ACCS Patient Assessment
Oxygen effects what the most quickly
Heart rate
What is late sign of hypoxia
Cyanosis
How to measure ventilation
RR, Vt, chest mov't, breath sounds, PaCO2, EtCO2
how to measure oxygenation
HR, color, sensorium, PaO2, SpO2
how to measure circulation
Heart rate, strength, and cardiac output
How to measure perfusion
BP, sensorium, temperature, urine output, hemodynamics
When an emergency what is the first priority
ventilation
4 life functions in order
1. Ventilation
2. Oxygenation
3. Circulation
4. Perfusion
Most common problem is with
oxygenation
What is the first drug given
Oxygen
If marked or severe
Go straight to the airway
Signs
Objective information, things you can see or measure (color, pulse, edema, blood pressure)
Symptoms
Subjective information, things a pt must tell you (dyspnea, pain, nausea, muscle weakness)
Physical Exam: Chest
Inspection
Palpation
Percussion
Auscultation
Smoking history: Pack-year
# of packs per day x # of years smoking
Ex. 1 pack per day x 20 years = 20 pack year smoker
Or 1/2 pack a day per year x 40 years = 20 pack year smoker
Advanced Directive
set of instructions documenting what Tx a patient wants if they were unable to make medical decisions
living will
Describes tx pt would want if they become terminally ill <6 months to live. Doesn't allow someone else
to make medical decisions
durable power of attorney for health care
, a legal document that designates a person to make health care decisions on behalf of a patient in the
event the patient becomes incapacitated
Normal UO
40-80mL/hr
1-2L per day
Sensible water loss (can measure)
Urine and vomit
Insensible water loss (can't measure)
lungs and skin
If intake exceeds output this could result in
weight gain
electrolyte imbalance
increased hemodynamic pressures
decreased lung compliance
Changes in CVP can indicate?
changes in fluid balance
Decreased CVP (<2 mmHg) can indicate:
hypovolemia (recommend fluid therapy)
Increased CVP (>6 mmHg) can indicate:
hypervolemia (recommend diuretics)
Normal level of consciousness
alert and responsive
If patient is lethargic, somnolent, or sleepy
Consider drug overdose or sleep apnea
If patient is Stuporous or confused
Drug overdose, intoxication
If patient is semicomatose
Responds only to painful stimuli
If patient is Obtunded
Drowsy state, may have decreased cough or gag reflex
coma
Doesn't respond to painful stimuli
Glasgow Coma Scale (GCS)
3-15
EMA
Eye opening response
4 spontaneously opening
3 to verbal stimuli
2 to pain
1 none
Most appropriate verbal response
5 Oriented
4 confused
3 inappropriate words
2 incoherent
1 None
Most integrated motor response (arm)
6 obeys commands
5 localizes pain
Oxygen effects what the most quickly
Heart rate
What is late sign of hypoxia
Cyanosis
How to measure ventilation
RR, Vt, chest mov't, breath sounds, PaCO2, EtCO2
how to measure oxygenation
HR, color, sensorium, PaO2, SpO2
how to measure circulation
Heart rate, strength, and cardiac output
How to measure perfusion
BP, sensorium, temperature, urine output, hemodynamics
When an emergency what is the first priority
ventilation
4 life functions in order
1. Ventilation
2. Oxygenation
3. Circulation
4. Perfusion
Most common problem is with
oxygenation
What is the first drug given
Oxygen
If marked or severe
Go straight to the airway
Signs
Objective information, things you can see or measure (color, pulse, edema, blood pressure)
Symptoms
Subjective information, things a pt must tell you (dyspnea, pain, nausea, muscle weakness)
Physical Exam: Chest
Inspection
Palpation
Percussion
Auscultation
Smoking history: Pack-year
# of packs per day x # of years smoking
Ex. 1 pack per day x 20 years = 20 pack year smoker
Or 1/2 pack a day per year x 40 years = 20 pack year smoker
Advanced Directive
set of instructions documenting what Tx a patient wants if they were unable to make medical decisions
living will
Describes tx pt would want if they become terminally ill <6 months to live. Doesn't allow someone else
to make medical decisions
durable power of attorney for health care
, a legal document that designates a person to make health care decisions on behalf of a patient in the
event the patient becomes incapacitated
Normal UO
40-80mL/hr
1-2L per day
Sensible water loss (can measure)
Urine and vomit
Insensible water loss (can't measure)
lungs and skin
If intake exceeds output this could result in
weight gain
electrolyte imbalance
increased hemodynamic pressures
decreased lung compliance
Changes in CVP can indicate?
changes in fluid balance
Decreased CVP (<2 mmHg) can indicate:
hypovolemia (recommend fluid therapy)
Increased CVP (>6 mmHg) can indicate:
hypervolemia (recommend diuretics)
Normal level of consciousness
alert and responsive
If patient is lethargic, somnolent, or sleepy
Consider drug overdose or sleep apnea
If patient is Stuporous or confused
Drug overdose, intoxication
If patient is semicomatose
Responds only to painful stimuli
If patient is Obtunded
Drowsy state, may have decreased cough or gag reflex
coma
Doesn't respond to painful stimuli
Glasgow Coma Scale (GCS)
3-15
EMA
Eye opening response
4 spontaneously opening
3 to verbal stimuli
2 to pain
1 none
Most appropriate verbal response
5 Oriented
4 confused
3 inappropriate words
2 incoherent
1 None
Most integrated motor response (arm)
6 obeys commands
5 localizes pain
