Chapter 12 | Primary Assessment

Question 1

List (in order):

primary assessment steps

7 points (and explain)

Answer 1

1. general impression: information gathered right away
2. mental status: determining LOC by assessing with AVPU
3. chief complaint: why EMS was called to scene
4. airway: manually open and consider adjunct or suctioning if necessary
5. breathing: check ventilation and consider oxygen therapy
6. circulation: pulses, skin condition, blood sweep, and shock treatment
7. patient priority: consider life threats to make transport decision

clarifications:

• italics means necessary point for explanation
• general impression and chief complaint are pretty self-explanatory
• LOC means level of consciousness
• AVPU is scale of LOC (alert, verbal, pain, unresponsive)

Question 2

Explain:

A-B-C vs. C-A-B

Answer 2

• A-B-C: For conscious patients, check airway, breathing, and then circulation
• C-A-B: For unconscious patients, check circulation, airway, and then breathing

Question 3

Fill in the blank:

When approaching primary assessment, always focus on [BLANK].

Answer 3

always focus on life threats.

Question 4

List:

signs indicating critical patient

5 points (patient’s behavior/appearance/condition)

Answer 4

• AMS
• pale/diaphoretic skin
• obvious trauma to head/chest/abdomen/pelvis
• positions of stress
• anxiety (people know when they gonna die)

Question 5

List:

appropriate assessments of painful stimuli

3 points

Answer 5

• sternum rub
• shoulder squeeze
• pen on fingernail

Question 6

List:

qualities of alert mental status

4 points (knowledge of…)

Answer 6

• person
• place
• time
• event

patient who is conscious, alert, and oriented is documented as CAOx4

Question 7

Explain:

qualities of verbal mental status

Answer 7

patient that is only responsive to verbal stimuli

Question 8

Explain:

qualities of painful mental status

Answer 8

patient that is only responsive to painful stimuli

Question 9

Explain:

qualities of unresponsive mental status

Answer 9

patient does not respond spontaneously, to verbal stimuli, or to painful stimuli

(when nothing in AVPU test works)

Question 10

List:

questions asked in breathing assessment

4 points

Answer 10

• is patient breathing?
• is breathing adequate?
• is patient hypoxic?
• is breathing affected by injuries?

Question 11

Define:

stable patient priority

Answer 11

patient exhibits no threats to ABCs

benign general impression

Question 12

Define:

potentially unstable patient priority

Answer 12

patient exhibits potential for ABCs to deteriorate

concerning general impression

Question 13

Define:

unstable patient priority

Answer 13

patient is facing immediate threats to ABCs

begin treating life-threats right away

Question 14

Define:

ABC

(acronym)

Answer 14

• Airway
• Breathing
• Circulation

primary assessment tool focusing on 3 key life necessities

Question 15

Define:

syncope

(“sink-o-pee”)

Answer 15

a loss of consciousness for a short period of time

Question 16

List:

targets for formulating general impression

2 points (primary assessment)

Answer 16

• environment (odors/sounds)
• patient appearance (age/race/expression/hygiene/position)

Question 17

Define:

general impression

Answer 17

EMT’s initial sense of the patient’s condition, based on immediate assessment of the patient’s environment, appearance, and chief complaint

“view from the door” or “big sick vs. little sick”

Question 18

Answer:

Which of the following is the most reliable means of determining whether a patient has any immediately life-threatening conditions?

A: use of intuition

B: through scene size-up

C: systematic approach to assessment

D: obtaining a detailed medical history

Answer 18

C

Question 19

Choose:

Which of the following differences should be expected when assessing a pediatric patient, as compared to an adult patient?

A: capillary refill is not as reliable an indicator of circulatory status

B: the normal respiratory rate is faster

C: the normal pulse rate is slower

D: an adult’s tongue is proportionally larger than that of a child and should always be considered as a potential airway obstruction

Answer 19

B

A is false and irrelevant

C is false becausee the pediatric pulse is typically faster than adults

D is backwards because a child’s tongue is proportionally larger than that of an adult

Question 20

Choose:

Which of the following presentations would be considered normal during the breathing phase of the primary assessment?

