EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/35512
ASSESSMENT TIPS at the jugular veins to see if they are fl at, full or distended. Jugular veins should be full but not distended when a patient is lying supine. Flat jugular veins may indicate hypovolemia or hemothorax, and you will need to look elsewhere for injuries. Look for swelling that would indicate bleeding into the tissues or subcutaneous emphysema from damage to a lung or another part of the airway. If there is no trauma involved, check for range of motion. Can the patient touch her chin to her chest and touch her ears to her shoulders without elevating the shoulder? Is the neck supple or stiff? Stiff neck can indicate meningitis. Palpate the neck and underside of the jaw for swollen lymph nodes. Lymph nodes are found in many places in the head and neck, but are particularly easy to palpate in the occipital region of the head, the posterior cervical region and under the jaw. Swollen lymph nodes may indicate an infection. Feel the trachea with your thumb and fi rst fi nger. It should be in the midline. Normal respirations will cause the trachea to move down a little, while a simple pneumothorax may cause it to “tug” in the direction of the pneumo- thorax. As pressure builds in a tension pneumothorax, the trachea will deviate away from the affected side, but this is a very late sign. Medic 92 arrives on scene and begins to assess the patient. The crew finds her lucid, interacting with her environment and able to answer all questions appropriately. She can state her name, where she is, the date and time, and describe her condition to them. They determine that her day has been unremarkable prior to onset of symptoms, with no ingestion of alcohol or recreational drugs, and no neurological or other symptoms prior to this event, but she now complains of an earache in her right ear and says she seems to have lost her sense of taste. She has no chronic illnesses and takes no regular medications other than oral contraceptives. She is physically fit, and her vital signs are within normal range. She appears normocephalic, there are no apparent injuries, and her pupils are round, equal and reactive. The Cincinnati Stroke Scale reveals For More Information Circle 37 on Reader Service Card See Us at Firehouse Expo Booth #205 38 JULY 2011 | EMSWORLD.com no arm drift, but there is somewhat slurred speech and pronounced right- sided facial droop. She cannot close her right eye completely, and cannot wrinkle her forehead or raise her eyebrow on that side. She cannot curl her tongue or whistle. When she attempts a broad smile, the right side of her mouth does not respond and she cannot show her teeth on that side. She is also observed to be drooling from that side of her mouth.