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.