNS STIMULATION OF SWEAT GLANDS
- WHAT AFFECTS CAP REFILL IN ADULTS
- SMOKING, MEDICATIONS, CHRONIC ELDERLY CONDITIONS, COLD WEATHER
- WHAT ARE FOUR TYPES OF PATIENTS
- TRAUMA PATIENT WITH SIGNIFICANT MOI, TRAUMA PATIENT WITH ISOLATED INJURY, RESPONSIVE MEDICAL PATIENT, UNRESPONSIVE MEDICAL PATIENT
- WHAT ARE SOME PREDICTORS OF SERIOUS INTERNAL INJURY
- EJECTION FROM VEHICLE, DEATH IN SAME PASSENGER COMPARTMENT, FALL OVER 20 FEET, ROLLOVER, HIGH SPEED COLLISION, VEHICLE-PEDESTRIAN, MOTORCYCLE, PENETRATION(HEAD, CHEST, ABDOMEN)
- WHAT ARE PREDICTORS OF SERIOUS INTERNAL INJURY FOR INFAANTS AND CHILDREN
- FALL OVER 10 FEET, BICYCLE COLLISION, MEDIUM-SPEED VEHICLE COLLISION WITH SEVER DAMAGE
- DCCAP-BTLS-PMS
- DEFORMITIES, CONTUSIONS, CREPITUS, ABRASIONS, PENETRATIONS, BURNS, TENDERNESS, LACERATIONS, SWELLING, PULSE, MOTOR, SENSATION
- IN WHAT ORDER IS HEAD TO TOE PERFORMED
- HEAD TO TOE THEN UPPER EXTREMITIES, ALLOWS EXAM IN PRIORITIES
- RALES
- FINE CRACKLING, INDICATES FLUID OR CONSOLIDATION IN LUNGS, MINOR ALVEOLAR OBSTRUCTION, ATELECTASIS
- RONCHI
- COARSE RATTLING, INDICATES SIGNIFICANT FLUID OR MUCUS ACCUMULATION IN BRONCHI
- WHEEZING
- PROLONGED HIGH PITCH EXPIRATORY SOUNDS, INDICATES NAROWING AIRWAYS, BRONCHIAN OBSTRUCTION, PROTECTIVE MECHANISM(CHF)
- STRIDOR
- HIGH PITCHED INSPIRATORY SOUND, AUDIBLE WITHOUT STETHOSCOPE, INDICATES UPPER AIRWAY OBSTRUCTION, FBO, SEVER SWELLING, ALLERGIC REACTION, BURNS, INFECTION, CROUP, EPIGLOTTITIS
- BREATH SOUNDS UNEQUAL =
- PNEUMOTHORAX, HEMOTHORAX
- BREATH AND HEART SOUNDS DISTANCE AND MUFFLED=
- POSSIBLE HEMOTHORAX
- HEART SOUNDS DIMINISHED =
- CARDIAC TAMPONADE
- PERCUSSION, HYPERRESONANT =
- TESNION PNEUMOTHORAX
- PERCUSSION, HYPORESONANT =
- HEMOTHORAX, PLEURAL EFFUSION
- CULLENS SIGN
- PERIUMBILICAL ECCHYMOSIS
- GREY TURNERS SIGN
- ECCHYMOSIS ALONG FLANKS
- WHAT ARE S/S OF ABDOMENAL ANEURISM
- EXAGGERATED PULSATION WITH TEARING PAIN
- RIGHT UPPER QUADRANT
- LIVER, GALL BLADDER, HEAD OD PANCREAS, PART OF DUODENUM, COLONRIGHT KIDNEY
- LEFT UPPER QUADRANT
- SPLEEN, TAIL OF PANCREAS, STOMACH, LEFT KIDNEY, PART OF COLAN
- RIGHT LOWER QUADRANT
- APPENDIX, ASCENDINC COLON, SMALL INTESTINE, RIGHT OVARY, FALLOPIAN TUBE
- LEFT LOWER QUADRANT
- SMALL INTESTINE, DESCENDING COLON, LEFT OVARY, FALLOPIAN TUBE
- REBOUND TENDERNESS
- RELEASE GENTAL PRESSURE QUICKLY, PAIN = INFLAMATION OF PERITONEUM
- ASCITES
- ACCUMULATION OF FLUID DUE TO INCREASED SYSTEMIC PRESSURE, CAUSED BY RIGHT HEART FAILURE, CIRRHOSIS, DISTENDED SPONGY ABDOMEN
- SAMPLE
- SIGNS/SYMPTOMS, ALERGIES, MEDICATIONS, PAST MEDICAL HISTORY, LAST ORAL INTAKE, EVENTS PRECEDING INCIDENT
- WHY IS ASSESSINT THE MEDICAL PATIEND DIFFERENT THAN THE TRAUMA PATIENT
- HISTORY TAKES PRECEDENCE (80%), PHYSICAL EXAM IDENTIFIES MEDICAL COMPLICATIONS RATHER THAN SIGNS OF INJURY (20%)
- UNEQUAL PMS IN UPPER EXTREMITIES =
- THORACIC ANEURYSM
- UNEQUAL PMS IN LOWER EXTREMITIES =
- ABDOMINAL ANEURYSM
- UNILATERAL DILATION OF EYES =
- BRIAN LESIONS, MENINGITIS, DRUG POISONING, 3RD NERVE PARALYSIS, INCREASED ICP
- BILATERAL SLUGGISH RESPONSE OF EYES =
- HYPOXIA
- FIXED, DILATED =
- SEVERE ANOXIA, COULD BE DUE TO SYMPATHETIC/ ANTICHOLINERGIC DRUGS
- PINPOINT =
- NARCOTIC OVERDOSE
- ORTHOSTATIC VITAL SIGNS
- TAKE PULSE/BP WITH PATIENT SUPINE, HAVE PATIENT SIT UP AND DANGLE FEET, IN 30-60 SEC. RETAKE VITALS, POSITIVE IF INCREASE PULSE 10-20 BPM, DECREASE BP 10-20 MMHG
- DISCONJUGATE GAZE =
- CNS INJURY, PRE-EXISTING PROBLEM, OCULAR MUSCLE ENTRAPMENT, OPTIC NERVE DAMAGE
- IF EYES CAN NOT FOLLOW H MOTION SUSPECT
- NERVE DAMAGE, ORBITAL FRACTUE
- IF EYES ARE DULL SUSPECT
- CIRCULATORY COMPROMISE
- IF SCLERA IS YELLOW SUSPECT
- LIVER DISFUNCTION
- WHEN DO YOU TAKE OUT CONTACTS
- WHEN PATIENT IS UNCONCIOUS AND TRANSPORT IS LONGER THAN 15 MIN., TOXIC MATERIAL IS IN EYE
- FLUIDS IN MOUTH, COFFEE-GROUND, FRESH BLOOD, PINK-TINGED SPUTUM, GREEN OR YELLOW PHLEGM, VOMITUS
- COFFEE-GROUND=BLEEDING IN STOMACH, FRESH BLOOD=UPPRE GI OR MOUTH TRAUMA, PINK TINGE=CHF, GREEN OR YELLOW=INFECTION, VOMITUS=GI OR BRAIN STEM