Chapter 19: Secondary Assessment and Reassessment

Purpura

Red-purple non-blanchable discoloration greater than 0.5 cm in diameter Cause: Intravascular defects, infection (Pg: 639)

Petechiae

Red-purple non-blanchable discoloration less than 0.5 cm in diameter Causes: Intravascular defects, infection (Pg: 639)

Ecchymoses

Red-purple non-blanchable discoloration of variable size Cause: Vascular wall destruction, trauma, vasculitis (Pg: 639)

A patient with a typical sore throat often has what?

Reddened and edematous uvula and tonsillar pillars. Yellow exudate is sometimes present (Pg: 655)

What can occur if bilateral pressure is placed on carotid arteries?

Syncope or bradycardia may occur (Pg: 655)

Onycholysis

Separation of the nail from its bed Can indicate: Psoriasis, dermatitis, fungal infection, and other conditions (Pg: 652)

Dullness

Should be heard over organs and solid masses (Pg: 666)

Left Lower Quadrant (LLQ)

- Lower pole of left kidney - Sigmoid colon - Portion of decending colon - Bladder (if distended) - Ovary and fallopian tube - Uterus (if enlarged) - Left ureter (Pg: 664)

Right Lower Quadrant (RLQ)

- Lower pole of right kidney - Cecum - Portion of ascending colon - Appendix - Bladder (if distended) - Ovary and fallopian tube - Uterus (if enlarged) - Right ureter (Pg: 664)

Tympanic temperature measurement is...

- Close to hypothalamus which makes an ideal spot to obtain core temperature - To obtain the most accurate reading, the ear canal should be straightened by gently pulling the pinna of the ear down and back in children younger than 3 or up and back in patients older than 3 Can be inaccurate in the following circumstances: patient's who have had ear surgery, have otitis media or excessive cerumen (earwax), have recently exercised, extreme temperatures, and are younger than 3 (Pg: 650)

Esophageal temperature probes...

- Continuous assessment of core temperature in patients older than 16 years old - Procedure most used to support therapeutic hypothermia after cardiac arrest or there are concerns for hypothermia/hyperthermia (Pg: 650)

Magnetic stethoscopes

- Have a single diaphragm end piece - A frequency dial for high-, low-, and full frequency sounds (Pg: 634)

Left Upper Quadrant (LUQ)

- Left lobe of liver - Spleen - Stomach - Body of pancreas - Left adrenal gland - Portion of left kidney - Splenic flexure of colon - Portions of transverse and descending colon (Pg: 664)

Right Upper Quadrant (RUQ)

- Liver and gallbladder - Pylorus - Duodenum - Head of pancreas - Right adrenal gland - Portion of right kidney - Hepatic flexure of colon - Portions of ascending and transverse colon (Pg: 664)

Vesicular breath sounds

- Lungs considered "clear" make normal vesicular breath sounds - Long inspiratory phase and shorter expiratory phase - Can be harsh or diminished - Harsh sounds can be associated with vigorous exercise - Harsh sounds can be seen in children who have thin and elastic chest wall - Diminished sounds can be heard in older adults, obese, or muscular individuals

Temporal temperature measurement...

- Measurement obtained quickly without discomfort - Scanned on forehead then lifted and placed behind ear - Hair, head coverings, diaphoresis and sweating can interfere with accuracy of reading (Pg: 650)

Rectal temperature measurement...

- Poses a risk of perforation - Can be distressing for patient - Generally reserved for young children and altered patients - Place patient supine (infants) - Place patient in left-lateral recumbent position with legs raised (adults) - Insert lubricated probe no more than 0.5-1 inches (2.5cm) - Provide most accurate readings; impractical for pre-hospital use (Pg: 650)

Axillary temperature measurement is usually taken in patients...

