Patient Assessment: Primary Survey

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Questions and Answers

What is the recommended timeframe for completing the primary survey in patient assessment?

  • As long as necessary to gather all information
  • Within 15-30 seconds
  • Within 5-10 minutes
  • Within 60-90 seconds (correct)

Which of the following is the correct order of steps in the <C>ABCDE approach to initial patient assessment?

  • Airway, Breathing, Catastrophic haemorrhage, Circulation, Disability, Exposure
  • Breathing, Airway, Circulation, Disability, Exposure, Catastrophic haemorrhage
  • Catastrophic haemorrhage, Airway, Breathing, Circulation, Disability, Exposure (correct)
  • Airway, Breathing, Circulation, Disability, Exposure, Catastrophic haemorrhage

What does the 'A' stand for in the AVPU scale used to assess a patient's level of consciousness?

  • Alert (correct)
  • Agitated
  • Aphasic
  • Ambulatory

Which of the following best describes 'catastrophic haemorrhage'?

<p>Bleeding that is likely to cause death in minutes if not controlled. (C)</p>
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Why is it important to avoid unnecessary movement of the head and neck in patients who have suffered traumatic injuries?

<p>To prevent potential cervical spine injury (C)</p>
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During the assessment of a patient's airway, what are the three key actions that should be performed?

<p>Look, listen, and feel (D)</p>
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Which of the following is NOT typically assessed during the 'Disability' component of the primary survey?

<p>Respiratory rate (C)</p>
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What does the acronym 'SAMPLE' stand for when taking a patient history?

<p>Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to illness/injury (A)</p>
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What is the significance of identifying a non-blanching rash during the 'Exposure' component of the primary survey?

<p>It may signal a serious illness such as sepsis. (D)</p>
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During reassessment, what illustrates the dynamic nature of a patient's clinical condition?

<p>The patient's condition frequently changes, either due to the illness and/or injury they have acquired, or as a result of an intervention you have performed (C)</p>
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What is the initial and immediate assessment of the patient and their current location called?

<p>General Impression (A)</p>
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In the context of patient assessment, what does the acronym SOCRATES help to organize?

<p>Signs and symptoms of the presenting complaint (C)</p>
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Which of the following is a key consideration during the 'Exposure' stage of patient assessment to maintain patient privacy?

<p>Avoiding unnecessary exposure in public to maintain dignity and prevent heat loss. (B)</p>
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What should clinicians do if they identify gurgling sounds while assessing the patient's airway?

<p>Address the obstruction before moving on to breathing. (A)</p>
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When assessing a patient's circulation, which of the following actions should be performed to evaluate cardiac output in addition to pulse assessment?

<p>Checking the color of the patient's limbs. (B)</p>
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During the 'head-to-toe' assessment, what specific observation is mentioned as potentially indicative of a diabetic patient?

<p>Breath odor resembling pear drops. (D)</p>
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A trauma patient has a respiratory rate of 10 breaths per minute, oxygen saturation on air of 93%, is on room air, systolic blood pressure of 108 mmHg, heart rate of 110 beats per minute, is alert, and has a temperature of 38.1°C. Using the NEWS2 chart, what is this patient's total score?

<p>6 (C)</p>
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A patient is found unresponsive. You shake the patient's shoulders gently, but they do not respond. According to the AVPU scale, how would you document this patient's level of consciousness?

<p>Unresponsive (A)</p>
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During a 'head-to-toe' assessment, you note bulging veins in the neck. Which of the following conditions might this finding indicate?

<p>Increased intracranial pressure or tension pneumothorax (C)</p>
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A patient is prescribed Drug X by their physician. During history taking, the patient mentions they also take Drug Y, prescribed to their spouse, for similar symptoms. They also use a herbal supplement bought online. What is the MOST appropriate action?

<p>Record Drug X, Drug Y, and the herbal supplement, noting the dosage and frequency for each, and that Drug Y was prescribed to the spouse. (D)</p>
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Which of the following BEST describes the primary mechanism by which airway edema, in the setting of anaphylaxis, leads to respiratory distress?

<p>Mechanical obstruction due to swelling of tissues around the airway. (D)</p>
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What is the MOST accurate description of the difference between a partial and complete airway obstruction?

<p>A partial obstruction allows some airflow, while a complete obstruction allows no airflow. (C)</p>
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A patient presents with dysphagia, what underlying condition should MOST concern the paramedic?

<p>Cerebrovascular accident. (D)</p>
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What role does the epiglottis play in protecting the airway during swallowing?

<p>Sealing off the entrance to the larynx to prevent food or liquid from entering the trachea. (C)</p>
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What is the MOST common infectious cause of epiglottitis?

