Paramedic chapter 11 - Details

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Abnormal breath sounds, such as wheezing, Rhonchi, crackles, strider, and pleural friction rubs

Adventitious breath sounds

A determination made when assessing mental status by looking at whether the patient is oriented in four areas: person, place, time, and the event itself. Each element provides information about different aspects of the patient’s memory

Alert and oriented (AxO)

Unequal pupils with a greater than 1-mm difference

Anisocoria

The language impairment that affects the production or understanding of speech and the ability to read or write

Aphasia

An episode characterized by some combination of apnea (central or obstructive), color change (cyanosis, pallid, Erythematosus, or plethoras) change in muscle tone (usually diminished), and choking or gagging

Apparent life- threatening event (ALTE)

Abnormal accumulation of fluid in the peritoneal cavity; typically signals liver failure

Ascites

The entry of fluids or solids into th trachea, bronchi, and lungs; the act of drawing material in or out by suction

Aspiration

The act of using a stethoscope to listen to sounds within the body

Auscultation

A method of assessing mental status by determining whether a patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally in the primary survey

AVPU

Bruising over the mastoid process, which may indicate a basilar skull fracture; also known as retroauricular ecchymosis or raccoon eyes

Battle sign

The combination of a narrowed pulse pressure, muffled heart tones, and jugular venous distinction associated with cardiac tamponade; usually caused by penetrating chest trauma

Beck triad

The measurement of the force exerted against the walls of teh blood vessels as the heart contracts and relaxes; it is calculated as the product of cardiac output and peripheral vascular resistance

Blood pressure (BP)

Hollow, tubular, lower-pitched sounds heard over the trachea

Bronchial sounds

A test of decreased breath sounds performed by placing the diaphragm of the stethoscope over the area in question while the patient says “ninety nine;” a loud, clear sound indicates lung consolidation

Bronchophony

A combination of the tracheal and vesicular breath sounds; heard where airways and alveoli are found, in the upper part of the sternum and between the scapulae

Bronchovesicular sounds

An abnormal whooshing sound of turbulent blood flow moving through a narrowed artery; usually heard in the carotid arteries

Bruit

The use of a noninvasive diagnostic tool that can quickly and efficiently provide information on a patient’s ventilator and circulatory status with a graphic and digital depiction similar to an electrocardiogram

Capnography

The use of a capnometer, which is a monitoring device used to measure the amount of expired carbon dioxide. The reading is usually given as a digital reading

Capnometry

Ear wax

Cerumen

The reason the patient is seeking help

Chief complaint

Wet rattling, bubbling, or crackling lung sounds indicative of fluid in the small airways; aka rales

Crackles

A crackling, grating, or grinding sound often heard when fragments of broken bones rub together

Crepitus

A composite picture of a number of factors in a patient’s life, such as dietary habits, current medications, allergies, exercise, alcohol or tobacco use, recreational drug use, sleep patterns and disorders, and immunizations

Current health status

The combination of a slowing pulse, rising blood pressure, and an erratic respiratory pattern; a grave sign for patients with head trauma or cerebrovascular accident

Cushing reflex

A blue-gray skin color that is caused by inadequate levels of oxygen in the blood

Cyanosis

An acute confusional state characterized by global impairment of thinking, perception, judgement, and memory

Delirium

The gradual and pervasive deterioration or loss of cognitive cortical functions

Dementia

Excessive sweating; it is often associated with shock

Diaphoresis

The result of residual pressure in the circulatory system while the left ventricle is relaxing (is, in diastole)

Diastolic pressure

The process of weighing the probability of one disease versus other diseases by comparing clinical findings that could account for a patient’s illness; also refers to teh list of possible conditions considered based on the patient’s signs and symptoms

Differential diagnosis

Double vision

Diplopia

Localized bruising or collection of blood within or under the skin

Ecchymosis

A test of decreased breath sounds performed by placing the diaphragm of the stethoscope over the area in question while the patient saying a drawn-out “eee;” and “A” sound indicates lung consolidation

Egophony

A field conclusion of the patient’s problem based on the clinical presentation and the exclusion of other possible causes through considering the differential diagnoses

Field impression

A type of physical exam that is typically performed on responsive patient who have sustained an isolated injury. This type of exam is based on the chief complaint and focuses on one body system or part

Focused exam

A systematic head to toe exam performed during the secondary assessment of a patient who has sustained a significant mechanism of injury, is unresponsive, or is in critical condition

Full body exam

The overal initial impression that determines the priority of patient care; based on the patient’s surroundings, the mechanism of injury, signs and symptoms, and the chief complaint

General impression

An evaluation tool used to determine level of consciousness by evaluating and assigning point values (scores) for eye opening, verbal response, and motor response, which are then totaled; effective in helping predict patient outcoes

GCS

Contraction of teh abdominal muscles indicating peritoneal irritation

Guarding

The perception that the heart is beating very strongly; felt upon palpating of the chest wall, this finding suggests hypertrophy; aka lift

Heave

A narrative detail of the symptoms that a patient is experiencing, usually obtained using the OPQRST mnemonic

History of teh present illness

Iatrogenic

Looking at the patient, either in general or at a specific area (ie a patients overall appearance from the door was, versus looking specifically at the chest wall for abnormalities/deformities)

Inspection

The visible bulging of teh jugular veins when a patient is in semi-Fowler or full Fowler position; indicates inadequate blood movement through the heart and or lungs

JVD

Korotkoff sounds

Outward curve of the thoracic spine

Kyphosis

Localized areas of the skin that do not resemble the area surrounding it

Lesions

A sensation felt upon palpating of teh chest wall, in which the heart beats extremely strongly; suggests hypertrophy; aka heave

