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The speaker discusses the importance of systematic catch-and-tell assessments for patients with non-significant neck injuries. They emphasize the need to focus on specific body parts to save time. They also discuss the assessment of the respiratory and cardiovascular systems, including chest inspection, auscultation, and checking vital signs. The speaker mentions the importance of assessing skin, comparing distal pulses, and checking blood pressure. They also discuss the assessment of neurological function, including mental status, pupil reactivity, and motor function. The speaker advises against measuring blood alcohol levels and mentions the potential causes of unequal pupils. Overall, the speaker emphasizes the need for thorough and comprehensive assessments in emergency situations. of the systematic catch-and-tell, the focused assessments performed on patients with non-significant neck injuries. They're responsive. A and O times four. They've got a good history. They can tell you what happened. Typically, it's based upon the chief complaint. The goal is to focus your attention on the body part. It saves time. I don't have to check the patient's genitalia and lower extremity if the injury is in the upper arm. Right? It saves time. So, in the respiratory system, remember, I don't have to check the patient's genitalia and lower extremity if the injury is in the upper arm. Right? It saves time. So, in the respiratory system, remember, IPA the chest, inspect, palpate, auscultate, listen for blood sounds, check for symmetry, chest rise, we're looking for that asymmetrical chest rise that might indicate a pneumothorax, that flail segment, that paradoxical motion that might indicate a flail segment. Right? Measure respiratory rate, look for retractions and increased work of breathing. We're looking for rate, rhythm, quality, depth. Right? Ranges of 12 to 20 for an adult, 15 to 30 for a child, 25 to 50 for an infant. 25 to 50 for an infant is highest for a newborn. Count the number of breaths times 30 seconds and multiply times 2. Same with a pulse. Respiratory rhythm. Is it regular or is it irregular? It could be regularly irregular, like in James Stokes' dreaming. Quality. No breathing in silence. I should not hear you. If I walk in a room and I can hear you breathing, that's audible. Like wheezes or bronchi, we can hear that. That's bad news. What type of breathing is, like, it's like a really raspy cough from someone who has been smoking for 30 years plus. And they got a raspy cough like a dry cough or a moist cough? Like it sounds more like a moist cough. Yeah, see, that's chronic bronchitis. That's chronic bronchitis. Because they're really my dad and I really want to get one of those, like, things to hear him but, like, he's very audible because he just, he's a hardcore smoker. Yay. Does he have, has he been diagnosed with CHF? No. I mean, COPD? No. He should go. Is he all the time? Does he have a cough like that all the time? Yeah, it's like probably once a day. Like, I'm like. You should get checked. So, quality breathing. Breathing accompanied by other sounds may indicate a significant respiratory problem like breathing with deep breaths or bronchial rolls. Right? Depth of breathing. We're looking for that tidal volume. Chest rise. The number one way to ensure proper ventilation is chest rise. Now, there's your lung sounds here. Right? You've got to stay inside the scapula. It kind of looks like he's riding on the scapula. We want to stay inside the scapula. What are we listening for when I hear normal breath sounds? Again, it should be clear, bilateral, all fields. Up here, we get tracheal breath sounds. Here are tracheal, bronchial. This is bronchial, vesicular. And this is vesicular. In other words, vessels like the alveoli. Wheezing, crackles, bronchi, or stridor. We discussed that stridor is a high-pitched whistling sound in the upper airway. So, in the cardiovascular system, we'll put trauma to the chest and listen for breath sounds. Consider pulse, respiratory rate, and blood pressure. All your vitals. Right? A full set of six vital signs. And that is the best. You don't just take one vital sign and say, oh, there's a problem here. You've got to get all six. And we get them right away. As soon as they walk in, man, my name is Greg. I'm an EMT, and I'm going to do some vitals while I'm asking you some questions. Get those vitals right away. That's your baseline. Consider your findings when assessing the skin. Compare distal pulses, right and left. Check blood pressures, right and left. Listen to the lung sounds, right and left. Normal heart rate for adults, 60 to 100. 80 to 120 for a child. 