EMT Quiz 3 Notes

Cardiovascular System exam:

2 major presentations: 1. cardiac patient 2. patient in shock or with a vascular problem Obtain history and medication exam: - description of chest pain Physical Exam: - look for signs in skin color, temp, and mental status - obtain pulse - obtain BP - note pulse pressure - look for JVD - may indicate heart failure or other obstructive conditions within the chest - palpate chest - observe posture and breathing

what order should you perform ABCs if a patient appears lifeless?

CAB

DCAP-BTLS on head

Check head, check face, check neck - step off, JVD, tracheal deviation(making sure the trachea is in line)

DCAP-BTLS on pelvis

Compression: bring hips up Flexion: bring hips down

Pediatric examination

Head: do not apply pressure to soft spots nose and ears: look for blood and clear fluids neck: children are vulnerable to spinal cord injuries because they have larger heads assess eyes/pupils Airway: keep infants head in neutral position and Childs head in neutral plus or sniffling position chest: check for bruising, equal chest rise, fall and crepitus and watch for difficulty breathing abdomen: not rigid or tender areas and distention pelvis: check for stability extremities: perform capillary refill and distal pulse including neuralgic component for motor function with sensation check

Respiratory System Exam:

History: - obtain history of exisiting condition and medication - determine is signs/symptoms match previous episode - determine is med dose has been taken correctly Physical exam: - patients mental status - level of respiratory distress and work of breathing - observe chest wall motion - auscultate lung sounds - use pulse ox - observe edema that may be hear in the lungs - assess for fever

What does an Emergency Medical Dispatcher (EMD) do?

They relay important information to you before arriving to a scene

What is the difference in secondary assessment between a responsive medical patient and a unresponsive medical patient?

Unresponsive: rapid phsycial exam, patient environment - gather history from bystanders/family members Responsive: chief complaint, focused physical exam

What should you do for your danger zone in no apparent hazards that you should not do if fuel is spilling out?

Use flares

What is SAMPLE and why is it used?

Used like a checklist for patient assessment Signs/Symptoms Allergies Medications Pertinent medical history Last oral intake Events, what lead to the problem

What is OPQRST and when is it used?

Used to develop information pertaining to chief complaint and HPI Onset - What was the patient doing when the pain began Provocation/Palliation - Does anything seem to trigger or make the pain/problem feel better Quality - Can you describe the pain Region/Radiation - where is the pain, does it shoot or spread anywhere? Severity - How bad is the pain, between 0-10? Time - When did the pain start?

What should you wear when dealing with an airborne disease?

a N-95 mask or HEPA respirator

What is the danger zone?

a zone around a wreckage, depends on the type of emergency being dealt with

LeVigns sign

indicates significant chest pain/discomfort patient has fist on their chest

how does a detailed physical exam differ from rapid trauma assessment?

it also included exam of the face, ears, eyes, nose and mouth

How far are your danger zone if you are dealing with hazardous materials?

it depends, you must check the emergency response guidebook

What is the importance of reassessment?

it is a means of determine trends in the patients conditions, often repeated frequently, must never be skipped except when lifesaving interventions prevent you

what is Reassessment?

it is gathering additional info to ensure that the plan of care is still appropriate - detect changes in the patients condition

what is a primary assessment?

it is the initial assessment or primary survey portion of the patient assessment in which you focus exclusively on life threats, especially ABC

What is clinical judgment?

judgement based on experience in observing and treating patients

what factors determine how serious a trauma patents condition is?

- location of the injury - patients mental status - patients airway status - vital signs - MOI - patients age or presence of preexisting condition

EMT approach to diagnosis

- must be effective - work in an uncontrolled environment - limited tools and skill set - narrow educational focus focus narrowly on conditions that have a high morbidity or mortality rate

General principles

- perform DCAP-BTLS on all areas - communicate with patient - assume spinal injury - stop/alter assessment to provide care

What to do to identify NOI?

- scan entire scene - obtain information from the patient, family members, or bystanders at the scene

What are the common associations with these MOIs? - injuries to bones/joints -burns -penetrating soft tissue

- typically a fall or vehicle collision - common to fire and explosions - associated with gsw

How to question bystanders?

1. what is the patients name 2. what happened 3. did you see anything else 4. did the patient complain before this happened 5. do they have any illnesses/problems 6. is the patient taking medication

what are the two types of patient in the secondary assessment

1. Medical patient - focus more on their history rather than exam 2. trauma patient - focus more on physical exam rather than history

What are the two types of patterns during a head on collision?

