Finding Out What’s Wrong: Victim Assessment Chapter 4

You have just arrived at the site of an emergency You have just arrived at the site of an emergency. What should you do first?

Step 1: Survey The Scene Piece together the puzzle Look for dangerous hazards Quickly determine: The number of victims The cause of injury Are there witnesses?

Survey The Scene #2 Do not approach the victim if threat exists

Survey The Scene #3 Attain consent Gain victim’s confidence Identify problems Don’t assume that the injury you see is the only one Gather info that will be helpful to EMS

Survey The Scene #4 Remain calm Call EMS if needed Do not move the victim unless it is necessary to support life or life threat exists

Step 2: The Initial Victim Assessment Identify and correct life threatening conditions related to Airway Breathing Circulation Disablity

Goal of the Initial Assessment To assess heart, lung, brain and spinal cord functioning (address life support – does the victim need CPR?) Cardio Pulmonary Resuscitation Cardio refers to heart Pulmonary refers to lungs Resuscitate refers to revival

How To Proceed Through The Initial Assessment: RAPABCD R - check for responsiveness A – alert V – responds to voice P – responds to pain U – unconscious, no responses A - activate EMS (911) P - position victim on the back

How To Proceed #2: RAP ABCD (checking for vital signs - pulse and respiration) A - Airway B - Breathing C - Circulation D – disability

Airway Open the airway by “head tilt, chin lift” If spinal cord injury is suspected, be more cautious Jaw thrust

Breathing Look, listen, and feel for breathing (no more than 10 seconds) Normal respiration rates (per minute) for adults: 12-20 , < 8 or > 24 need care children 30 baby 40

Circulation Check for signs of circulation: 10 seconds Breathing Coughing Movement Skin color (pale or blue) and temperature (hot, cold, cool or moist) Feel forehead with back of hand Search for severe bleeding ** pulse at the carotid artery nearest you

Normal pulse rates: Adults: 60 - 100 Children: 80 - 100 Lower for fit and hypothermic Children: 80 - 100 Babies: 100-140

Initial Victim Assessment: Physical Exam Head to toe for major injury or unresponsive Minor injury, examine complaint only More regarding head to toe exam will follow

The Physical Exam Identify yourself Obtain consent Ask and use the victim’s name Ask about chief complaint Use SAMPLE to help you remember questions to ask the victim

Questions To Ask: SAMPLE S - symptoms symptom: something the victim tells the first aider sign: something the first aider sees, hears, or feels A - Allergies

Sample #2 M - Medication P - Pre-existing illnesses L - Last food (food poisoning? hypoglycemia?) E - Events prior to the injury

Steps of The Secondary Survey or Physical Exam Systematically look and feel (LAF) Look for: DOTS D - deformity O - open wounds T - tenderness S - swelling Start with the head for adults, feet for children

Check The Head DOTS Feel both sides of the head CSF fluid (clear fluid from ear or nose / halo effect)

Check Eyes: PEARL Are pupils equal and react to light? Use flashlight or cover one eye with a hand Pupils normally contract in one second No pupil reaction could mean death, coma, cataracts, artificial eye

Check Eyes #2 Pupil dilation occurs within 30-60 seconds of a cardiac arrest Look for unequal pupils (stroke, head or brain injury) Check inner eye lid: it should be pink

Check Neck and Chest Check for cuts, bruises, compare sides Apply slight pressure to sides of chest (checking for broken ribs)

Abdomen Ask if pain is present If pain is present, gently press on opposite side of pain site to help determine area affected Feel for lumps Feel the 4 abdominal quadrants

Pelvis Gently press downward and squeeze inward

Extremity Assessment Check arms and legs deformity tenderness Check for : C - Circulation (pulse sites) S - Sensation M - Movement

Extremity Assessment #2 Compare extremities Check temperature of the extremity Check nail bed instant refilling means good circulation normal refill time is < 2 seconds

Spine and Back Ask victim about movement in extremities Wiggle fingers, toes Have victim press foot against your hand Have victim squeeze your hand Babinski reflex test Injured? Big toe flexes upward

Check for a Medical Alert Tag 24 hour emergency phone number Do not remove tag unless absolutely necessary

Reassess ABC’s: Every 5 minutes if unconscious Every 15 minutes if conscious

Role Play Secondary Survey Lab Activity

Is There a Head or Spinal Injury? Always stabilize the head immediately P 192, 193 – 195 Details on subsequent slide

Signs of Spinal Cord Injuries Painful movement of arms and legs Numbness, tingling, weakness, burning, lessened sensation in arms or legs Loss of bowel or bladder control Paralysis of arms or legs Deformity

Always Remember! RAPABCD

Post Emergency Numbers Near The Telephone Fire department Police Ambulance or EMS (paramedics) Physician Poison Control Center

Have You Ever Called 911?

Calling Emergency Medical Services (EMS - 911) A two minute delay in calling EMS can be deadly If in doubt, call EMS Questions by dispatchers are not to question the need of the call but to determine the level of need

What To Tell 911 Dispatcher First, speak slowly and clearly When calling from a cell phone, give the address immediately Listen carefully to the dispatcher

Tell The Dispatcher : Location Telephone number What has happened Number of persons needing help Special conditions Your assessment of the victim Do not hang up unless the dispatcher instructs you to