- Younger than 6 years old - Children who are uncooperative - Patient's with suppressed immune systems - Patient's who have an altered level of consciousness (Pg: 649)

Spider angioma

Red central body with radiating spider-like legs blanch with pressure to the central body Causes: Liver disease, vitamin B deficiency, idiopathic (Pg: 639)

Scoring Deep Tendon Reflexes

0 No response 1 Sluggish or diminished 2 Active or expected response 3 More brisk than expected, slightly hyperactive 4 Brisk, hyperactive, with intermittent or transient clonus

Rectal temperatures will often read...

0.5 degrees celsius or 0.9 degrees Fahrenheit higher than oral temperatures (Pg: 649)

Axillary and temporal temperatures will often read....

0.5 degrees celsius or 0.9 degrees Fahrenheit less than oral temperatures (Pg: 649)

The blood pressure cuff is placed on the patient's arm with the lower end of the cuff positioned where?

1-2 inches (3 to 5cm) above the antecubital space (Pg: 547)

What are normal eye exam findings?

1. A clear, yellow optic nerve disk 2. Yellow to creamy-pink retina 3. Light red arteries and dark red veins 4. 3:2 vein-to-artery ratio in size proportion (Pg: 654)

Constricted pupils may indicate the following:

1. CNS injury or disease 2. Narcotic drug use (Heroin, Fentanyl) 3. Eye medications (Pg: 651)

Dilated pupils may indicate the following:

1. Cardiac arrest 2. CNS injury 3. Hypoxia/ anoxia 4. Drug use (LSD) 5. Atropine 6. Amphetamines (Pg: 651)

One dilated or unresponsive may indicate the following:

1. Cerebrovascular accident 2. Head injury 3. Direct trauma to eye 4. Eye medications (Pg: 651)

What are normal ear exam findings?

1. Cerumen will be dry (tan or light yellow) or moist (dark yellow or brown) 2. The ear canal shall not be inflamed (a sign of infection) 3. The tympanic membrane should be translucent or pearly gray (pink or red indicates inflammation) (Pg: 654)

Crackles may be classified further as:

1. Coarse crackles (wet, low pitched sounds) 2. Fine crackles (dry, high pitched sounds) May be subtle and hard to hear. If suspected, patient should be asked to cough (Pg: 660)

Range of motion can be tested in the following manner:

1. Flexion: Touching the chin to the chest 2. Rotation: Touching the chin to each shoulder 3. Lateral bending: Touching each ear to each shoulder 4. Extension: Tilting the head backward (Pg: 655)

Enlarged gums may be a sign of what five things?

1. Indicate pregnancy 2. Leukemia 3. Poor oral hygiene 4. Puberty 5. Some medications like phenytoin (Pg: 655)

Examination of the genitalia of both men and women should be preformed in the pre-hospital setting only if...

1. Indicated by patient compliant 2. Pregnancy with imminent delivery 3. Mechanism of injury (Pg: 666)

What are four techniques commonly used during physical examination?

1. Inspection 2. Palpation 3. Percussion 4. Auscultation (Pg: 632)

What is the paramedic looking for upon palpation?

1. Texture 2. Masses 3. Fluid 4. Crepitus 5. Assess skin temperature (Pg: 632)

The peripheral vascular system includes:

1. The arteries 2. Veins 3. Lymphatic system 4. Lymph nodes 5. Includes fluid exchange in the capillary bed (Pg: 669)

Genitalia with what signs can indicate possible STD's?

1. Ulcers 2. Vesicles 3. Discharges (with or without pain) (Pg: 666)

Normal breath sounds are classified as:

1. Vesicular breath sounds 2. Bronchovesicular breath sounds 3. Bronchial breath sounds (Pg: 659)

Normal respiratory rate for adults as stated in the book is what?

12-24 breaths/minute (Pg: 646)

What is the general liver size?

2.4-4.7 inches (6 to 12cm) (Pg: 666)

What is the normal body temperature?

37 degrees Celsius 98.6 degrees Fahrenheit

Oral temperature measurement is usually taken in patient's older than what age?

