1. Finding Out What’s Wrong
Chapter 4
Finding Out What’s Wrong
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2. Victim Assessment Overview (1 of 2)
Knowing what to do and what not to do is crucial during an emergency.
A victim assessment is a sequence of actions that helps determine what is wrong.
A primary check will determine if:
there is illness or injury.
whether the victim is responsive or unresponsive.
if a life-threatening condition exists.
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3. Victim Assessment Overview (2 of 2)

4. Assessment Steps Scene size-up Primary check Secondary check
SAMPLE history
Reassessment

5. Scene Size-Up Look for hazards. Notice the potential for violence.
Be observant of weapons.
Reduce exposure to potentially dangerous body substances.
Determine whether the problem is an injury or an illness .
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6. Primary Check (1 of 2)
Identify life-threatening conditions so that you can immediately take action to treat the conditions.
Responsiveness
Circulation
Breathing
Severe bleeding

7. Primary Check (2 of 2) Form a first impression. Injury or illness?
Responsive or unresponsive?
Breathing adequately?
Talking?
Bleeding?
Chance of exposure to blood or body fluids?
Danger to you, victim, or bystanders?

8. Check Responsiveness
Tap the victim on the shoulder and ask, “Are you okay?”
Use the AVPU scale.
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9. Alert Victim Evaluate ability to remember. What is your name?
Do you know where you are?
What are the month and year?
What happened?

10. An Unresponsive Victim RAP-CAB (1 of 4)
R = Responsive? Tap shoulder and shout, “Are you okay?”
Courtesy of Berta A. Daniels, 2010

11. An Unresponsive Victim RAP-CAB (2 of 4)
A = Activate emergency medical services (EMS)
Courtesy of Berta A. Daniels, 2010

12. An Unresponsive Victim RAP-CAB (3 of 4)
P = Position the victim on his or her back.
C = Cardiopulmonary resuscitation (CPR)
Start with 30 chest compressions if the victim is not breathing.
Courtesy of Berta A. Daniels, 2010

13. An Unresponsive Victim RAP-CAB (4 of 4)
A = Airway
Open the airway.
B = Breaths
Give two breaths and continue CPR.
Courtesy of Berta A. Daniels, 2010

14. A Responsive Victim RAP-ABC
R = Responsiveness A = Activate EMS P = Position A = Airway B = Breathing C = Circulation

15. Check for Breathing Chest movement Normal and abnormal breath sounds
Feeling adequate air movement

16. Check for Severe Bleeding
Check for a large amount of blood.
Around the victim
On the victim’s clothing
Control bleeding.
Wear exam gloves.

17. Position the Victim Most victims should not be moved. Exceptions:
Unsafe location
Victim is face down and needs CPR.
Victim has difficulty breathing from vomit or secretions.
First aider is alone and must leave to get help.

18. High Arm IN Endangered Spine (HAINES) (1 of 2)
Keep left arm straight, extended above the head with upper part of the arm next to the head.
Bring right arm across the chest.
Place back of right hand against the left cheek and hold it there.
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19. High Arm IN Endangered Spine (HAINES) (2 of 2)
Bend the far leg at the knee and pull the bent leg to roll the victim toward you.
Head stays on left arm while rolling.
Right hand stabilizes the head.
Right bent knee prevents rolling.
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20. Left Side Advantages Keeps the airway open Delays vomiting
Delays a poison’s effect
Relieves pressure on a pregnant woman’s vena cava

21. Secondary Check (1 of 2)
Determine whether the cause or mechanism of injury was significant.
Assume a victim with a head injury also has a spinal injury.

22. Secondary Check (2 of 2) For a responsive victim:
Ask if he or she can feel or wiggle the fingers and toes.
For an unresponsive victim:
Check spinal cord with Babinski reflex test.

23. Signs and Symptoms Signs Symptoms See Feel Hear Smell
Things the victim feels
Things the victim can describe
Chief complaint

24. DOTS D = Deformity O = Open wounds T = Tenderness S = Swelling
© Johnathan Noden-Wilkinson/ShutterStock, Inc.

25. Significant Cause of Injury (1 of 5)
Check the head.
Check eyes (PERRL).
Check the ears.
Check the nose.
Check the mouth.
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26. Significant Cause of Injury (2 of 5)
Check the neck.
Check the chest.
Gently press inward.
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27. Significant Cause of Injury (3 of 5)
Check the abdomen.
Gently press on all four quadrants.
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28. Significant Cause of Injury (4 of 5)
Check pelvis.
Gently press downward on tops of hips.
Press downward.
Author: Is the third bullet necessary or redundant?

29. Significant Cause of Injury (5 of 5)
Check extremities.
Circulation
Sensation
Movement
Check back.

30. Special Considerations (1 of 4)
Skin condition
Color
Temperature
Moisture

31. Special Considerations (2 of 4)
Capillary refill test
Press fingernail or toenail for a few seconds and release.

32. Special Considerations (3 of 4)
Expose injury.
Explain what you are doing.
Maintain privacy.
Prevent exposure to cold.

33. Special Considerations (4 of 4)
Check the following for medical identification tags:
Wallet
Purse
Necklace
Bracelet
Courtesy of the MedicAlert Foundation ®
Courtesy of the MedicAlert Foundation ®

34. SAMPLE History

35. Recheck Serious illness or injury: every 15 minutes
Unresponsive victim: at least every 5 minutes

36. Triage Process of prioritizing multiple victims Immediate care
Delayed care
“Walking wounded”
Dead