Secondary Assessment: SAMPLE - - Signs and Symptoms (history of present issues);
- Allergies;
- Medications;
- Past Medical History, Pertinent Negatives;
- Last Oral Intake;
- Events (leading to present: trauma or medical)
Secondary Assessment: OPQRST-I - especially for Respiratory and Cardiac patients:
- Onset;
- Provocation/Palliation;
- Quality;
- Radiation;
- Scale/Severity;
- Time;
- Interventions
Initial Assessment: G-CAAT - - General Impression;
- Chief Complaints, Life Threats (hemorrhage);
- AVPU;
- ABC's (airway, breathing, circulation);
- Transport Decision (Load and Go or Stay and Play)
Components of General Impression - ASSS-FLOP-VD:
- Apparent state of health;
- Skin color, obvious lesions;
- Signs of distress;
,- Sexual development;
- Facial expressions;
- Level of consciousness;
- Odors;
- Posture, Motor, Gait;
- Vital statistics;
- Dress, Grooming, Hygiene
Components of AVPU - - Alert;
- responds to Verbal stimuli;
- responds to Painful stimuli;
- Unresponsive
What is OPQRST? - a mnemonic for remembering the questions to ask when assessing the
patient's chief complaint or major symptoms
Onset - - When and how did the symptom begin?
- Ask the patient if the onset was sudden or gradual.
- Also determine if the onset was associated with a particular activity.
Initial Assessment: B-SMNAC - - BSI (body substance isolation);
- Scene Safety;
- Mechanism of Injury (MOI)/Nature of Illness (NOI);
- Number of Patients;
- Assistance (additional units, Fire, Police, etc.);
- C-spine (and/or C-collar)
Provocation/palliation: - - What makes the symptom worse?
,- What makes the symptom better?
Quality - How would you describe the pain?
Radiation - - Where do you feel the pain?;
- Where does the pain go?
Scale/Severity - - On a scale from 0 to 10, with 10 being the worst.
- How bad is the symptom?
Time - - Determine if the symptom has been present for minutes, hours, days, weeks, months, or
years;
- The length of time the symptoms are present is important to document
Secondary Assessment: V-FITD - - Vital Signs, baseline (VS);
- Focused Physical Exam (performed);
- Interventions (RX's per medical direction, etc.);
- Transport (re-evaluate decision);
- Detailed Physical Exam (verbalized);
Order of Initial Assessment - - B-SMNAC;
- G-CAAT;
Order of Secondary Assessment - - OPQRST-I;
- SAMPLE;
- V-FITD
S1 - "Lub"
Caused by the closing of the Mitral (Bicuspid) and Tricuspid atrioventricular valves.
, S2 - "Dub"
Caused by blood closing the semilunar valves (aortic and pulmonic).
S3 - "Ta"
Oft referred to as the galloping heart, caused by blood sloshing around in a compliant left ventricle.
S4 - A rare noise in the middle of "lub," caused by a failing left ventricle and best heard in the
cardiac apex.
Ta-LUB-dub, ta-LUB-dub
Septum - 2 Sub Types - Separates the two halves of the heart.
Interatrial and Interventricular
NSAID - Nonsteroidal Anti-inflammatory Drug
Antipyretic Agent - Inhibits Prostaglandins
Acts on hypothalamus, heat regulation center.
Vasodilation & Sweating
Platelet Inhibitor - Prevents formation of thromboxane A2
Decreased Afterload Effects - Decreased Arteriole Pressure = Decreased Aortic Pressure = Left
Ventricle Works Better
Decreased Preload Effects - 1. Venous Dilation = Decreased Preload = Decreased Heart Size
2. Decreased Heart Size = Increased Blood Flow to Coronary and Collateral Vessels = Myocardial
Perfusion is Improved