2. ASSESSMENT I

3. SCENE SIZE - UP 4 main components of scene size – up: 1. Scene safety 2.Mechanism of injury(MOI)or Nature of illness(NOI) 3.Number of victims 4.Resources needed * Survey scene to determine the scene is safe t0 approach victims. * Do not approach if environment is unsafe, you’re not properly trained, don’t have necessary equipment. * Use (BSI) precautions – gloves, mask, eye protection.

4. Protect Yourself At Specific Scenes: *Crash/Rescue scenes requiring special victim extrication. *Involving toxic substances in confined spaces. *Crime scenes with potential violence. *Unstable, sloping surfaces or environmental hazards, water or ice. *Protect the victim from the environment when necessary. *Protect bystanders from injury or illness.

5. Protect Yourself At Specific Scenes: Cont. *Determine (MOI) or (NOI). Consider forces that could cause an injury. This helps identify possible injuries. *Determine how the incident happened & why you were called. *Determine how many victims are involved. *Determine resources needed – fire, police, rescue.

6. INITIAL ASSESSMENT *Initial assessment is performed to identify immediate threats to life. *5 components of initial assessment: 1. Forming a general impression of victim. 2. Assess levels of consciousness of mental status. 3. Assess victim’s airway. 4. Assess victim’s breathing. 5. Assess victim’s circulation (movement, coughing, pulse, severe bleeding & skin characteristics.)

7. INITIAL ASSESSMENT CONT. *Begin initial assessment by rapidly forming a general impression of victims condition: -determine the chief complaint. -determine if the victim is ill or injured. -determine the victim’s gender & approximate age. *Assess victim’s mental status -can vary among 4 levels: 1. Alert – able to respond to you 2. Verbal – responds to verbal commands only.

8. INTITIAL ASSESSMENT CONT. 3. Painful – responds to painful stimulus only. 4. Unresponsive *speak to victim to see if he/she is responsive or not. *infants, young children, people with disabilities, may not respond (crying) or can’t clearly indentify problem *responsive victim = ask for consent to help. *unresponsive victim = check ABC’s

9. AIRWAY *position head & neck to open airway – open mouth & check for obstruction. *a person who is speaking/crying is conscious, has open airway, is breathing, and has a pulse. *the tongue can fall back into throat, blocking airway of unresponsive victim lying on their back. *unresponsive victim – open airway using 1 of 2 methods: 1. illness – use head tilt/chin lift technique. 2. Injury – use jaw thrust without head tilt. Protects the head and neck. *inspect & clear obvious obstructions blocking airway, (food or dentures.)

10. BREATHING *look, listen, feel for breathing. *determine if victim is breathing adequately, is in breathing distress, or not breathing at all. *Victim is breathing = determine rate & quality. -to determine rate: listen/feel number of breaths in 30 seconds, times by 2 (number of breaths per minute.) - to determine quality: any normal sounds – gasping, noisy whistling, crowing, gurgling, snoring, fast, slow, or painful breathing.

11. BREATHING CONT. *victim not breathing= provide rescue breathing. - establish airway (head/neck tilt or jaw thrust) -give 2 short breaths= if breaths go in, assess circulation; breaths don’t go in, clear airway obstruction. *breathing rates: -adults= 12 to 20 breaths per minute -children (1-12) 15 to 30 breaths per minute -infant (under 1 years old) 25 to 50 breathes per min. *see chart on page 145.

12. CIRCULATION *Assessing circulation includes: - checking for breathing - checking for coughing - checking for any movement - checking for a pulse -adult 60-100 beats/min. -athlete 50 or under -infant newborn 120-160 (for chart see p.148)

13. CIRCULATION CONT. *checking for severe bleeding *checking for skin appearance: -color (pale/ashen) -temperature (hot/cold) -moisture (moist/dry) *capillary refill: (most reliable in infants and children) -technique used to estimate how body is reacting to injury or illness.

14. CIRCULATION CONT. *to check pulse for conscious victim: -adult: carotid artery -child: radial (wrist) or brachial (upper arm) artery -infant: brachial artery *to check pulse on unconscious victim: -adult/child: carotid artery -infant: brachial artery

15. CIRCULATION CONT. *if a pulse is present, determine rate & quality: -find radial artery, count beats for 30 seconds, times by 2 = beats per minute. *quality of pulse refers to the strength or weakness of heart pumping. *A victim who is unresponsive, not breathing, & no pulse is in CARDIAC ARREST ! Start CPR!!! *record/report findings of initial assessment; Victims age, gender, chief complaint, level of consciousness, airway, breathing, circulation status.