6 years old (Pg: 649)

Clubbing

A change in the angle between the nail and nail base that approaches and exceeds 180 degrees; flattening and enlargement at fingertips Can indicate: Chronic cardiac or respiratory disease (Pg: 652)

Macule

A flat, circumscribed area that is a change in color of skin; less than 0.4 inches (1cm) in diameter (Freckles, flat moles(nevi), petechiae, measles, scarlet fever) (Pg: 640)

Patch

A flat, nonpalpable, irregular-shaped macule greater than 0.4 (1cm) in diameter (Vitiligo, port-wine stains, congenital dermal melanocytosis, cafe-au-lait patch)

Crepitus

A grating sound or sensation that may be caused by bone fragments rubbing or other sources, such as with joint inflammation (Pg: 630)

Scoliosis

A lateral deviation of the spine (Pg: 656)

Skin color, texture, and appearance can be affected by..

A person's age (Pg:638)

Apical impulse

A pulsation of the left ventricle of the heart that is palpable and sometimes visible at the fifth intercostal space to the left of the midline (Pg: 630)

The cuff is slowly deflated at what rate?

A rate of 2 to 3 mm Hg/sec (Pg: 647)

Six cardinal fields of gaze

A test to evaluate extraocular muscle function; performed by having the patient visually track an object in six visual fields in an H pattern (Pg: 652)

Capillary hemangioma (nevus flammeus)

Red irregular macular patches Cause: dilation of dermal capillaries (Pg: 639)

Splinter hemorrhages

Red or brown linear streaks in nail bed Associated with: minor nail trauma, bacterial endocarditis, and trichinosis (Pg: 652)

Bruit

Abnormal sound or murmur that may be heard during auscultation of the carotid artery or another organ or gland May indicate: local obstruction Low pitched and difficult to hear (Pg: 663)

Dysphonia

Abnormal speaking voice (Pg: 636)

What are the three major types of stethoscopes?

Acoustic, magnetic, and electronic stethoscopes (Pg: 634)

Adult/child BP cuff widths

Adult: 1/3-1/2 the circumference of the limb Children: the width should cover about 2/3's of the limb (Pg: 635)

A flat abdomen is common in who?

Adults who are athletic (Pg: 665)

What else can inspection provide?

Alert the paramedic to patient's mental status, and to possible injury or underlying illness (Pg: 632)

Papule

An elevated, firm, circumscribed area; less than 0.4 inches (1cm) in diameter (Warts (verruca), elevated moles, lichen planus) (Pg: 640)

Romberg test

Ask the patient to stand with their feet together, and then ask patient to close their eyes. Although slight swaying is normal, a loss of balance is abnormal (positive Romberg test) (Pg: 673)

Egophony test

Asked to say the letter "e-e-e" If the vocal sounds more closely resemble the letter "a" a lung consolidation may be present (Pg: 662)

Digit span

Asking a person to count from 1 to 10 using only even or odd numbers (Pg: 637)

Venous star

Bluish spider, liner or irregularly shaped; does not blanch with pressure Cause: increased pressure in superficial veins (Pg: 639)

Bronchial breath sounds

Breath sounds heard over the trachea. Highest pitch -Short inspiratory phase and long expiration phase (Pg: 658)

Auscultation

Calls for the use of a stethoscope and is used to assess body sounds made by movement of various fluids or gases in the patient's organs or tissues (Pg: 633)

How do you hear high-frequency sounds?

Can be heard when the chest piece is placed firmly against the chest wall (Pg: 634)

S2 (the "dub sound")

Caused by the closure of aortic (A2) and pulmonic (P2) valves (Pg: 662)

S1 (the "lub sound")

Caused by the closure of the mitral (M1) and tricuspid (T1) valves (Pg: 662)

Barrel chest

Chest wall diameter is increased in patients with COPD (Pg: 656)

Convex abdomens are common in who?

Children and adults who have poor exercise habits (Pg: 665)

Tunable stethoscopes...

Combine the bell and diaphragm (Pg: 634)

Electronic stethoscopes can..

