Unit 16 Primary Assessment

Overview Steps of primary assessment Evaluation of patient Immediate actions required Determine patient priority

Introduction Primary assessment begins while approaching patient Establishes injury or illness Detects life-threatening conditions Determines immediate intervention

The Primary Assessment Assessment priorities find and treat life-threatening problems first Rapid, systematic assessment of vital functions Life-threatening problems managed as they are found Less urgent problems managed after secondary assessments

Steps of the Primary Assessment ABCs Airway Breathing Circulation Assessment of ABCs begins by noting general appearance and mental status

General Impression Formed in first 15 seconds of observation Questions to ask about patient: Does patient appear to be awake? Does patient appear to be very ill or in pain? Does problem seem to be related to medical illness or to traumatic injury?

Mental Status Alert Aware Oriented

Mental Status (cont’d.) Responsive to voice Eyes only open in response to verbal stimulation Responsive to pain Patient awakens only in response to painful stimuli Unresponsive Does not respond to verbal or painful stimuli Requires immediate intervention

Figure 16.1 Use a sternal rub to check for a patient’s response to a painful stimulus

Airway Awake and alert: airway is likely being maintained without difficulty Awake but cannot speak: further assessment required Not awake: immediate concern Open, assess, suction, and secure

Figure 16.2 Open, assess, suction, and secure the airway

Breathing Determine presence of breathing Assess adequacy Look, listen, feel Assess adequacy Respiratory rate Inadequate depth Marked effort

Breathing (cont’d.) Look Inspect chest for obvious wounds or uneven breathing Equal and adequate chest movement Rate of breathing: bradypnea or tachypnea Use of accessory muscles Skin signs

Breathing (cont’d.) Listen Listen for air movement Stethoscope: used to evaluate effectiveness of air movement Figure 16.3 Look, listen, and feel for breathing

Breathing (cont’d.) Feel Check for deformity or instability Tenderness suggests rib fracture Crepitus: subcutaneous air pockets Sign air may be escaping lungs and entering chest cavity

Circulation Assess for a pulse Presence of radial pulse: sufficient blood flow Presence of carotid pulse but no radial pulse: blood pressure is low Absence of carotid pulse: perform chest compressions

Circulation (cont’d.) Assess for bleeding Check for external hemorrhage Small bleed: not of immediate concern Large bleed: immediately control by applying direct pressure to wound Check skin for changes in temperature and color

Circulation (cont’d.) Circulatory support Performed when signs of inadequate circulation are present Signs of circulation absent: initiate CPR immediately May need military anti-shock trousers/pneumatic anti-shock garment (MAST/PASG)

Determine Patient Priority Does patient require immediate, rapid transport to hospital? Is there time for focused physical exam and history? Is ALS intercept or aeromedical transport required?

Determine Patient Priority (cont’d.) High priority “Load and go” Usually requires ALS intercept Patient is considered unstable and critical Best treatment: definitive care provided by advanced life support providers or hospitals

Determine Patient Priority (cont’d.) Low priority Stable patient Continue assessment “Stay and play” Rapid transport not required

Conclusion Primary assessment: first step of patient assessments General impressions help with prioritizing Airway, breathing, and circulation must be quickly evaluated Life-threatening problems must be addressed immediately