<p>Bacterial. (B)</p>
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A patient presents with fever, sore throat, difficulty swallowing, and is drooling, what should the paramedic suspect?

<p>Epiglottitis. (B)</p>
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Which patient population is MOST commonly affected by Croup?

<p>Infants and young children. (D)</p>
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A child presents with a barking cough and inspiratory stridor, what is the MOST likely cause?

<p>Croup. (C)</p>
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What is the MOST accurate description of a peritonsillar abscess?

<p>A collection of pus between the tonsils and the muscular wall of the pharynx. (D)</p>
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What is the immediate treatment for partial airway obstruction with stridor in a patient who is well oxygenated?

<p>Encouraging the patient to cough. (C)</p>
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What is the correct anatomical location for performing back blows to relieve airway obstruction?

<p>Between the shoulder blades. (C)</p>
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How do positive pressure ventilations help in cases of foreign body obstruction of the airway?

<p>They may force the obstruction into a main bronchus. (C)</p>
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In what situation is the use of Magill forceps and a laryngoscope MOST appropriate for airway clearance?

<p>In an unconscious patient with a visible foreign body in the supraglottic region. (B)</p>
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What is the NEXT step after foreign body airway obstruction is relieved?

<p>Evaluation returns to the start of the primary survey approach. (D)</p>
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What does a hoarse voice indicate in a patient status post airway obstruction?

<p>Laryngeal edema. (A)</p>
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Which of the following best describes the long-term management of a patient that has a foreign body removed from their airway?

<p>Observe for signs of edema, pulmonary edema, or aspiration in hospital. (C)</p>
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A construction worker falls from scaffolding and lands on his neck. He is conscious, but struggling to breath. You see no external obstructions in the airway. What is the MOST likely cause?

<p>Trauma. (D)</p>
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Why is it important to transport and admit a patient to the hospital even if they are able to sit up and talk after a choking incident?

<p>Hospital are better equipped to deal with any further medical issues. (D)</p>
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Which of the following is the MOST common cause of airway obstruction listed?

<p>Airway oedema. (A)</p>
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Which of the following is the MOST LIKELY reason the elderly are at a higher risk for choking events?

<p>Poor dentition. (D)</p>
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A 78-year-old male in a cafe is having difficulty breathing, and is cyanosed, what is the MOST likely provisional diagnosis?

<p>Choking complete obstruction. (C)</p>
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All of the following are TRUE regarding the differences in anaphylaxis vs mechanical airway obstruction EXCEPT?

<p>Anaphylaxis is an altered level of consciousness in the absence of hypoxia. (A)</p>
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A patient who is in severe respiratory distress has a complete obstruction that cannot be relieved in field but oxygen saturation is 99% on room air. What is the MOST LIKELY reason this patient has a normal SpO2 if the obstruction cannot be relieved?

<p>Lack of exertion. (C)</p>
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You are transporting a patient status post foreign body removal at a cafe. En route, the patient has a tonic clonic seizure, and is post ictal and has snoring respirations. Which of the following is the BEST course of action?

<p>Insert an oropharyngeal airway. (C)</p>
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What is the correct sequence of events in a normal swallow?

<p>As the food is passed into the superior pharynx three pharyngeal constrictor muscles working in sequence propel it through the pharynx and past the larynx as the larynx is pulled up, allowing the epiglottis to effectively seal off the entrance to the larynx. (D)</p>
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What is the MOST accurate reason for managing patients with an impaired conscious level in a lateral position?

<p>They are at risk to vomit. (B)</p>
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You are called to a kindergarten classroom where a 4 year old patient is reported to be choking after swallowing a small toy. Upon arrival, the child remains cyanotic, unresponsive, and ineffective abdominal thrusts have failed to yield any improvement. What crucial but easily over-looked modification should be made at this stage?

<p>Check the oropharynx. (A)</p>
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What is a potential complication associated with the sharp back blows given while managing a patient's airway?

<p>Bone damage to spine. (A)</p>
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Patients with suspected epiglottitis should be managed with as little intervention as possible in the pre-hospital setting.

<p>True. (A)</p>
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Complete obstruction can occur with a mechanical obstruction above the vocal cords, but an incomplete obstruction with stridor is far more likely?

<p>True. (B)</p>
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What is true regarding patients with known anaphylaxis?

<p>Airway angioedema is difficult to hear with stridor. (D)</p>
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What finding is most reliable in distinguishing upper airway obstruction from lower airway disorders?

<p>Accessory muscle use. (A)</p>
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What describes best why a conscious patient is speaking freely status post foreign body airway obstruction event?

<p>The obstruction was relieved. (A)</p>
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Of the following, which is the best strategy for managing a conscious patient with respiratory distress from suspected airway obstruction?