100 to 140 for infants. As high as 160. Up to 205 for newborns. I don't care what age you are. If you're over 200, there's a problem. Okay? Pulse quality. Is it bounding? Like when you put your finger on it, you feel it. It feels like you're pushing your hand off. It's bounding. It's a very strong pulse. Ready is very weak. It's barely palpable, like a bashful pulse. Is it regular? Is it irregular? Your pulse can be regular. Your pulse can be regularly irregular. Is it irregular? Is it irregular? Your pulse can be regularly irregular or it can be irregularly irregular. Most common cause of irregularly irregular pulses is atrial fibrillation. If you have a patient who's been in a flutter, a flutter makes more of an irregular or regularly irregular rate. Blood pressure. Pressure of circulating blood against the walls of the artery. A drop in blood pressure indicates a loss of blood or volume. A loss of vascular tone like that neurogenic shock or maybe septic shock, psychogenic shock, or anaphylactic shock or a cardiac pumping problem which would be cardiogenic. Either way, a shock. Decrease in blood pressure is a late sign. A drop in blood pressure and level of consciousness is a sign of decompensated shock. The next step is irreversible shock. You don't want that. Abnormally high blood pressure may result in a rupture or other critical damage to the arterial system. You could have an aneurysm, you could have a thoracic aneurysm, abdominal aneurysm, you could have a cerebral aneurysm. Blood pressure cuff with a gauge contains the following components. A wide outer cuff upper arm, an inflatable wide bladder, a ball pump with a one-way valve and a pressure gauge, the burden gauge. It's not affected by gravity. They put it on right there and they're wrapping it around. That's the artery mark and the artery is right there. You put the stethoscope right there and pump it up. I like to go to about 180. Put the stethoscope here and wait for a second. If I hear a pulse, go up higher. If I don't hear a beat, then I'm good. I start deflating it. Let that release go just a little bit. I want you to go slowly like this. When you start hearing the beat usually you'll see it bounce. Don't look at the bounce. Listen for the beat. It'll stop bouncing about 10 millimeters of heart rate pressure before you hear a beat. So you start seeing the bounce and all of a sudden you'll hear... It might be very quiet but you've got to listen. That's the systolic. It keeps going down, down, down and then you stop hearing it. That's the diastolic. Sometimes you can have a diastolic at zero. Sometimes you'll hear a beat all the way down to zero. If you do, you do. Write down what you got. Systolic blood pressure. I didn't give you guys this or maybe I did. I don't remember. To calculate a blood pressure if you get a relative range a safe low or a minimum low normal systolic blood pressure. For a child it's 2 times age plus 70. From 1 to 18 it's 2 times age plus 70. So a 10 year old 90. For a 12 year old 94. That's a good baseline systolic blood pressure. 2 times the age plus 70. There you go. Two times age plus 70 is a good diastolic range. Once you get above 18 age plus 100 for men and age plus 90 for women and that's up to about age you know about age 40 and after age 40 it should level off. Anything above that anything above 140 is bad. 140 over 90 is considered high blood pressure. I know they used to say that a long time ago 140 over 90 What we do for most doctors 140 over 90 is considered hypertension. But you have ranges of hypertension. They might not do anything but tell you to exercise and eat less sodium. They might not give you medication. Neurological assessment should be performed with any patient who has changes in mental status a possible head injury stupor, dizziness, and drowsiness and syncope. We know what are those neurological assessments. We've got our ANO our affluent ANO status and then we have our glass glaucoma scale which is verbal, motor what is it eye, verbal and motor and then we have our eight points we've got vision we also have our CSM Those are our neurological assessments. We're going to do those on all augmented status patients. What else are we going to do on all augmented status patients? Thank you. The pupil is the flat center portion of the eye normally round and approximately equal size. Pupils are equal and round regular in size, reactive to light and accommodation EERRLA Does EMS ever do the blood alcohol? No, we don't measure that. There's some states that do we don't because the police normally do it because the police has evidence so the police usually will do it because they want to enter it as their evidence If we do it there's no guarantee there's no guarantee there's no guarantee that we did it right So there's pinpoint pupils there's dilated pupils Greg, we can't pay the student officer whatever it is because it says here in the sexual harassment we're supposed to actually give the officer in a paper bag whatever the patient used the paper she used That's during assault That's during sexual assault He's talking about blood alcohol If you take a measurement of a blood alcohol Breathalyzer That's different And then this is unequal pupils most common cause of this in a healthy patient is anuscorium which is the genital unequal