A: respiratory rate of 12 with adequate depth

B: respiratory rate of 16 with altered mental status

C: respiratory rate of 6 with shallow depth

D: respiratory rate of 28 with adequate depth

Answer 20

A

although on the lower end of the acceptable range for RR, 12 bpm would be considered normal if the patient is breathing adequately

B is wrong because, although an RR of 16 is within the acceptable range, an altered mental status would be a cause for concern during the breathing phase of the primary assessment

Question 21

Choose:

Which of the following is NOT part of the general impression?

A: patient’s facial expression

B: patient’s age and race

C: position in which the patient is found

D: patient’s past medical history

Answer 21

D

although potentially important, the patient’s past medical history does not directly relate to the formation of a general impression

Question 22

Choose:

In EMS, what does mental status refer to?

A: patient’s level of awareness of his surroundings

B: any history of mental illness that the patient may have

C: patient’s general level of intelligence

D: none of the above

Answer 22

A

Question 23

Define:

CAOx4

Answer 23

patient who is conscious, alert, and oriented and knows person, place, time, and event

(also expressed as “AOx4”)

Question 24

Fill in the blank:

The purpose of the primary assessment is to [BLANK].

Answer 24

The purpose of the primary assessment is to detect and treat immediately life-threatening problems.

Question 25

# Choose (and explain why): Which of the following is *true* concerning the primary assessment? ## Footnote **A:** Manual airway maneuvers must be performed on all patients. **B:** The EMT should perform a sternal rub on all patients to test for response to painful stimuli. **C:** External bleeding will be obvious as you enter the room and initially see the patient. **D:** The primary assessment begins by just observing the patient as you enter the room.

Answer 25

**D** ## Footnote *the primary assessment begins as soon as the EMT first sees the patient* *A is wrong* because not all patients are going to require airway maneuvers *B is wrong* because you should check alertnes in order of AVPU *C is wrong* because external bleeding is not always obvious depending on lighting, clothing, and type of injury

Question 26

# Answer: You are at the scene where a 19-year-old female college student has been drinking large quantities of alcohol throughout the evening. On your arrival, the patient is lying on her back with no signs of trauma, has vomited, and has slow, wet sounding respirations. **What should you do *next*?**

Answer 26

Since this is a non-trauma patient with slow, wet sounding respirations, **opening her airway** with the **head-tilt, chin lift maneuver** would be indicated.

Question 27

# Choose (and explain why): Your patient is a middle-aged man who appears to be *in distress* and is *clutching his chest*. **These observations lead you to suspect *which type of problem*?** ## Footnote **A:** choking **B:** cardiac **C:** anaphylaxis **D:** digestive

Answer 27

**B** ## Footnote *having a hand clenched over the chest (Levine's sign) is a sign of cardiac chest pain* *A is wrong* because a choking patient will typically put his hand to his throat *C is wrong* because an anaphylactic patient is not generally found clutching his chest *D is wrong* because digestive problems will typically cause abdominal discomfort

Question 28

# Define: LOC | (abbreviation)

Answer 28

**l**evel **o**f **c**onsciousness

Question 29

# Define: C/C | (abbreviation)

Answer 29

**c**hief **c**omplaint

Question 30

# Fill in the blank: For an *unconscious patient*, presume that the patient has **[BLANK]** until proven otherwise.

Answer 30

For an unconscious patient, presume that the patient has **a critical injury or life-threatening condition** until proven otherwise.

Question 31

# True or false: One major difference between the primary assessment of a responsive trauma patient and the primary assessment of an unresponsive trauma patient is *the assessment is done more quickly on the responsive patient*.

Answer 31

false ## Footnote rapid trauma/medical assessment is used for patients with serious MOI/NOI focused trauma/medical assessment is used for non-serious MOI/NOI

Question 32

# True or false: One major difference between the primary assessment of a responsive trauma patient and the primary assessment of an unresponsive trauma patient is *the unresponsive patient is a higher priority for immediate transport*.

Answer 32

true ## Footnote unresponsive patient will be higher priority and in need of quicker transport

Question 33

# True or false: *There is no difference* between the primary assessment of a responsive trauma patient and the primary assessment of an unresponsive trauma patient.

Answer 33

false ## Footnote A-B-C for responsive patients C-A-B for unresponsive patients

Question 34

# True or false: One major difference between the primary assessment of a responsive trauma patient and the primary assessment of an unresponsive trauma patient is *a jaw-thrust maneuver should always be used on the responsive patient*.