<p>Allow the patient to assume a comfortable position. (A)</p>
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How is the severity of the airway obstruction commonly assessed?

<p>Measurement of end-tidal CO2. (B)</p>
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In the setting of airway obstruction, which is the most common complication due to overzealous rescue attempts?

<p>Fractured ribs. (B)</p>
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What is the primary aim in treatment of a suspected airway obstruction?

<p>Solve the problem. (D)</p>
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An elderly patient experiences syncope, exhibiting agonal gasps shortly after. There is a strong smell of almonds and a witness reports the patient was eating cherries when the incident occurred. The paramedic should initially consider:

<p>Cyanide Poisoning. (C)</p>
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What is the best and most accurate way to determine difficulty or ease of intubation success?

<p>Direct visualization of the glottic opening. (D)</p>
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What are the three specific locations swelling can occur, depending on pathology?

<p>At different points in the airway and the presentation can be altered. (D)</p>
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Flashcards

What is a primary survey?

A rapid patient assessment and management process, usually completed within 60-90 seconds.

What is general impression?

First and immediate assessment of the patient and their surroundings to determine illness/injury severity.

What is catastrophic haemorrhage?

Bleeding that poses an immediate threat to life due to rapid blood loss.

Airway Assessment

Look, listen, and feel for signs of airway obstruction, noisy breathing, or absent breath sounds.

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Breathing Assessment

Look, listen, and feel to assess the rate and quality of patient's breathing.

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Circulation Assessment

Assess circulation by checking limb color and feeling for presence/quality of pulse.

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What is the AVPU scale?

AVPU: Alert, Verbal, Pain, Unresponsive. Used for rapid consciousness assessment.

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Exposure Assessment

Assess for signs of obvious injury/illness needing quick management.

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What does SAMPLE stand for?

Signs/symptoms, allergies, medications, past history, last intake, events leading to incident.

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What does SOCRATES stand for?

Used to gather details of presenting symptoms; Site, onset, character, radiation, associations, timing, exacerbating/relieving factors, severity.

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What does reassessment involve?

Reassess vital signs, primary survey, presenting problem, review treatment, monitor the patient's condition.

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What is 'Head-to-toe' assessment?

Comprehensive physical exam to identify injuries or illness signs.

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What is National Early Warning Score (NEWS)?

Standardized scoring system for acute illness assessment using physiological parameters.

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Face Assessment

Observe face for injuries, fluid leakage, and deformities.

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Scalp examination

Look for lacerations, bruises, and deformity; palpate for tenderness and depressions.

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Extremities Assessment

Check extremities/limbs for lacerations bruising, swelling, deformities and feel for distal pulses and check motor and sensory function.

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Identify vital signs to reassess.

Respiratory rate, oxygen saturation, pulse rate, blood pressure, consciousness level, temperature.

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Respiratory Distress Causes

Respiratory distress can arise from the inability to ventilate, externally or internally respirate.

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Airway Obstruction

Partial or complete blockage of the upper airway.

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Inability to ventilate

Inability to move air in and out of the lungs & alveoli.

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Inability to externally respirate

Inability to move oxygen and carbon dioxide from alveoli into blood.

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Inability to internally respirate

Blood's inability to sufficiently deliver oxygen to cells.

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Dysphagia

A swallowing difficulty following a cerebrovascular accident, CVA

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Epiglottitis

Infection affecting the epiglottis that can cause airway obstruction.

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Croup

Viral infection causing edema of the larynx, trachea, and bronchi.

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Peritonsillar Abscess

Collection of pus between tonsils and pharynx wall.

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Airway Oedema

Airway swelling due to fluid shift, causing airway narrowing.

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Asthma Symptoms

Wheezing, breathlessness, chest tightness, and coughing.

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Gas Trapping

Trapped air in the lungs due to increased airway resistance.

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Airway Remodelling

Small airways structural changes occurring between acute episodes.

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Inflammatory Cell Infiltration

Airway wall infiltration by mast cells, eosinophils and neutrophils.

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Dynamic Hyperinflation

A unique effect whereby inhalation opens airways, exhalation traps air.

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Asthma pathway

IgE-mediated response to common allergens.

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PASSRESPS

Rapid patient assessment of respiratory status.

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Asthma Management

To improve ventilation, reduce bronchospasm, oedema and mucus.

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Asthma and Beta-agonists

Short-acting beta-adrenergic agonists decrease intracellular calcium.

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Combined asthma therapies

Adding ipratropium bromide to SABA is better than SABA alone

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Heliox

Lacks evidence, used for airflow by reducing density.