Lift

Inward curve of the lumbar spine just above the buttocks. An exaggerated form results in the condition known as swayback

Lordosis

The series of events that result in traumatic injuries; teh forces that act on the body to cause injury

MOI

A blotchy pattern on the skin; a typical finding in states of severe protracted hypoperfuion and shock

Mottling

An abnormal whooshing sound heard over teh heart that indicates turbulent blood flow around a cardiac valve

Murmur

The general type of illness a patient is apparently experiencing

NOI

An instrument used to examine. Patient’s eyes and view the retina and aqueous fluid; consists of a concave mirror and a artery-powered light that is usually contained in the handle

Ophthalmoscope

Multiple sets of vital signs taken from he patient in different positions. (For example, in the supine and sitting or standing positions) to determine the degree of hypovolemic; aka tilt test

Orthostatic vital signs

An instrument used to examine the ears of a patient; consists of a head and a handle. The head contains and electric light source and a low-power magnifying lensS

Otoscope

Paleness

Pallor

Physical touching for the purpose of obtaining information (for example, to detect tenderness)

Palpation

Tingling feeling or sensory change

Paresthesias

Information obtained during the history-taking process, such as the patient’s general state of health, childhood and adult diseases, surgeries and hospitalizations, psychiatric and mental illnesses, or traumatic injuries, which may relate to the patient’s current codnition

Past medical history

A fracture that occurs when normal forces are applied to abnormal bone structures

Pathological fracture

Information about the patient’s chief complaint, present symptoms, and previous illnesses

Patient history

Gently striking the surface of the body, typically overlying various body cavities, to detect changes in teh densities of the underlying structures

Percussion

The circulation of oxygenated blood through the body tissues and vessels

Perfusion

The absence of certain signs and symptoms normally expected fo specific illnesses or conditions; these findings warrant no medical ca or intervention, but demonstrate the thoroughness of the patient exam and history

Pertinent negatives

Squeaking or grating sounds that occur when the pleural linings rub together, which may be heard oninspiration, expiration, or both; commonly caused by inflammation of the pleura

Pleural friction rubs

The part of the assessment process that focuses on identifying immediate or potential life- threatening conditions so you can initiate lifesaving care

Primary survey

Reflex reactions such as babinski, grasping, and sucking signs normally found in infants

Primitive reflexes

The drifting of one arm downward toward a patient’s feet while he or she holds out his or her arms, plan side up, with his or her eyes shut; can be a sign of a stroke

Pronator drift

The perception of the position and movement of the body or limbs

Prprioception

The wave of pressure created as the heart contracts and forces blood out the left ventricle and into the major arteries; palpated at a point where an artery passes close to a bone

Pulse

An assessment tool used to measure oxygen saturation of hemoglobin in the capillary beds

Pulse oximetry

A 60-90 second non systematic review and palpation of the patient’s body to identify injuries that must be managed or protected immediately; aka the rapid full body sweep

Rapid full body scan

The portion of the assessment process in which a patient’s condition is reevaluated and responses to treatment is assessed

Reassessment

Involuntary motor responses to a specific sensory stimuli, such as a tap on the knee or stroking the eyelash

Reflexes

Coarse, low pitched breath sounds heard in patients with chronic mucus in the upper airways

Rhonchi

A clinically important sign characterized by marked peritoneal irritation and guarding, indicating an injury or illness for which urgent surgical intervention may be required

Rigidity

Redness; one of the classic signs of inflammation

Rubor

A step in the patient assessment process involving a quick assessment of the scene and its surroundings to gather information about the overall safety and stability of the scene and the MOI or NOI. This process is carried out before you enter and begin patient care

Scene size up

Sideways curvature of the spine

Scoliosis

The process by which more detailed, quantifiable, objective information is obtained from the patient about his or her overall state of health

Secondary assessment

Objective observations that can be seen, heard, felt, smelled, or measured

Signs

A subsection of teh patient history that provides valuable information regarding the patient’s overall health status and helps to identify risk factors for various disease processes; includes items such as tobacco use, alcohol and drug use, sexual behavior, diet, travel history, living environment and occupation

Social history

A blood pressure cuff

Sphygmomanometer

In the context of heart sounds, a situation in which events on the right side of heart occur slightly later than those on the left side, and create two discernible sounds rather than one heart sound

Splitting

A harsh, high pitched respiratory sound produced as air moves past an obstruction within or immediately above the glottis opening; associated with severe upper airway obstruction

Stridor

Subjective infomation the patient feels, such as pain, discomfort or other abnormality

Symptoms

BP created by the left ventricle as it contracts (that is, In systole)

Systolic pressure

A condition in which the skin slowly retracts after being pinched and pulled away slightly from the body; a sign of dehydration

Tenting

A humming vibration that an be palpated through the chest wall, suggesting n underlying bruit or murmur

Thrill

A fracture that occurs when abnormal forces are applied to normal bone structures

Traumatic fracture

Loss of skin elasticity

Turgor

Narrowing of teh diameter of blood vessel

Vasoconstriction

Widening of teh diameter of blood vessel

Vasodilation

Normal breath sounds made by air moving in and out of the alveoli

Vesicular sounds

Determined by the ability or inability to see, and by how far

Visual acuity

A high pitched whistling sound that may be heard on inspiration, expiration, or both, indicating air movement through a constricted lower air way, as in asthma

Wheezing

A test of decreased breath sounds performed by placing the diaphragm of the stethoscope over the area in question as the patient whispers “ninety nine;” a loud, clear sound indicates lungconsolidation

Whispered pectoriloquy

The one diagnosis from a differential list used to base the patient’s treatment plan

Working diagnosis

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