1. Up and over: patient strikes their head on windshield, causing head and neck injuries 2. down and under: patient strikes knees on dash causing knee, leg, and hip injuries and possible internal bleeding

What are the six parts of a primary assessment?

1. forming a general impression 2. assessing mental status (AVPU) 3. assessing airway 4. assessing breathing 5. assessing circulation 6. determining the priority of the patient for treatment and transport to the hospital

How to apply a cervical collar?

1. inline stabilization 2. measure proper collar size 3. place chin support first 4. wrap collar around neck and secure 5. ensure fit and neutral stabilization

What are the 3 components of secondary assessment?

1. physical exam 2. patient history 3. vital signs

What does Reassessment involve?

1. repeating primary assessment 2. repeating and recording vital signs 3. repeating the physical exam 4. checking interventions - ensure adequacy of oxygen delivery and artificial ventilation, ensure management of any bleeding is effective, etc.

What are the three collisions in an MVC?

1. vehicle strikes object 2. patients body strikes interior of vehicle 3. patients organs strikes body surface

what are the severe fall guidelines?

Adults: fall greater than 20 feet Children under 15: fall greater than 10 feet or 2-3 times their size

What is a penetrating trauma?

An injury caused by an object that passes through the skin or other body tissue

Tripod position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward. Indicated difficulty breathing

What rules out if a patient is stable?

Any threat to their ABCs

What situation should you never enter if you are trying to provide care?

Any violent situation

what does DCAP-BTLS stand for?

D = Deformities. C = Contusions. A = Abrasions - cuts/rash P = Punctures/ penetration B = Burns. 1st, 2nd, 3rd T = Tenderness. L = Lacerations. S = Swelling.

What two ways can bullets cause damage?

Damage directly from projectile: bullet will damage anything in its path Pressure related damage or cavitation: bullet can create pressure that causes a cavity greater than the size of that bullet

What is the EM approach to a diagnosis?

Goal: rule out life-threatening conditions - perform physical exam - may be responsible for many patients - gather history - rule out worst case scenario

Traditional approach to diagnosis

Interview the patient in the controlled environment of a clinic/office 1. assess the patient 2. list of "differential diagnosis" 3. Run test and labs to rule out diagnosis 4. come to a conclusion

types of medications

Lisinopril, captopril, HZTC - blood pressure Humalog, Humalin, Lantus, Metformin - diabetes Cardizem, Amio - high blood pressure/chest pain, heart rhythm Celexa, Xanax, Lexapro, Lithium, Paxil, Seroquel - treatments for mental health disorders ex: depression, anxiety, etc.

What are the three types of penetrating trauma?

Low velocity: knife, anything propelled by the hand Medium Velocity: handguns, bows, ballistic knives High Velocity: high powered/assault rifle types

Nervous system exam:

Mental status - an indicator of brain function Body exam for signs of dysfunction - any facial asymmetry, slurred speech, weakness or inability to move extremities History: - determine mental status - determine patients normal state of mental functioning - obstanin history of neurologic conditions - not patient speech Physical Exam: - Perform stroke scale - Check peripheral sensation and movement, exams should be equal - Gently palpate the spine for tenderness or deformity - Check extremity strength - Check pupils for equality and reactivity - If patient is walking, examin their gate, can they keep balance?

Musculoskeletal system exam:

Most common injuries occur from trauma history: - prior injuries - any blood thinning medication underlying diseases or conditions that make fractures more common Physical exam: - Inspect for signs of injury such as deformity, swelling, or bruising - Palpate areas of suspected injury, palpate gently - Compare sides of the body and note any asymmetry - Be alert for crepitation (the feeling of bone ends rubbing together) as you palpate - Head-to-toe exam: often done when there are multiple injuries, or the patient is unresponsive

Important physical findings

Neck: JVD, medical identification devices Chest: breath sounds Abdomen: distention, firmness, rigidity Pelvis: incontinence of urine or feces extremities: pulse, motor function, sensation, oxygen saturation, medical identification devies

What are the types of danger zones?

No apparent hazard: at least 50 feet in all direction Fuel spillage: minimum of 100 feet Vehicle on fire: extends at least 100 feet Wires are down: danger zone is the area in which people/vehicles may come into contact with wires

What do you do if a patients airway isn't open

Open the airway: "Make it, check it, keep it"

DCAP-BTLS on genitals

Priapism: severe indication of spinal injury - penis erection in absence of stimuli

What is secondary assessment?