pupils But if I see that and I see this after a head trauma I'd expect there's an injury on the patient's left side Oh no Those are earpods, right? A small population exhibits that anuscorium which is caused by a cause of depressed brain function Injury of the brain or brain stem Trauma or stroke, brain tumor Inadequate oxygenation and drugs or toxins Pearls Pearl locks People around regular size reacted to light and accommodation They follow you with their Follow your finger with their eye Check for bilateral muscle strength and weakness Remember CSMs, right? Complete a thorough sensory assessment Test for pain, sensation, and position CSN Circulation sensory motor function Check one side to the other Head, scalp, and spine You're going to palpate You're going to check for the eyes Check the sclera Check the zygoma As well as the patient's nose and ears and the drainage Check the maxilla and the mandible just like I told you Check the mouth for broken and missing teeth and any unusual odors of the mouth Again, use those sensors Inspect, palpate, and oscillate the chest We're looking for abnormal signs The abdomen We're going to palpate for tenderness We're going to palpate for distention Rigidity and rebound tenderness Distention Rigidity and rebound tenderness We're going to palpate each of the four quadrants If the patient has pain We're going to palpate the furthest away and move toward that pain But to be honest with you, if I have a patient with significant abdominal pain I will take their word for it Pelvis, we're going to push down and in, we're looking for stability of the pelvis Extremities, we're going to check all four extremities We're looking for DCAP, DCLS Posterior, we're going to long roll the patient and we're going to run our fingers down the spine We're going to check the back buttocks, posterior, lumbar, thorax region for bleeding, drainage listen to lung sounds This is a pulse oximeter It is the SPO2 and heart rate and it gives us a measurement I don't use that as my primary I don't slap that on, you would write that on my PCR I do my first set of vital signs manually Then I put that on So I know your heart rate is 74 because I took your heart rate and now I put the pulse oximeter and it reads 73 I know it's accurate So I can leave that on now and spot check and I know that it's accurate So I can use that for subsequent vitals but not your first Same with if you have a manual blood pressure cuff Get your first blood pressure or automatic blood pressure cuff Get your manual one first and then use the automatic Measure the oxygen saturation of the hemoglobin in the capillary bed Capnography, we measure the amount of exhaled CO2 between 5-6% of exhaled O2 or 35-45 mmHg of dissolved carbon dioxide in the gas Blood Glucometry checking the blood sugar This is a BP cuff called a stigma manometer Perform your reassessment We perform at regular intervals We're constantly reassessing our patient We're doing vitals every 5 minutes on an unstable 15 minutes on a stable but we're constantly reassessing our patient Talk to your patient Have a conversation with them Look for trends Multiple vital signs will tell us if our patient is trending up or trending down Ask the following questions Is the current treatment for improving the patient's condition? Has an already identified problem gotten worse? Has an identified problem gotten better? And what is the nature of any newly identified problem? So it's a constant reassessment It's not just like I said, okay, I'm going to sit behind you and do my PCR now You're going to constantly work with your patient Check all interventions Check all interventions Most important are the patient's ABC's Manage bleeding Check all interventions Most important are the patient's ABC's Manage bleeding Check all interventions Most important are the patient's ABC's Manage bleeding Check all interventions Most important are the patient's ABC's Manage bleeding Check all interventions Most important are the patient's ABC's Manage bleeding And again, you can have external and internal The external, I can pack it, I can turnip it, I can bandage it The internal, I have to keep the patient immobilized The internal, I have to keep the patient immobilized Identify internal bleeding Identify internal bleeding Look for the, it can't be identified per se But you can definitely have a high index of suspicion But you can definitely have a high index of suspicion And you can call ALS and we can come in and give TXA And you can call ALS and we can come in and give TXA Ensure adequacy of other interventions And consider the need for new interventions Document any changes whether positive or negative Sometimes you do everything right And the patient still degrades It happens Rule number one, people die Rule number two, you can't always change rule number one Document what you've done and what you've found During the scene size-up You routinely determine all of the following except Which one? Does it matter? Maybe destination it matters