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Chapter 3 Victim Assessment

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1 Chapter 3 Victim Assessment

2 Learning Objectives When you have mastered the material in this chapter, you will be able to 1 Understand how to properly assess a victim 2 Describe how to establish rapport with the victim 3 Explain how to survey and control the scene 4 Describe and conduct a primary survey 5 Know how to conduct a neurologic exam 6 Explain how to determine the chief complaint 7 Understand the significance of vital signs (pulse, respiration, and relative skin temperature) 8 Explain how to take a history 9 Understand the sequence and practical application of a secondary survey 2

3 In most cases, conduct victim assessment in this order:
1. Conduct a scene size-up. 2. Establish rapport and control. 3. Conduct a primary survey. 4. Conduct a brief neurologic (i.e., “neuro”) exam. 5. Determine the chief complaint. 6. Assess vital signs. 7. Look for medical information devices. 8. Take a SAMPLE history. 9. Conduct a secondary survey. You may need to adapt or change the sequence, depending on your experience and the specific emergency situation. 3

4 Conduct a Scene Size-Up
1. Take body substance isolation precautions by using personal protective equipment (PPE), if possible. 2. Assess the safety of the scene. 3. Determine if the victim is injured or ill. 4. Determine the number of victims. 5. Determine the resources needed. 4

5 Establishing Rapport and Control
Three C’s: Competence Confidence Compassion 5

6 To establish control of the scene, do the following:
Move smoothly and deliberately. Position yourself at a comfortable level in relation to the victim. Stay where the victim can see you without twisting his or her neck. Keep your eye level above that of the victim. Conduct your survey in an unhurried, systematic way. Emotions escalate quickly in tense situations, so keep your voice calm and quiet. If there is more than one victim, determine which victim(s) needs the most immediate care. 6

7 Progress Check 1. To establish scene control, use the three Cs—competence, confidence, and ____________. (control/charisma/compassion) 2. An important part of introducing yourself to the victim is obtaining ____________. (the victim’s name/consent for treatment/a history of what happened) 3. To maintain control, keep your voice __________. (calm and deliberate/powerful and authoritative/loud and demanding) 4. Position yourself with your eye level ____________ that of the victim. (above/even with/below) 7

8 Conducting the Primary Survey
1. If the victim is conscious, ask, “What happened?” The response will provide information about the airway status, the adequacy of breathing, mental status, and mechanism of injury or nature of the illness. 2. Ask, “Where do you hurt?” The response will identify the most likely points of injury. 3. Visually scan the victim for general appearance, pale skin, cyanosis (blueness from lack of oxygen), and sweating. 8

9 Breathing Look for chest rise and fall.
Listen for sounds of air movement at the mouth and nose. Feel on your cheek for air passing in and out of the mouth or nose. 9

10 Circulation To assess for circulation, check the radial pulse (at the wrist on the thumb side) 10

11 Vocabulary Triage- A system of sorting victims into categories by treatment priority Cyanosis- Bluish discoloration from lack of oxygen ABCDs- Airway, breathing, circulation (hemorrhage) and disability Radial pulse- The pulse at the wrist on the thumb side Signs- Things you can observe about the victim, such as bleeding Symptoms- Things the victim describes to you, such as abdominal pain 11

12 Disability There are four general levels of responsiveness:
Alert—The victim’s eyes are open. Response to verbal stimuli—The victim opens his or her eyes to verbal commands to do so. Response to pain—The victim appears to be asleep and does not respond when spoken to, but winces, grimaces, or jerks away when pinched. Unresponsive—The victim appears to be asleep and does not respond in any way when pinched. 12

13 PROGRESS CHECK 1. The major goal of the primary survey is to check for ____________. (breathing/heartbeat/life-threatening problems) 2. You can determine both the level of consciousness and the adequacy of ventilation by ___________. (watching for chest movement/checking the pulse/asking if the victim is okay) 3. To conduct the primary survey, check the ____________. (pulse/breathing/ABCDs) 4. Unless you find life-threatening problems, you should be able to complete the primary survey in ____________. (1 minute/2 minutes/5 minutes) 5. The only kind of bleeding you should try to control during the primary survey is ____________. (major bleeding/bleeding from a chest wound/bleeding from the head) 13

14 3.3 Conducting the Neuro Exam
1. Talk to the victim. 2. Note the victim’s speech. 3. Determine whether he or she can understand by assessing his or her response to a simple command, such as “Squeeze my hand”. 4. Determine how easily the victim can be aroused. 14

15 Vital Signs Pulse Respiration (Breathing) Temperature and Skin Color
Rate Strength Rhythm Respiration (Breathing) Temperature and Skin Color Paleness Redness Blueness (cyanosis) 15