Compensate for environmental noise; therefore they may be beneficial for the use of the prehospital setting (Pg: 634)

Thoracic kyphosis

Concave curvature of the thoracic segment of the vertebral column (Pg: 656)

Pulse deficit

Condition that exists when the radial pulse is less than the ventricular rate; indicates a lack of peripheral perfusion (Pg: 630)

Diminshed breath sounds

Condition that lessens airflow E.g. endotracheal tube misplacement, pneumothorax, partial airway obstruction, and pulmonary disease (Pg: 658-659)

Secondary assessment

Consists of physical examination techniques, vital signs, assessment of body systems, and the skillful use of examination equipment (Pg: 630)

Rhonchi (Sonorous wheeze)

Continuous, low-pitched, rumbling sounds usually heard on expiration They do not involve the small airways Passage of the airway obstructed by thick secretions, muscular spasm, new tissue growth, or external pressure collapsing the airway lumen (Pg: 661)

What is discoloration of genitals called?

Coopernail sign (Pg: 666)

Edema is said to be "pitting" when...

Depression of the tissue remains after removal of pressure (Done by pressuring firmly using thumb for 5 seconds) (Pg: 670)

What is Cullen sign?

Discoloration around the umbilicus (Pg: 664)

Crust (Secondary skin lesion)

Dried serum, blood or purulent exudates; slightly elevated Size varies: brown, red, tan, or straw-colored Ex. scab on abrasion or eczema (Pg: 645)

Tumor

Elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 0.8 inches (2cm) in diameter (Neoplasms, benign tumor, lipoma, hemangioma) (Pg: 641)

Cyst

Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid semisolid material (Sebaceous cyst, cystic acne) (Pg: 642)

Vesicle

Elevated, circumscribed, superficial, not into the dermis; filled with serous fluid; less than 0.4 inches (1cm) diameter (Varicella (chickenpox), herpes zoster (shingles) (Pg: 641)

Plaque

Elevated, firm, and rough lesion with flat top surface greater than 0.4 inches (1cm) in diameter (Psoriasis, seborrheic, and actinic keratosis)

Nodule

Elevated, firm, circumscribed; deeper in dermis than a papule; 0.4-0.8 inches (1-2cm) in diameter (Erythema nodosum, lipomas, nodules) (Pg: 641)

Wheal

Elevated, irregular-shaped area of cutaneous edema; solid transient, variable diameter (Insect bites, urticaria, allergic reaction, wheal) (Pg: 641)

Pustule

Elevated, superficial lesions; similar to a vesicle but filled with purulent fluid (Impetigo, acne) (Pg: 642)

A normal spleen usually cannot be palpated in an adult. A palpable spleen is most likely what?

Enlarged 3x it's normal size Palpation of spleen can cause rupture and should be preformed with caution (Pg: 666)

Emaciated

Extremely lean from lack of nutrition (Pg: 645)

Ataxia

Failure of muscle coordination (Pg: 636)

Geriatric skin

Often wrinkly, dry, with uneven pigmentation Thinning epidermis, decreased collagen, and various proliferative lesions (Pg: 638)

Telangiectasia

Fine, irregular red line Cause: dilation of capillaries (Pg: 639)

Telangiectasia

Fine, irregular, red lines produced by capillary dilation (Telangiectasia in rosacea) (Pg: 642)

Patient's basic appearance can described as what three things?

Frail: describing a patient with a heightened vulnerability to functional dependence. Patient's who have low physical activity, muscle weakness, and slowed performance Robust: describes a patient who appears strong and healthy Vigorous: Patients who appear full of energy (Pg: 638)

Increased bowel sounds may indicate what?