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Study Notes

Patient Assessment Process

  • Patient assessment involves a systematic approach to evaluate a patient's condition
  • The chapter focuses on the order of the assessment process

Primary Survey

  • It is a swift assessment and management process, completed within 60–90 seconds
  • Steps should be addressed in order
  • Check for life-threatening haemorrhage before checking the airway, especially in trauma patients
  • In trauma cases avoid unnecessary head and neck movement to protect the cervical spine

Components of primary survey: <C>ABCDE

  • <C> Catastrophic haemorrhage: Identify and control life-threatening bleeding
  • A: Airway: Assess and maintain airway patency
  • B: Breathing: Evaluate breathing effectiveness
  • C: Circulation: Assess circulation status
  • D: Disability: Assess level of consciousness
  • E: Exposure: Expose the patient to identify injuries

Assessing Airway

  • Look for signs of airway obstruction
  • Listen for noisy or absent breathing sounds
  • Feel for air movement

Breathing Assessment

  • Adopt a look, listen, and feel approach
  • Determine if the patient is breathing
  • Determine adequacy of breathing through rate and depth of chest movement.

Circulation Assessment

  • Assess circulation by observing the colour of the patient's limbs
  • Palpate for a pulse to determine heart rate and cardiac output effectiveness

Disability Assessment

  • Disability assessment entails evaluating the patient’s level of consciousness using the AVPU
  • Assess pupils and blood sugar

AVPU Scale:

  • A: Alert – The patient is awake and responsive
  • V: Responds to Verbal stimulus – The patient responds to voice
  • P: Responds to Pain – The patient responds to painful stimulus
  • U: Unresponsive – The patient does not respond to any stimulus

Exposure

  • Perform a quick 'head-to-toe' assessment to identify obvious injuries
  • Be mindful when working out of hospital to maintain patient privacy and prevent heat loss, especially in trauma

History Taking

  • Ascertain the presenting complaint i.e. the main reason for calling for help

SAMPLE History:

  • S: Signs and Symptoms of the presenting complaint
  • A: Allergies, especially to medications and food
  • M: Medications, including dosage and frequency
  • P: Past medical history, including illnesses and surgeries
  • L: Last oral intake
  • E: Events leading to the current illness or injury

SOCRATES acronym for assessing signs and symptoms specifically:

  • S: Site of the symptom
  • O: Onset of the symptom
  • C: Character of the symptom
  • R: Radiation of the symptom
  • A: Associations with other signs and symptoms
  • T: Timing of the symptom
  • E: Exacerbating/relieving factors
  • S: Severity of the symptom

Secondary Survey

  • A more detailed assessment based on findings from the primary survey and history

Reassessing Vital Signs

  • Minimum set of observations include respiratory rate, oxygen saturations, pulse rate, blood pressure, level of consciousness, blood sugar, temperature

National Early Warning Score (NEWS2)

  • NEWS2 aims to improve: assessment of acute illness, detection of clinical deterioration and initiation of a timely and competent clinical response
  • NEWS2 is not suitable for use with children under 16 years or pregnant women

Head-to-toe Assessment

  • A rapid comprehensive full-body assessment to identify signs of injury or illness
  • Not always appropriate, but consider in cases of multiple injuries or when the patient is collapsed and has limited or non-existent medical history

Head-to-toe Procedure:

  • Look at the face for injuries, fluid leakage, and deformities
  • Inspect the area around the eyes for injuries
  • Check the eyes for redness and contact lenses
  • Assess the pupils using a pen torch
  • Look behind the ears for bruising or fluid/blood
  • Look for bruising, lacerations and deformity around the head and then gently feel for tenderness and depressions of the skull
  • Feel the cheekbones for tenderness, symmetry and instability
  • Feel the maxilla (below the nose)
  • Check the nose for blood and fluid
  • Feel the jaw
  • Assess the mouth and nose for cyanosis, foreign objects, bleeding, lacerations, and deformities
  • Smell the patient's breath for specific odours
  • Look at the neck and note any lacerations, bruises and/or deformity
  • Look for bulging veins in the neck and feel the trachea
  • Feel the back of the neck for tenderness and deformity
  • Look at the chest for any obvious injury and watch the chest rise and fall
  • Gently feel the ribs, ensuring they are intact and identifying if they are tender
  • Listen for breath sounds
  • Roll the patient and listen to the back of the chest, also look for injuries and feel for deformities and tenderness
  • Check the abdomen and pelvis for obvious injury and gently feel the abdomen
  • Look at the pelvis for signs of injury, then gently feel the iliac crests for signs of instability, tenderness or crepitus
  • Check the extremities for lacerations, bruises, swelling, deformities, and the presence of medical bracelets

Reassessment:

  • Monitor dynamic changes in patient's clinical condition

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