Emergency Assessment Techniques

Narrative Writing Styles

A way to tell a story using different methods

Scene Assessment

Scene size-up: Quickly assess the scene for safety hazards
Mechanism of injury: How the injury occured, helps to determine what injuries are likely
Number of patients: How many people need treatment
Resources needed: What equipment and personnel are needed
Additional help: Are more resources required
Safety of the scene: This is the primary concern and should be addressed first

Initial Assessment

This is the most important part of the assessment and should be completed in the first 60-90 seconds
Determine the patient's level of consciousness and airway
Identify any life-threatening conditions
Check for breathing and circulation
Perform a rapid scan of the patient's body
Take vital signs

GCS Score Predictions

15: No neurological disabilities
13-14: Mild dysfunction
9-12: Moderate to severe dysfunction
3-8: Severe dysfunction

Current Health Status Elements

Medications
Allergies
Past medical history
Last meal
Events leading up to the injury
Pain level
Mental status

Three (3) Mechanisms that produce ABD pain

Trauma: Falls, motor vehicle accidents, violence
Surgical: Complications from surgery such as adhesions or infections
Medical: Appendicitis, pancreatitis, gastrointestinal bleeding

Tilt-test

Positive results indicate a decrease in blood pressure and increase in pulse
The patient may also experience dizziness or lightheadedness

Rapid Trauma Assessment

This is performed after the initial assessment and before the focused physical examination
It is a quick assessment of the head, neck, chest, abdomen, pelvis, and extremities

Mental Status Evaluation - COASTMAP

C: Consciousness - level of alertness
O: Orientation - awareness of person, place, and time
A: Activity - level of physical activity
S: Speech - clarity, fluency, and appropriateness
T: Thoughts - content and organization
M: Memory - ability to recall recent and past events
A: Affect - mood and emotional state
P: Perception - awareness of surroundings and ability to interpret stimuli

Ongoing Assessment Elements

Vitals signs: Pulse, respirations, blood pressure
Level of consciousness
Pain level
Appearance
Skin color and condition
Pupil size and reactivity

Drug (Definition)

A substance or mixture of substances manufactured, sold, or represented for use in:
- Diagnosis, treatment, or prevention of disease
- Other than food
- Affecting the structure or function of the body

Health Canada - Approval of Medications

Health Products and Food Branch (HPFB) is the branch of government that approves medication in Canada.

Medication Names

Generic name: The chemical name of the drug (Acetaminophen)
Brand name: The name given to the drug by the manufacturer (Tylenol)
Trade name: A proprietary name for a drug (Ibuprofen)

Sources of Medicine

Prescription: Requires a doctor's order
Over-the-counter: Available without a doctor's order
Complementary and alternative medicine: Herbal remedies, acupuncture, etc.
Illicit drugs: Drugs that are illegal to buy, sell, or possess

Scheduled Drugs

Schedule I: Narcotics such as opium, heroin, morphine, and cocaine
Schedule II: Cannabis and cannabis resin
Schedule III: Stimulants such as amphetamines, and hallucinogens such as LSD
Schedule IV: Anabolic steroids, barbiturates, benzodiazepines
Schedule V: Repealed
Schedule VI: Precursors that can be used to create other scheduled drugs
Schedule VII: Repealed
Schedule VIII: Repealed
Schedule IX: Devices that can be used to create tablets or capsules

Drug Development and Approval

Average time for approval: 9 years
Testing in animal species: Two species
Clinical trial phases:
- Phase I: Initial safety and dosage testing in a small group of healthy volunteers
- Phase II: Further safety testing and dosage optimization in a larger group of people with the disease
- Phase III: Large-scale efficacy and safety trials in a diverse patient population
- Phase IV: Long-term surveillance for rare side effects

Pediatric Assessment Triangle

A quick and easy method for assessing a child's condition
Appearance: General appearance and demeanor
Work of breathing: Effort needed to breathe
Circulation: Skin color, capillary refill, and pulse

Pediatric Appearance Features

T: Tone - muscle tone
I: Interactiveness - level of engagement with the environment
C: Consolability - ability to be comforted
L: Look or gaze - eye contact and alertness
S: Speech or cry - quality and strength of cry

