1. Unit 16
Primary Assessment

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

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

4. 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

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

6. 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?

7. Mental Status
Alert
Aware
Oriented

8. 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

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

10. 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

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

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

13. 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

14. 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

16. 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

17. 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

19. 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

20. 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)

21. 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?

23. 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

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

25. 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