Gastroenteritis or intestinal obstruction (Pg: 665)

Upper and lower abdominal reflexes

Gently stroke each quadrant of the abdomen with tongue blade. A normal reflex is slight movement of the umbilicus (Pg: 674)

Cremasteric reflex

Gently stroke inner thigh (proximal to distal) The testicle and scrotum should rise on the side that is stroked (Pg: 674)

Plantar reflex

Gently stroke the lateral side of foot from hell to the ball then across the foot to the medial side. In the healthy adult, reflex represents a downward flexion of the toes towards the source of stimulus (Pg: 674)

Scale (secondary skin lesion)

Heaped-up keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size (Flaking of skin with seborrheic dermatitis following scarlet fever, or flaking of skin following drug reaction; dry skin) (Pg: 643)

Asymmetrical distension of the abdomen may result from what?

Hernias, tumor, bowel obstruction, or enlarged abdominal organs (Pg: 665)

Crackle

High-pitched, discontinuous sound that is usually heard at the end of inspiration. Similar to hair being rubbed between the fingers Caused by: Disruptive passage of air in small airways or alveoli (Pg: 659)

Wheeze

High-pitched, musical noises that are usually louder during expiration Caused by: high-velocity air traveling through narrow airways may occur because of asthma and other constructive diseases and heart failure Can occur on inspiration or expiration (Pg: 660)

Absent lung sounds

Indicate total cessation of breathing process Localized breath sounds may indicate: endotracheal tube misplacement, pneumothorax, and hemothorax (Pg: 658)

Paronychia

Inflammation of the skin at the base of nail May indicate: local infection or trauma (Pg: 652)

Nystagmus

Involuntary jerking movements of the eye (Pg: 652)

Keloid (Secondary skin lesion)

Irregular-shaped, elevated, progressively enlarging scar; grows beyond boundaries of wound; caused by excessive collagen formation during healing (keloid formation following surgery) (Pg: 643)

Ophthalmoscope

Is used to inspect structures of the eye, including the retina, choroid, optic nerve disk, macula (oval, yellow spot at the center of the retina), and retinal vessels (Pg: 634)

Transverse white lines

Longitudinal white streaks in the nail plate May indicate: systemic disorder (Pg: 652)

Aphasia

Loss of the ability to understand or express speech (Pg: 636)

Ulcer (Secondary skin lesion)

Loss of the epidermis and dermis; concave; varies in size Ex. Decubiti, stasis ulcer (Pg: 645)

Excoriation (Secondary skin lesion)

Loss of the epidermis; linear, hollowed-out crusted area ex. abrasion or scratch; scabies (Pg: 644)

Pleural fiction rub

Low pitched, dry rubbing or grating sound Caused by movement of inflamed pleural surfaces as they slide on one another during breathing May be auscultated on inspiration and expiration May indicate: pleurisy, viral infection, tuberculosis, or pulmonary embolism (Pg: 661)

The bell (on the stethoscope) is central for listening to what?

Low-pitched sounds (e.g certain heart sounds) (Pg: 633)

The diaphragm (on the stethoscope) filters out what?

Low-pitched sounds and therefore emphasizes high-pitched sounds (eg. high pitched sounds include breath sounds) (Pg: 633)

Tympany

Major sound that should be noted during percussion because of the normal presence of air in the stomach and intestines (Pg: 666)

What are two non-traditional EMS tools?

Ophthalmoscope and otoscope (Pg: 634)

Assessment of Cranial Nerves (Part 1)

Nerve I (Olfactory) - test sense of smell Nerve II (Optic) - Test for visual acuity Nerve III (Oculomotor) - Inspect size and shape of pupils; check pupil response to light Nerves III (Oculomotor), IV (Trochlear), and VI (Abducens) - Test extra ocular movements by asking patients to look up and down, to the left and right, and diagonally up and down (six cardinal directions of gaze)

Assessment of Cranial Nerves (Part 2)

Nerve V (Trigeminal) - Test motor movement by asking the patient to clench teeth while you palpate the temporal and masseter muscles. Test sensation by touching the forehead, cheeks, and jaw on each side Nerve VII (Facial) - Inspect face at rest and during conversation. Ask patient to raise eyebrows, frown etc, assess strength of facial muscles, and note any weakness or asymmetry Nerve VIII (Vestibulocochlear) - Assess hearing acuity

