Finding Out What’s Wrong:

Victim Assessment

Chapter 4

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 neededDo 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–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

PelvisGently 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