Provides more information about the patient through examinations and taking vital signs

GI system exam:

REMEMBER: they may be trauma to the GI system anywhere from the mouth to the anus Small details are important History: - last oral intake - history of GI issues - any vomiting - bowel movements - pain/discomfort Physical Exam: - Observe patients' position - Assess the abdomen - Inspect other parts of GI system as appropriate - Inspect if there is vomitus or feces available

What is a rapid physical exam?

Similar to physical exam for trauma patient Assess head, neck, chest, abdomen, pelvis, extremities, and posterior Consider ALS backup

what is SMR?

Spinal Motion Restriction: - restrict movement of head, neck and spine when spinal injury is possible objective: hold patients head in a neutral in line position or "Manuel Stabilization" of the head and neck

when is secondary assessment performed?

after the scene size-up and primary assessment

What is the ABC?

airway, breathing, circulation

What should you always do early in a call

always take proper standard precautions

What is blunt force trauma?

and injury caused by a blow that strikes the body but does not penetrate the skin or other body tissues

what are trends?

any changes over time in a patient

What to do during a pediatric physical exam

approach children slowly and evaluate from toe to head no not use equipment without first explaining to them explain what you will do step by step use simple language never lie to a child is exposed, quickly cover them with a blanket

History taking techniques

ask open-ended questions use mnemonics - sample - PMH - opqrst - HPI Only ask closed-ended questions during an emergency

What is a detailed physical exam?

assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury

what is representative heuristics?

assumption that patient has a condition solely based on their signs and symptoms

where will a second assessment be done for critical patients?

in an ambulance en route

When should you perform a physical exam?

before, during or after patient history

What does BSI (body substance isolation) include?

blood, saliva, and any other fluids or content

What is the "Look Test"?

brief and rapid assessment of patients condition upon first look LOOK: patients age, sex, and position LISTEN: moaning, snoring, gurgling SMELL: fumes, urine, feces, vomit, dear

Types of signs on patient skin

calluses: blood sugar device, patient most likely diabetic contusion: depending on stages of healing, patient may have had it for a while, extreme case - abuse two bites: snake bite, insect bite clubbed fingers: low o2 saturation jaundice: liver failure striations: irritation, scratching, injection port - drug abuse big object like figure inside arm: dialysis patient

what can happen during a rotational impact collision?

cars are struck then spun initial impact causes subsequent impacts can cause multiple injury patterns

What is the anchoring and adjustment heuristic?

consideration of a particular condition to be likely and later thinking its anchored to that hypothesis

What is a diagnosis?

description/label for a patients condition that assists a clinician in further evaluation and treatment based on: patients history, physical exam and vital signs

What is illusory correlation?

drawing a conclusion from seeing how one thing causes another, misleading because two events could be distinct

Why is it important to scene for scene hazards, infection control concerns, MOI, and number of patients

emergencies are often unpredictable and can pose many dangers if not careful

What is the availability heuristic?

estimating the likelihood of events based on their availability in memory

What are the types of threats of violence present?

fighting/loud voices visible weapons signs of alcohol/drugs unusual silence: sign for suspicion knowledge of prior violence

What is the scene size up?

first part of patient assessment process, determines if there are any threats to your safety, bystanders or your patients safety

What can happen during a rear end collision?

head and neck injuries, violent jerking of the body

what can happen during a Side-impact (T-bone/broadside) collision?

head remains still as the body is pushed laterally, injury to the neck potential in causing skeletal and internal injuries

What is a HEPA respirator?

high efficiency particulate air respirator, filters out the air in your environment

HPI vs PMH

history of present illness vs past medical history

What is a high priority condition?

if a patient is unresponsive, have a poor general impression, difficulty breathing, in shock, complicated childbirth, chest pain consistent with cardiac problems, uncontrolled bleeding, and severe pain anywhere

How can an EMT think like an experienced physician?

learn to love ambiguity understand the limitations of tech and people realize that no one strategy works for everything form a strong foundation of knowledge organize data in your head change the way you think learn from others reflect on what you have learned

What is heuristic evaluation?

learned shortcuts that speed up the process of reaching a diagnosis

how to check a patients posterior body?

log roll maneuver and assess posterior for wounds, tenderness, or deformities

What do you do when you first approach a scene?

look and listen for other emergency units, look for signs of a collision related power outage, observe traffic flow, look for smoke in the direction of the collision scene

What is the final part of scene size up?

look for any additional patients and determine if you have sufficient resources to handle the call, immediately call for additional ambulances if necessary

