Finding Out What’s Wrong: Victim Assessment Chapter 4
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