16 16

17 PROGRESS CHECK 1. A neuro exam checks both motor and ____________ function. (visual/sensory/psychological) 2. Slurring of speech, garbled speech, or vagueness in answering questions indicates deteriorating ____________. (mental status/motor control/speech ability) 3. If a victim can’t speak, give a simple ___________ to assess mental status. (stimulus/test/command) 4. Determine how easily victims can be aroused from an altered mental status by using either verbal or ____________ stimuli. (touch/painful/sound) 17

18 When taking a history: Assess the scene.
Ask questions. Whenever possible, ask open-ended questions, because you don’t want to suggest answers to the victim. Get a history by talking to friends or family members. 18

19 SAMPLE S What are the signs and symptoms the victim is complaining of?
A What is the victim allergic to? M What medications does the victim take, both prescription and over-the-counter? P What is the pertinent past medical history of the victim? L When was the last time the victim had something to eat or drink? E What were the events prior to the incident? 19

20 During the survey, use the following approach:
Look for deformities, wounds, bleeding, discoloration, penetration, openings in the neck, and unusual chest movement. Listen for unusual breathing sounds, gurgling sounds, or crepitus (a sandpaperlike noise made by broken bone ends rubbing against each other). Feel for unusual masses, swelling, hardness, softness, mushiness, muscle spasms, pulsations, tenderness, deformities, and temperature. Smell for unusual odors on the victim’s breath, body, or clothing. 20

21 DOTS D Deformity O Open wounds T Tenderness S Swelling 21

22 PROGRESS CHECK 1. The chief complaint is the victim’s assessment of where he or she ____________. (is injured/is compromised/hurts) 2. You can rely on your ____________ to assess vital signs; you do not need specialized equipment. (intuition/senses/wristwatch) 3. Take the pulse of an unconscious victim at the ____________ artery. (carotid/brachial/radial) 4. Take the pulse of a conscious victim at the ____________ artery. (carotid/brachial/radial) 5. Use the back of your hand to check the victim’s relative _________. (respiration/pulse/temperature) 6. When possible, ask the victim ____________ questions (yes-no/open-ended) 7. The sample history should be taken ____________ the primary survey. (before/after/during) 22

23 Face, Mouth, Ears, Nose Check the following:
Deformities, open wounds, tenderness, swelling Forehead, eye orbits, and facial structures for abnormalities Ears and nose for blood or clear fluid and injury Eyes for pupil size and reactivity to light Eyes for the ability to track a moving object smoothly and evenly in all four quadrants Mouth for lacerations, unusual breath odor, and teeth alignment 23

24 Skull and Neck Check the following:
Deformities, open wounds, tenderness, swelling Scalp for depressions and bruises Trachea for position (it should be in the middle of the neck) Neck for depressions, bruises, wounds, pain, and tenderness 24

25 Chest Check for the following:
Deformities, open wounds, tenderness, swelling Soft-tissue injuries, such as cuts, bruises, indentations, impaled objects, or open chest wounds Signs of fractures Respiratory distress and symmetry of chest rise and fall Pain, tenderness, or instability over the ribs 25

26 Abdomen Inspect and palpate for deformities, open wounds, tenderness, rigidity (hard and contracted abdominal muscles) and swelling. Look for protrusions, soft-tissue wounds, lumps, swelling, or bruising. Palpate the four quadrants separately with the pads of your fingers for hardening or abdominal masses. If you suspect injury, feel that quadrant last. Ask about pain. 26

27 Pelvic Region Injury in the pelvic region can cause extreme pain and excessive bleeding, so be gentle Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for tenderness, crepitus, and instability. Look for loss of bladder control, bleeding, or erection of the penis (a sign of central nervous system injury). Check the strength of the femoral pulse. 27

28 Lower Extremities Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for abnormal position of the legs. Feel for protrusions, depressions, and abnormal movement. Check for tenderness in the calves. 28

29 Upper Extremities Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for equal grip strength in both hands. Assess for motor function by asking the victim to squeeze your finger or wiggle his or her fingers. Assess for sensation by light touch and by a pinch to each hand. 29

30 PROGRESS CHECK 1. During the secondary survey, conduct a full-body assessment ____________. (from head-to-toe/from toe-to-head) 2. Never move the victim unnecessarily until you are sure ____________. (emergency personnel are on the way/there are no spinal injuries/the victim is not in pain) 3. During the secondary survey, keep the head and neck ____________. (aligned/immobile/comfortable) 30

31 KEY TERMS Make sure you understand the following key terms: triage
cyanosis radial pulse ABCDs carotid pulse signs symptoms crepitus 31

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