Assessment of Cranial Nerves (Part 3)

Nerves IX and X (Glossopharyngeal and vagus) - Assess ability to swallow, produce salvia, produce normal sounds, test for gag-reflex, and instructing patient to hold their breath and observe for slowing of heart rate Nerve XI (Spinal accessory) - Ask patient to raise and lower shoulders and turn head Nerve XII (Hypoglossal) - Ask patient to stick out tongue and move it in several directions

Bronchovesicular breath sounds

Normal breath sounds heard over major bronchi or in the posterior chest between the scapula - Louder and harsher than vesicular sounds - Equal inspiratory and expiratory phases (Pg: 658)

Symmetrical distension of the abdomen may result from what?

Obesity, enlarged organs, fluid or gas (Pg: 665)

Muffling while listening to the heart may mean what?

Obesity, obstructive lung disease, infectious uremic pericarditis, malignancy, and presence of fluid in the pericardial sac (Pg: 663)

Abnormal Skin Color and Possible Causes

Pallor (decreased color): shock, dehydration, fright Cyanosis (blue color): cardiorespiratory insufficiency, cold environment Jaundice (yellow-orange color): liver disease, red blood cell destruction Red: Fever, inflammation, carbon monoxide poisoning (Pg: 638)

Lip exam findings:

Pallor of the lips = anemia Cyanosis of the lips = cardiorespiratory insufficiency Red lips = late sign of carbon monoxide poisoning (Pg: 655)

What are significant inspection findings?

Patient hygiene, clothing, eye gaze, body language and position, skin color, and odor (Pg: 632)

whispered pectoriloquy test

Patient is asked to whisper as the posterior lungs are auscultated. If vocal sounds are transmitted clearly or there is an increased loudness of whispering during auscultation, indicates lung consolidation (Pg: 662)

What patient's can have priapism?

Patient's with leukemia, sickle cell disease, or spinal injury (Pg: 666)

Pediatric Skin

Pediatric light skin - may be milky white/rose/deep hue of pink Pediatric dark skin - may have various brown, yellow, olive-green, or blue tones Usually smooth, slightly dry, and not oily or clammy

Pronator drift test

Performed by having the patient close their eyes and hold both arms out from the body (Pg: 673)

Inflammation of the pericardial sac may cause a sound called what?

Pericardial friction rub; the rub may result from infectious pericarditis, myocardial infarction, uremia, trauma, and autoimmune pericarditis (Pg: 663)

Decreased or absent bowel sounds may indicate what?

Peritonitis (inflammation of the lining of the abdominal cavity) or ileus (inactive peristaltic activity) (Pg: 665)

Psoriasis

Pitting, discoloration and subungual thickening of the nail plate May lead to: splinter hemorrhages (Pg: 652)

Lung consolidation usually indicates what?

Pneumonia or pleural effusion (Pg: 662)

Dysarthria

Poorly articulated speech (Pg: 636)

Coma is a state of...

Profound unconsciousness; a patient in a coma has no spontaneous eye movements, do not respond to verbal/painful stimuli, and cannot be aroused (Pg: 636)

Heart murmurs

Prolonged sounds caused by a disruption in the blood flow into, through, or out of the heart Most cause: valvular defects (Pg: 663)

Pigeon chest

Prominent sternal protrusion (Pg: 656)

What are the most typical causes of crackles?

