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SA 107 paramedic
assessment
| Question | Answer |
|---|---|
| What are the components of scene size up? | 1. Scene safety 2. standard precautions 3. MOI / NOI (c-spine consideration) 4. number of patients 5. additional resources |
| What are examples of significant MOI's | MVC w/ occupant death, ejection, or rollover. high speed collision, auto-ped collision, fall greater than 20 feet (adult), penetrating injury to the head, neck, chest, abdomen |
| What are the components of Primary Survey? | 1. general impression, 2. level of consciousness 3. airway 4. breathing 5. circulation 6. disability 7. exposure 8. identify priority patients |
| How does the primary survey change for patients that are lifeless or have severe external bleeding? | C-A-B-D-E |
| What do you have to monitor closely with burn victims? | airway management |
| How do you calculate minute ventilation? | MV= tidal volume x respiratory rate |
| What are the components to checking a pulse? | rate, rhythm, quality |
| What is the scoring for eyes on the GCS? | 1- does not open 2 - opens to painful stimuli 3 - opens to voice 4 - spontaneously opens |
| What is the scoring for verbal on the GCS? | 1 - none 2 - incomprehensive 3 - inappropriate 4 - confused 5 - normal |
| What is the scoring for motor on the GCS? | 1 - none 2- extension 3 - flexion 4 - withdrawal 5 - localized 6 -obeys commands |
| What is the range of scores on the GCS? | 3-15 |
| What is the difference between onset and time? | onset is when did the symptoms start and what were they doing, time is has it happened before |
| What does p stand for in OPQRST? | provocation, palliation, postion |
| What does r stand for in OPQRST? | region, radiation, referral |
| Pertinent positive- | signs / symptoms that are present |
| Pertinent negative- | signs / symptoms that are not present |
| Where are the pulses that are checked during secondary assessment? | carotid, brachial, radial, apical, femoral, popliteal, dorsalis pedis, posterior tibialis |
| Heart rate ranges (adults)- | 60-100 bpm (normal) <60 bradicardia >100 tachycardia |
| respiration ranges (adults)- | 12-24 per minute (normal) <12 hypoventilation >24 hyperventilation |
| Tachypnea- | any abnormally rapid respiration |
| hyperventilation- | increased rate or depth of respiration causing a decrease in blood levels of carbon dioxide |
| hyperpnea- | increased rate of breathing to meet the metabolic demands of the body |
| calculate pulse pressure | pulse pressure = systolic - diastolic |
| Calculate Mean Arterial Pressure (MAP) | [SBP + (2x DBP)] /3 or DBP+ 1/3 (SBP-DBP) |
| MAP ranges | normal = 70 - 100 mmHg medical shock = 65 traumatic shock = greater or equal to 80 (head injury) |
| receptive speech- | does not understand words |
| expressive speech- | understands but does not give appropriate response |
| dysarthria- | slurred speech, unable to pronunciate |
| dysphonia- | voice breaking, staining or struggling |
| confabulation- | making up things |
| perseveration- | repeating questions, phrases |
| What does a pale conjunctival pallor indicate? | blood loss |
| What is the angle of Louis? | where the manubruim ans strenum meet. Used to help locate heart sounds. |
| What does rales indicate if symmetrical? | CHF |
| What does rales indicate if asymmetrical? | pneumonia |
| What causes friction rub? | the visceral and parietal pleura are inflamed |
| What is systemic circulation? | carries oxygen rich blood to the body tissues |
| What is pulmonary circulation? | carries oxygen poor blood back to the lungs |
| What is S1? | systole. Ventricular contraction. Closure of the tricuspid and mitral valves. |
| What is S2? | diastole. Ventricular relaxation. closure of the semilunar valves. |
| Parameters of pulse strength | 0 = no pulse present 1+ = weak, thready 2+ = normal 3+ = bounding |
| Bruits- | abnormal sound that may be heard when auscultating a major artery indicating obstruction or turbulent flow |
| Thrills- | Vibrations or tremors palpable over an artery indicating abnormal blood flow |
| Peripheral Edema grading system- | 0= no edema, 1+ = pits for 1 second, 2+ = pits for 2 seconds, 3+ = pits for 3 seconds, 4+ = pits for 4 or more seconds |
| Peritoneal Cavity- | potential space between the membranes that separates the intra-abdominal organs from the abdominal wall. |
| Retroperitoneum- | anatomical space in the abdominal cavity behind the peritonuem. |
| Visceral pain indicates- | Specific organ involved. Pain is usually dull and achy and poorly localized. |
| Parietal pain indicates- | Irritation of the peritoneal lining. Pain is typically more severe and localized in nature. |
| Referred pain indicates- | Visceral pain that is felt in a different part of the body. Occurs when organs share a common nerve pathway. |
| Cullen's sign- | Peri-umbilical ecchymosis indicates a very sick person. |
| Grey-Turner's sign- | Flank ecchymosis. Indicates severe internal hemorrhage in the retroperitoneum. |
| Difference between guarding and rigidity- | guarding is voluntary and rigidity is involuntary due to inflammation. |
| Murphy's Sign is used to indicate what? | Cholecystitis. Have patient raise their legs and inhale while your hands are placed above their gallbladder. If there is a hitch in the patient's breathing it's a positive indication for cholecystitis. |
| Kehr's Sign- | Referred pain. Right shoulder indicates liver injury or disease. Left shoulder indicates splenic injury or disease. |
| How do you test for kidney infection / stones? | Make a fist and tap the costovertebral angles on the back. If there is pain it's a positive indication. |
| What does a shortened leg that is rotated externally indicate? | Hip fracture |
| What does an internally rotated leg with knee flexion indicate? | hip dislocation |
| Dermatomes- | area of the skin innervated by a single spinal nerve |
| Where is the spine injury if all feeling is lost below the clavicular line? | C4. airway issue because diaphragm is innervated from C3, C4, and C5. |
| Where is the spine injury if all feeling is lost below the nipple line? | T4 |
| Where is the spine injury if all feeling is lost below the umbilicus? | T10 |
| Where is the spine injury if all feeling is lost below the inguinal line? | L1 |
| Cranial nerve I | Olfactory, do not test in field |
| Cranial nerve II | Optic, test by reading name tag or clock. |
| Cranial nerve III, IV, and VI | III = oculomotor IV = trochlear VI = abducens test by checking pupil size, reaction to light and movement |
| Cranial nerve V | Trigeminal, test by touching both sides of the face on the forehead, cheek, and jawline. |
| Cranial nerve VII | Facial, check for symmetry by having the patient raise eyebrows, puff out cheeks ans show teeth. |
| Cranial nerve VIII | Vestibulocochlear, if patient is remaining upright and following directions this nerve is normal |
| Cranial nerve IX, X, XII | IX = glossopharyngeal X = vagus XII = hypoglossal Have patient open their mouth, stick out their tongue and say 'AH' checking for symmetry at the back of the throat. |
| Cranial nerve XI | Accessory, test by having the patient shrug and turn their head side to side. |
| What is the way to test for cerebellar function? | finger to nose while moving your finger. heel-to-shin, stand upright with eyes closed, and tandem walk. Make sure you are braced to catch the patient before this test. |
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