CLS Week 3, Primary Assessment and Vital Signs

How often do you check the vitals on a stable patient compaired to that of an unstable patient.

15 min and 5 min

What is the normal SBP

90 to 120

Blood pressure in child

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Describe the difference between the effort and efficacy of breathing

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What are the two types of airway opening devices?

A Oropharyngeal Airway (Mouth) A Nasopharyngeal Airway (Nose)

What is the difference between a Primary Survey and a Secondary Survey

A Primary survey is an initial assessment A secondary survey is a detailed assessment

ABCCDDE

Airway Breathing Circulation & C Spine Defibrillation & Disability Exposure

AVPU

Alert Verbally responsive Pain Responsive Unresponsive

What are the circulation cardiovascular signs

Appearance eg pale, sweaty, agitated

Causes of decerebrate extension include:

Bleeding in the brain from any cause (intracranial hemorrhage) Brain stem tumor Cerebral infarction (stroke) Encephalopathy (brain problem due to drugs, poisoning, or infection) Head injury Hepatic encephalopathy (brain problem due to liver failure) Increased pressure in the brain (intracranial hypertension) from any cause Primary brain tumor Secondary brain tumor

Causes include:

Bleeding in the brain from any cause (intracranial hemorrhage) Brain stem tumor Cerebral infarction (stroke) Encephalopathy (brain problem due to drugs, poisoning, or infection) Head injury Hepatic encephalopathy (brain problem due to liver failure) Increased pressure in the brain (intracranial hypertension) from any cause Primary brain tumor Secondary brain tumor

Pupils equally constricted signs of CNE

CNS Injury Narcotic drug use Eye medication

pupils are unequal

CVA Head injury Direct trauma to eye Eye medication

What are the pulses which can indicate rough SBP levels, and what are the levels they indicate?

Capillary refill (<2 sec) SBP level - radial 70mmHg, femoral 60mmHg, carotid 50mmHg,

Location of Pulses

Carotid Femoral Radial Brachial Popliteal Posterior tibial Dorsalis pedis Apical (heart)

Capillary refill is tested by? It is more reliable in what group?

Compressing capillaries, often in the nails, and timing how long it takes for them to refill with blood. More reliable in infants and children than adults

Primary survey, D5RA

Disease (PPE) Dispatch (What info do we have) Determine is the scene safe Determine the MOI Determine the No of Patients Request help Assess c-spine

After Initial Assessment

Focused Trauma History or Focused Medical History

In a adult in the Glasgow coma scale what is 6-1 score Motor

Follows Commands=6, Localises Pain=5, Withdraws to pain=4, Decorticate Flexion= 3, Decerebrate Extension=2, No Response=1

Steps in Responsive Mental Status

HPI SAMPLE Focused Physical Exam Vital Signs Transport Ongoing assessment

By Expose we mean:

Head to toe looking for injury

What is HPI

History of Present Illness

Skin Temp can be described in what terms? Skin Condition is described in what terms?

Hot, cool, cold and Dry, Clammy, Diaphoresis

What is the Purpose of the Primary Survey

ID immediate life threats to the patient. Transport decision (load and go or stay and play). Done in a logical sequential order.

What is the SBP at this level of the assessment

If the patient has a radial pulse BP >70mmHg it is an early assessment tool for to check their BP

After Sizing up the scene what is the next step

Initial Assessment

What is a Pulse Oximeter and what can it indicate signs of?

It assess the pulse and can indicate signs of hypoxia.

How can we keep an airway open on unconscious patient that has a MOI

Jaw thrust

Steps in Not significant Trauma Assessment

MOI Not Significant Focused Trauma Assessment Vital Signs SAMPLE Transport Ongoing assessment

Steps in Significant Trauma Assessment

MOI Significant Rapid trauma assessment Vital signs SAMPLE Transport Detailed Patient exam Ongoing assessment

What is a Glucometer

Measures Blood Sugar Level

Respiratory Quality is assessed as?

Normal, Shallow, Laboured, Noisy

Pulse Rates are classed as?

Normal, Tachycardia, Bradycardia

What makes up a Secondary survey?

Nose to Toes Vital Signs Complete History

how do we monitor respirations?

Observe rise and fall of chest, as it ranges for all age groups.

In a adult in the Glasgow coma scale what is 4-1 score Eyes

Open=4, To Voice=3, To Pain=2, No response = 1

In a adult in the Glasgow coma scale what is 5-1 score Verbal

Oriented and Alert=5, Disoriented=4, Nonsensical Speech=3, Moans and unintelligible= 2, Unresponsive=1

In a healthy patient their eyes should be

PEARL pupils are equal active and reactive to light.

Skin Colour descriptions?

Pallor Cyanosis Flushing Jaundice Mottling

Check Pupils, what is PEARL

Pupils are Equal, Active and Reactive to Light

Respiratory and pulse Rhythms are classed as:

Regular or irregular

Pupils equally dilated or unresponsive signs of CaCHD

Sign of Cardiac Arrest CNS Injury Hypoxia Drug Use

What is a SAMPLE

Signs and symptoms Alergies Medications Previous Medical History Last in's and out's Events Leading up to incident

Respiratory rates are described as:

Slow - Bradypnea (or Hypoventilation) Fast - Tachypnea (or Hypervenilation)

Pulse Quality is classed as?

Strong, Weak, thready, bounding.

Vital Signs spsbpr

Sugar Levels Pulse Skin Blood Pressure Pupils Respirations

What should you be looking for as you approach the patient?

The patient's: Appearance: gender, age, colour, nutritional state, sweating, clothing, position Behaviour: interactions with others, distress, movement, agitation Gross observations of level of illness

What is process of using an Pulse Oximeter

Turn on, Attach to patient, troubleshoot any errors, and continually re-reassess.

Steps in Unresponsive Mental Status

Unresponsive Rapid Physical exam Vital Signs HPI SAMPLE Transport Ongoing assessment

How is a person's Blood Pressure usually expressed? What scale is it measured in? What is a normal resting adult blood pressure?

Usually expressed in terms of the systolic pressure over diastolic pressure. Normally measured in millimeters of mercury (mm Hg). Normal resting blood pressure for an adult is approximately 120/80 mm Hg.

In summary, what should some patients have assessed as part of the vital signs.

Vital Signs, Blood sugar level Temperature (tympanic, oral, axillary, rectal) ECG

In summary what should most patients have done.

Vital signs, Pulse (rate, rhythm, quality) Respiratory (rate, rhythm, quality, depth) Blood pressure Glasgow coma score Skin colour, condition, and temperature Pupils Pulse Oximetry

What is a normal BSL

between 4.0 and 8.0

This type of posturing usually means there has been severe

damage to the brain.

What is decorticate flexion indicative of?

damage to the nerve pathway between the brain and spinal cord.

A person can also have decorticate posture on one side of the body and

decerebrate posture on the other side.

How can we keep an airway open on unconscious patient that has no MOI

head tilt chin lift

Lifepak can automatically measure blood pressure however,

it still requires operator monitoring.

How can we keep an airway open on conscious patient that has no MOI

not required they are conscious

The posturing may occur on

one or both sides of the body.

When checking BP, which method uses Palpation and which uses Auscultation?

palpation is checking the pulse as releasing the valve on the cuff. Palpaption=systolic only. Ausculataion is listening for the Korotkoff sound on cuff release. Ausculataion give you the systolic and diastolic BP.

Decerebrate posture is an abnormal body posture that involves

the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards.

Or alternate between

the two.