Pulmonary edema, and pneumonia Start at the base of the lungs due to gravity (Pg: 660)

Vital signs for infants (1m-1 year)

Pulse: 100-190 RR: 30-53 BP: 72-104/37-56 (Pg: 647)

Vital signs for Newborn

Pulse: 100-205 RR: 30-60 BP: 67-84/35-53 (Pg: 647)

Vital signs for 12-15 year olds

Pulse: 70-90 RR: 12-20 BP: 110-131/64-83 (Pg: 647)

Vital signs for school aged (6 to 12 years old)

Pulse: 75-118 RR: 18-25 BP: 97-120/57-80 (Pg: 647)

Vital signs for preschool (3-5 years old)

Pulse: 80-120 RR: 20-28 BP: 89-112/46-72 (Pg: 647)

Vital signs for toddler (1-2 years old)

Pulse: 98-140 RR: 22-37 BP: 86-106/42-63 (Pg: 647)

Deep tendon reflexes

Reflexes that examine the sensory and motor pathways of a nerve; often associated with muscle stretching (tested using a reflex hammer)

What medical conditions may result to body odor?

Renal, and liver diseases (Pg: 636)

Lung percussion

Resonance = heard all over in healthy lungs Hyperresonance = associated with overinflation, or hyperinflation May indicate: Pulmonary disease, pneumothorax, or asthma Dullness or flatness = presence of fluid or pulmonary congestion (Pg: 657-658)

Adventitious breath sounds:

Result from obstruction of the large and small airways that is most commonly heard during inspiration Divided into: discontinuous and continuous Discontinuous: crackles Continuous: Wheezes or rhonchi (Pg: 659)

What is the basic heart sound?

S1 and S2 ("lub-dub") are normal sounds that occur when the heart contracts (Pg: 662)

What does pericardial friction rub sound like?

Scratching, grating or squeaking quality and tend to be louder on inspiration Can be differentiated from pleural friction rubs by their continued presence when the patient holds their breath (Pg: 663)

Skin is normally smooth, soft, and flexible. However, in adults skin is...

Skin may be wrinkled and leathery from decreased amounts of collagen and subcutaneous fats as well as reduced secretions from sweat glands (Pg: 651)

Electronic stethoscopes convert...

Sound vibrations into electrical impulses that are amplified. The impulses are transmitted to a speaker where they are converted to sound (Pg: 634)

Acoustic stethoscopes transmit...

Sound waves form the source to the paramedic's ears; most have a rigid diaphragm (Pg: 634)

What is frequently associated with significant cervical spine injury in the trauma victim?

Spontaneous cervical muscle spasm (Pg: 670)

What is the basic equipment used during the comprehensive physical examination?

Stethoscope, ophthalmoscope, otoscope and blood pressure cuff (Pg: 634)

Palpating the patient's lower orbital rim determines what?

Structural integrity (Pg: 653)

When wheezing occurs in a localized area, the paramedic should suspect what?

Suspect a foreign body obstruction, tumor, or mucus plug (Pg: 660)

How do you hear low frequency sounds?

The chest piece is placed lightly on the chest for auscultation (Pg: 634)

Turgor refers to what?

The elasticity of the skin (Pg: 651)

Which area of skin is most reliable when conducting a turgor test?

The forehead as it is less affected by age-dependent changes (Pg: 651)

How is the technique of percussion preformed?

The paramedic striking one finger against another to produce vibrations and sound waves of underlying tissues (Pg: 632)

Bronchophony test

The patient is asked to whisper "toy boat" or "blue balloons" while lungs are auscultated. Vocal sounds will be louder where consolidation is present (Pg: 662)

Tented skin that does not quickly return to normal may indicate what?

The patient is dehydrated (Pg: 651)

A healthy liver usually cannot be palpated unless...

The patient is thin (Pg: 666)

subcutaneous emphysema

The presence of air in the subcutaneous tissues May be observed by bubbling or cracking sensation upon palpation of the neck (Pg: 655)

Bronchial breath sounds auscultated in the peripheral lung field indicate what?

The presence of fluid of exudate in the alveoli Diseases that contribute to this: tumors, pneumonia, and pulmonary edema (Pg: 659)

Terry's nails

The presence of transverse white bands that cover the nail except for a narrow zone at the distal tip Associated with: Cirrhosis (Pg: 652)

The point at which what occurs is the patient's diastolic pressure?

The sounds change in quality or become muffled (Pg: 647)

What is the only palpable landmark on the neck?

