primary assessment
the first element in a patient assessment; steps taken for the purpose of discovering and dealing with any life-threatening problems.
six parts of primary assessment
1) forming a general impression
2) assessing mental status
3) assessing airway
4) assessing breathing
5) assessing circulation
6) determining the priority of the patient for treatment and transport to the hospital
primary assessment/primary survey/initial survey
what is always the first element in the total assessment of the patient?
general impression
impressions of the patient's condition that is formed on first approaching the patient, based on the patient's environment, chief complaint and appearance; helps determine patient severity; helps set priorities for care and transport
look test
providers often get a "feeling" about the patient's condition; this feelings comes from environmental observations as well as from the brief but valuable information obtained by that first look at the patient as the EMT approaches
general impressions that indicate a critical patient
1) Altered mental status
2) Anxiety
3) Pale, sweaty skin
4) Obvious trauma to head, chest, abdomen, pelvis
5) Specific positions indicating distress
tripod position
indication of significant difficulty in breathing
Levine's sign
indication of significant chest pain or discomfort
1) Resuscitate by beginning CPR compressions
2) Prepare AED as soon as possible
what steps must be taken for a patient that appears lifeless?
chief complaint
in emergency medicine, the reason EMS was called, usually in the patient's own words; may be specific "abdominal pain"; may be vague "not feeling good
1) Look
2) Listen
3) Smell
forming a general impression includes what 3 senses?
mental status
level of responsiveness
Alert
Verbal response
Pain response
Unresponsive
a memory aid for classifying a patient's level of responsiveness or mental status
situations calling for breathing assistance
1) Respiratory arrest
2) Not alert, inadequate breathing
3) Some alertness, inadequate breathing
4) Adequate breathing, but signs suggesting respiratory distress or hypoxia
circulation
1) assess pulse
2) assess skin
3) assess bleeding
pale; cool and clammy
skin conditions that suggest shock
1) within normal limits
2) unusually slow
3) unusually fast
what should you take notice in when assessing pulse?
priority
the decision regarding the need for immediate transport of the patient versus further assessment and care at the scene
immediately
any life threats found while evaluating the ABC's must be treated ______________.
stable
a patient that has vital signs that are in the normal range or just slightly abnormal
true
true or false: a patients priority can change as the patient's condition changes
1) poor general impression
2) unresponsive
3) responsive, but not following commands
4) difficulty breathing
5) shock
6) complicated childbirth
7) chest pain consistent with cardiac problems
8) uncontrolled bleeding
9) severe pain anywhere
high priority conditions
need for priority transport
1) initiate priority transport if a life-threatening problem cannot be controlled or threatens to recur
2) continue assessment and care en route
clinical judgement
When an EMT feels that a patient just "doesn't look right," this is
called:
upon first contact with the patient
In any patient with suspected spinal injury, an EMT should apply manual stabilization:
talking to the infant
The mental status of unresponsive infants is typically checked by flicking the feet and:
clinical judgement
The "sixth sense" that an EMT develops about a patient's condition is known as
_________________________ _________________________.
person, place, time
An awake patient's mental status can be assessed by determining his/her orientation to
_________________________, _________________________, and
_________________________.
positive-pressure ventilations
If a patient is not alert and his/her breathing rate is slower than 8 breaths per minute, provide
_________________________-_________________________
_________________________
neutral
In child and infant trauma patients, the head should be immobilized in a _________________________ position
unstable
patient condition: unresponsive
what is the patient status?
potentially unstable
patient condition: severe pain
stable
patient condition: broken arm
unstable
patient condition: difficulty breathing
potentially unstable
patient condition: cut; bleeding controlled
1) poor general impressions
2) unresponsive
3) responsive, but not following commands
4) difficulty breathing
5) shock
6) complicated childbirth
7) chest pains consistent with cardiac problems
8) uncontrolled bleeding
9) severe pain anywhere
List eight high-priority concerns
1) mechanism of injury
2) nature of illness
3) mental status
4) vital signs
5) significant blood loss
List five things that will help the EMT determine if the patient is stable, unstable, or potentially
unstable.
general impressions
What BEST defines the immediate sense of the patient's degree of distress, formulated from the patient's immediate environment, appearance, and chief complaint?
the reason why the patient summoned EMS
Which of the following describes the chief complaint?
there was not enough in the question to answer
Which of the following conditions does NOT require intervention in the "Breathing" phase of the primary assessment?
taking a blood pressure reading
In the primary assessment, which of the following is NOT an acceptable method of assessing the patient's circulatory status?
at the radial artery
During the primary assessment of a responsive adult patient, where should the pulse be checked?
open the airway
Your patient is a 33-year-old man who has been ejected from his vehicle during a high-speed collision. During your general assessment it is discovered that he is not moving, does not appear to have adequate respiration, and has suffered a large amount of
transport priority
Your patient is a 42-year-old woman who fell a couple of feet from a ladder and is complaining of pain in her ankle. Which of the following are you unable to determine from the information given?
flick the heel of the infant
Which of the following is an appropriate method for an EMT to use when attempting to gauge a 6-month-old infant's mental status?
capillary refill
Which of the following findings is NOT used to assess an adult's circulation?