 The circulation assessment consists of evaluating the pulse and skin and controlling hemorrhage

 Capillary refill  May provide information regarding the patient’s cardiovascular status.  Refill time greater than 2 seconds is caused by shunting and capillary closure to peripheral capillary beds and suggests inadequate circulation and impaired cardiovascular function.

 Treat for and anticipate shock  Elevate lower extremities  Keep patient warm  Follow local protocols regarding use of PASG  Fluid replacement

 Once the initial assessment is completed, determine the patient’s priority.  If serious injury or illness is indicated by the initial assessment, conduct rapid head-to- toe assessment for other potential life- threats and initiate transport.

 Poor general impression  Unresponsive  Conscious but cannot follow commands  Difficulty breathing  Hypoperfusion  Complicated childbirth  Chest pain and BP below 100 systolic  Uncontrolled bleeding  Severe pain  Multiple injuries

© Glen Jackson

 Trauma patient with significant mechanism of injury  Trauma patient with isolated injury  Responsive medical patient  Unresponsive medical patient

 Sustained significant injury  Exhibits altered mental status from the incident

© Robert J. Bennett

 Ejection from vehicle  Death in same passenger compartment  Fall from higher than 20 feet  Rollover of vehicle  High-speed motor vehicle collision  Vehicle-passenger collision  Motorcycle crash  Penetration of the head, chest, or abdomen

 Fall from higher than ten feet  Bicycle collision  Medium-speed vehicle collision with resulting severe vehicle deformity

Courtesy of Edward T. Dickinson, MD

 Not a detailed physical exam  Fast, systematic assessment for other life-threatening injuries  Findings may influence transport decision

 Deformity  Contusion  Abrasion  Penetration  Burns  Tenderness  Lacerations  Swelling

 Inspect the anterior neck  Tracheal deviation  Jugular venous distension  Subcutaneous emphysema

 Inspect  Accessory muscle use  Flail chest  Palpate  Stability  Auscultate  Equal and adequate air movement

 Inspect  Exaggerated abdominal motion  Bruising or discoloration Cullen’s sign Grey-Turner’s sign  Palpate  Rigidity  Tenderness

 Assess all four extremities  Stability  Circulation  Sensation  Motor function

 No significant mechanism of injury  Shows no signs of systemic involvement  Does not require an extensive history  Does not require a comprehensive physical exam

 History takes priority when assessing the medical patient.  Initiate treatments as you are assessing.

 Chief complaint  History of the present illness  Past history  Current health status

 The pain, discomfort, or dysfunction causing patient to call for help  “What seems to be the problem?”

 Onset  Provocation or Palliation  Quality  Region/Radiation  Severity  Time  Associated Symptoms  Pertinent Negatives

 Symptoms  Allergies  Medications  Past medical history  Last oral intake  Events preceding the incident

 General state of health  Childhood and adult diseases  Psychiatric illnesses  Accidents and injuries  Surgeries and hospitalizations

 Current medications  Allergies  Tobacco use  Alcohol and substance abuse  Diet  Screening exams  Immunizations  Sleep patterns  Exercise and leisure activities  Environmental hazards  Use of safety measures  Family history  Social history

 Use exam techniques relative to your patients situation or complaint.  Common presentations:  Cardiac chest pain/respiratory distress  Altered mental status  Acute abdomen

 Blood pressure  Pulse  Respiration  Temperature  Pupils  Orthostatic vitals (if possibly hypovolemic)

 Pulse oximetry  Capnography  Cardiac monitoring  Blood glucose determination

 Initial assessment  Rapid medical assessment  Similar to the rapid trauma assessment except you will look for signs of illness rather than injury  Brief history

 Mental status and speech  Cranial nerves  Motor system  Reflexes  Sensory system

 Biceps  Triceps  Brachioradialis  Quadriceps  Achilles  Abdominal plantar

 Pain  Light touch  Temperature  Position  Vibration  Discriminative

 Pulse rate and quality  Blood pressure  Respiration rate and quality  Skin condition  Temperature

 Detects trends  Determines changes  Assesses intervention’s effects

 Mental status  Airway patency  Breathing rate and quality  Pulse rate and quality  Skin condition  Transport priorities  Vital signs  Focused assessment  Effects of interventions  Management plans

 The Scene Size-Up  The Initial Assessment  The Focused History and Physical Exam  The Detailed Physical Exam  Ongoing Assessment