Answer 34

false ## Footnote choice of manual airway maneuver is based on potential for spinal injury jaw-thrust maneuver is usually not used on responsive patients unless they have head, neck, or spinal injuries

Question 35

# Choose: Your 38-year-old male patient has no life-threatening external hemorrhage, but his skin is cool, pale, and moist. **This could indicate:** ## Footnote **A.** increased perfusion. **B.** high blood pressure. **C.** poor circulation. **D.** cold exposure.

Answer 35

**C**

Question 36

# Choose: *You are treating a patient who you have decided, after your primary assessment, should be a high-priority patient.* **All of the following would be considered high-priority conditions *except*:** ## Footnote **A.** difficulty breathing. **B.** responsive but not following commands. **C.** an uncomplicated childbirth. **D.** chest pain with systolic pressure less than 100.

Answer 36

**C**

Question 37

# Choose: During the primary assessment of a 55-year-old female with a chief complaint of chest pain, you note that her breathing rate is 24 and SpO₂ is 94%. **You should consider:** ## Footnote **A.** oxygen by a nasal cannula. **B.** providing bag-valve mask ventilations. **C.** administering oxygen by nonrebreather mask. **D.** using a paper bag to slow down the rate.

Answer 37

**C** ## Footnote *You should consider administering oxygen hy nonrebrearher mask since the patient is breathing hut has an SpO₂ of less than 95%* *A is wrong* because nasal cannula is too little *B is wrong* because bag-valve mask ventilations are not needed *D is wrong* because the paper bag trick is dangerous and can lead to hypoxia

Question 38

# Choose: The "chief complaint" is best described as which of the following? ## Footnote **A.** Your interpretation of the patient's main problem. **B.** A concise report from witnesses and family. **C.** A response to an open-ended question documented in the patient's own words. **D.** The field impression.

Answer 38

**C** ## Footnote *The chief complaint comes from the patient and is documented in the patient's own words.*

Question 39

# Choose: A 55-year-old female states that her chest "feels heavy" and that she "can't catch her breath". During your assessment, you note her skin is pale, cool, and clammy. With only the previous information, **which of the following is the next best step in treatment?** ## Footnote **A.** Obtain an initial set of vital signs. **B.** Apply AED pads and analyze the heart rhythm. **C.** Assess the patient's mental status. **D.** Obtain a history of past medical illnesses.

Answer 39

**A** ## Footnote *The patient has classic signs of a cardiac event occurring. The next step should be to quickly evaluate her vital signs; BP, HR, and SpO2. For Paramedics, this means a 12-lead EKG as well and preparing for rapid transport to a hospital with a cath-lab or request ALS intercept (for BLS)/air medical for suspected myocardial infarction should time and distance be an issue.*

Question 40

# Choose: You find a patient unresponsive after an apparent fall from a roof. After checking for any life-threatening conditions and assessing their airway, breathing, and circulation, **what is the next step in managing this patient?** ## Footnote **A.** Call for helicopter transport **B.** Obtain baseline vitals **C.** Place the patient on a backboard **D.** Decide treatment priority

Answer 40

**D** ## Footnote *In this scenario, the patient has suffered an apparent fall from a roof and is unresponsive. The first step is to check for any life-threatening conditions and assess the patient's airway, breathing, and circulation. After this initial assessment, the next step is determining the patient's treatment priority based on the information obtained during the assessment. This may include aggressive field treatment for injuries other than potential cervical spine injury. It's important to note that placing the patient on a backboard should be done only after the patient's treatment priority has been determined as it may not be the best way to transport them.*

Question 41

# Choose: A 55-year-old female states that her chest "feels heavy" and that she "can't catch her breath". During your assessment, you note her skin is pale, cool, and clammy. With only the previous information, **which of the following is the next best step in treatment?** ## Footnote **A.** Obtain an initial set of vital signs. **B.** Apply AED pads and analyze the heart rhythm. **C.** Assess the patient's mental status. **D.** Obtain a history of past medical illnesses.

Answer 41

**A** ## Footnote *The patient has classic signs of a cardiac event occurring. The next step should be to quickly evaluate her vital signs; BP, HR, and SpO2. For Paramedics, this means a 12-lead EKG as well and preparing for rapid transport to a hospital with a cath-lab or request ALS intercept (for BLS)/air medical for suspected myocardial infarction should time and distance be an issue.*