The spinous process of the seventh cervical vertebrae (Pg: 670)

Inspection

The visual assessment of patient and their surroundings (Pg: 632)

Scar (Secondary skin lesion)

Thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis ex. healed wound or surgical incision (Pg: 644)

Atrophy (Secondary skin lesion)

Thinning of the skin surface and loss of skin markings; skin translucent and paperlike Ex. striae, aged skin

If measured manually, the cuff is inflated to what point?

To a point about 30 mm Hg above where the brachial pulse can no longer be palpated (Pg: 647)

Palpation of the apical impulse may be useful when what?

To compare the relationship of peripheral pulses with the pulse produced by ventricular contraction (Pg: 662)

Where is the lub-dub sound best heard?

Toward the apex of the heart at the fifth intercostal space (Pg: 662)

Beau lines

Transverse depression in the nail bed that inhibits nail growth Can be associated with: systemic illness, severe infections and nail injury (Pg: 652)

The light from the otoscope allows visualization of what?

Tympanic membrane (Pg: 635)

Percussion tones and examples:

Tympany (the loudest) - Gastric bubble Hyperresonance - air-filled lungs (eg, COPD, pneumothorax) Resonance - Healthy lungs Dullness - Liver Flat (the quietest) - Muscle (Pg: 633)

Breath or body odors can point to...

Underlying conditions or illness (e.g alcohol, acetone (diabetic ketoacidosis), feces (bowel obstruction), and halitosis from throat infections, dental caries, and poor dental/oral hygiene (Pg: 636)

Anisocoria

Unequal pupils (Pg: 650)

Superficial and Deep Tendon Reflexes

Upper abdominal - T7, T8, T9 Lower abdominal - T10 and T 11 Cremasteric - T12, L1, and L2 Plantar - L4, L5, S1, and S2 -Deep Tendon- Biceps - C5 and C6 Brachioradial - C5 and C6 Triceps - C6, C7, and C8 Patellar - L2, L3, and L4 Achilles - S1 and S2

Otoscope

Used to examine deep structures of the external and middle ear (Pg: 635)

Stridor

Usually inspiratory, crowing type sound that can be heard without the aid of stethoscope Indicates: significant narrowing or obstruction of the larynx or trachea Caused by: epiglottitis, viral croup, anaphylaxis, foreign body aspiration, or more than one of these factors (Pg: 661)

White spots on nails

Usually result from minor injury or cuticle manipulation (Pg: 652)

Bulla

Vesicle greater than 0.4 inches (1cm) in diameter (Blister, pemphigus vulgaris) (Pg: 642)

Insufficient calcium may be indicated by what finding on the nail bed?

Yellow tint (Pg: 651)

Funnel chest

an indentation of the lower sternum above the xiphoid process (Pg: 656)

Superficial reflexes

are elicited by sensory afferents from the skin. These include abdominal, cremasteric (men), and plantar reflexes (Pg: 674)

Thrills

are like bruits but are described as fine vibrations or tremors that may indicate blood flow obstruction (Pg: 663)

Serial sevens

counting down from one hundred by sevens (Pg: 637)

What is Grey Turner sign?

discoloration around flank (Pg: 664)

Dysconjugate gaze

failure of the eyes to move with synchronized motion; may be diagnostic of a neurologic injury (Pg: 630)

Exudate

fluid, such as pus, that leaks out of an infected wound

Palpation

is a technique in which the paramedic uses the hands and fingers to gather information by touch (Pg: 632)

Percussion

is used to evaluate the presence of air or fluid in body tissues (Pg: 632)

Fissure (Secondary skin lesion)

linear crack or break from the epidermis to the dermis; may be moist or dry ex. athlete's foot, cracks at the corner of the mouth (Pg: 644)

Erosion (Secondary Skin Lesion)

loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla ex. Varicella, variola after rupture (Pg: 644)

Lichenification (secondary skin lesion)

rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity (Chronic dermatitis, atopic dermatitis) (Pg: 643)