What do you do at the scene?

look for clues to escaped hazardous materials, look for patients on or near the road, look for smoke, look for any broken utility and downed wires, be alert and watch for signals from police or other emergency personnel

what is confirmation bias?

looking primarily for evidence that supports he diagnosis you already have in mind

What should you do before continuing onto the second assessment?

make sure the patient has no immediate life threats

What should you always consider with airbags?

may occasionally cause injuries, often cause damage to windshields, may deploy and turn nearby objects into projectiles, may have nontoxic powder that will be found on the patient and car

Immune system Exam:

most common - allergies - Assessment determines whether the reaction is severe (anaphylaxis) or not History: - history of allergies - history of asthma - tightness in chest or throat? - Any medications fro allergic reactions? - gi distress, itchiness, or rash Exam: - Inspect point of contact with an allergen, is there a stinger? Swelling? - Inspect patients' skin for widespread rash or hives - Inspect face, lips, and mouth for swelling - Listen to the patient speak, is their voice hoarse or raspy? Stridor? - Listen to patients' lungs to ensure adequate breathing

Endocrine system exam:

most common - diabetic patients obtain history of endocrine conditions and medication Physical Exam: - Evaluate mental status - Observe patient's skin - Obtain a blood glucose level - Look for an insulin pump - Look for medical jewelry that identifies if patient is diabetic

what can happen during a rollover collision?

most serious potential for multiple impacts frequently cause ejection of anyone not wearing a seatbelt

What is an MVC?

motor vehicle collision

HPI for trauma patientes

nature of force involved direction and strength of force protective equipment? action taken to prevent/minimize injury areas of pain resulting from incident

Techniques to physical exam

observe: look for patient for an overall sense of their condition and evaluating their chief complaint Ausculate: listen for signs of abnormal condition, done with stethoscope Palpate: feel and area for deformities or other abnormal findings

What is a stable patient?

patient with vital signs within normal range

What is the importance of Body System Exams?

provides a deeper understanding of the conditions you assess

How will you perform the secondary assessment on a trauma patient?

remember: injuries can range from slight to severe low priority patient: - determine chief complaint - physical exam - baseline vitals - obtain past medical history high priority: - chief complaint - spinal precautions if indicated - consider a request for ALS - perform rapid trauma assessment - assess baseline vitals - obtain patient history

what are types of heuristic shortcuts?

representative availability overconfidence confirmation bias illusory correlation anchoring and adjustment search satisfying

Secondary assessment on trauma patient responsive vs unresponsive

responsive: - no significant MOI - Responsive - Single injury - Alert and Oriented Unresponsive: - significant MOI - mutliple injuries - multiple body systems invovled

what is a symptom?

something a patient tells you they have such as pain or difficulty breathing

What is a sign?

something you can see such as deformity or swelling

When should you reassess a patient?

stable patient: reassess every 15 minutes unstable/potentially unstable: every 5 minutes

DCAP-BTLS on chest(upper torso)

start at clavicle check sternum apply c-collar complete sternum check high and wet check paradoxical motion crepitation

what is search satisfying heuristic?

stopping to look for other causes of potential conditon after determining what is causing a patients current problem

what is patient priority?

the decision regarding the need for immediate transport of the patient versus further assessment and care at the scene

What should you consider upon arrive to a fall scene?

the height at which the patient fell, the surface they fell onto, the part of the patient that hit the surface, and if anything interrupted the fall

What is the chief complaint?

the main reason to why EMS was called, usually in patients own words

What are the dangers of blunt force trauma?

they are subtle and often easy to overlook they cause serious injury and even rupture internal organs and vessels

What does an incident commander do?

they are the responder responsible for the overall coordination of activities at the scene

what is overconfidence heuristics?

thinking you know more than you do, can lead to the wrong diagnosis

What is AVPU and what is it used for?

used to determine the level of consciousness/mental status in a patient A - Is the patient Alert - determine orientation: person, place, time, and event V - Does the patient respond to verbal stimuli P - Does the patient respond to Painful stimuli U- Unresponsive

Focused Physical exam

usually brief examine areas of concern based on chief complaints

What is a Mechanism of Injury (MOI)?

what caused the injury

What is Nature of the Illness (NOI)?

what is medically wrong with a patient

what is regression in a child?

when a child is stressed, they may act like a younger child

when is it okay to skip the secondary assessment?

when the patient is in such an extreme condition that there is no time

What does the term "staging" mean?

you should park away from the scene until it is secure