Stridor

Obstruction at the level of the glottis (voice box)
Causes a high-pitched, whistling sound during breathing

Grunting

Obstruction in the lower airway
Used as a form of auto-PEEP (positive end-expiratory pressure) to keep the airways open

Wheezing

Constricted or blocked small airways
Causes a whistling or wheezing sound during breathing

Pallor

Initial sign of poor circulation, anemia, or hypoxia
Causes a pale skin color

Mottling

Vasomotor instability in the capillary beds
Causes a blotchy or mottled skin color
It can also be a normal response to a cold environment

Cyanosis

Blue or purple discoloration of the skin and mucous membranes indicating poor perfusion or poor oxygenation
Caused by low levels of oxygen in the blood

Acrocyanosis

Blue hands or feet in an infant less than 2 months old
A normal finding when the infant is cold

How to use a Browlow Tape

Placement: Place the tape on the child's forehead
Measurement: Measure the distance between the brow line and the top of the child's head
Age: Use the tape to determine the child's approximate age
Medications: Use the tape to estimate the appropriate dosage of medication

Skin CTC

Color: Skin color
Temperature: Skin temperature
Condition: Skin condition. Such as, moist, dry, clammy, or sweaty

Children aged 1 - 10 Minimum BP

70 + (age x 2)

Pediatric Respiration Rates

Age Resp rate HR SBP DBP

Neonate (0 - 1 month) 30 - 60 90 - 160 67 - 84 35 - 53 Infant (1 month - 1 year) 30 - 53 90 - 160 72 - 104 37 - 56 Toddler (1 year - 2 years) 22 - 37 80 - 120 86 - 106 42 - 63 Preschool (3 - 5 years) 20 - 28 65 - 100 89 - 112 46 - 72 School-aged (6 - 12 years) 18 - 25 58 - 90 97 - 120 57 - 80 Adolescent (12 - 15) 12 - 20 50 - 90 110 - 131 64 - 83

Geriatric Assessment Tool - GEMS Diamond

G: Geriatric patient
E: Environmental assessment - Living conditions, safety, support systems
M: Medical assessment - Physical exam, vital signs, medication review
S: Social assessment - Family and social support, mental status, financial resources

PE Triad

P: Pain - Assess location, intensity, and quality of pain
E: Edema - Assess the presence of swelling
E: Ecchymosis - Assess the presence of bruising

Causes of Delirium

D: Drugs or toxins
E: Emotional (depression, anxiety) or electrolytes (sodium, potassium)
L: Low PaO2 (low oxygen levels)
I: Infection (pneumonia, urinary tract infection)
R: Retention of stool or urine
I: Ictal state (seizures)
U: Undernutrition or underhydration
M: Metabolism (thyroid disease, liver failure)
S: Subdural hematoma (bleeding in the brain)

Types of Elderly Maltreatment

Physical abuse: Hitting, kicking, slapping, or other physical harm
Sexual abuse: Any non-consensual sexual contact
Emotional abuse: Verbal abuse, intimidation, or threats
Neglect: Failure to provide basic needs such as food, water, shelter, or medical care
Financial exploitation: Misuse or theft of money or property

Emergency Assessment Techniques

Choose a study mode

Podcast

Questions and Answers

What does cyanosis indicate in a patient?

Which of the following respiratory rates is normal for a toddler aged 1 to 2 years?

What does the 'GEMS diamond' stand for in geriatric assessments?

Which of the following is NOT a cause of delirium as per the PE triad?

In infants under 2 months, what is the condition characterized by blue hands or feet known as?

What is the GCS score range that indicates mild neurological dysfunction?

Which mechanism is associated with producing abdominal pain related to positive tilt-test results?

How long should the initial assessment take during an assessment process?

What is included in the mental status evaluation method known as COASTMAP?

Which of these drugs is classified under Schedule II?

In the pediatric assessment triangle, which of the following corresponds to 'T'?

What is the average time required to develop, test, and approve a new drug?

What is one of the initial signs of poor circulation, anemia, or hypoxia?

Study Notes