Physical Assessment Determining extent of injury Gathering important information

Start with 10 Second Survey What dangers exist? To victims? To self – can you safely enter area to help? Cause of Injury? How many victims? Attain consent! Attend to the more quiet ones first May not be breathing Lacking heart rate Do not move the victim unless it is necessary to support life

Then what? Call EMS, if needed. Follow 10-s survey w/ initial victim assessment: Identify life-threatening injury or illness Correct conditions using ABCs (Airway, Breathing Circulation) Next, do physical exam and take S.A.M.P.L.E history Identifies nature of injury and its severity Determines 1 st Aid course of action

Initial Victim Assessment: AVPU If spinal injury is suspected, ask someone to hold head to minimize movement and further injury Check and determine level of responsiveness (AVPU) indicator of overall condition Speak to the victim. Tap them. Ask/Shout, “Are you okay?” Ability to talk = breathing w/heartbeat If not = unresponsive

Initial Victim Assessment: AVPU AVPU Scale: A = Alert and Aware Eyes open Knows name, date, time, place V = Responds to verbal stimulus Not oriented to time, place Responds in a meaningful way P = Responds to painful stimulus Eyes do not open Responds when trapezium muscle is pinched U = Unresponsive Eyes do not open Does not respond to pinching of muscles

Initial Victim Assessment: ABC’s Identify life-threatening injuries w/ ABC’s A: Airway – is it open for breathing? If crying, speaking, coughing  it is open If responsive victim cannot do the above  obstruction Adult: use Heimlich maneuver (abdominal thrusts) Child: Visual check for blockage, finger-sweep Unresponsive victims on their back: tilt head, lift chin to open airway. (Tongue blockage, likely) Unresponsive victims w/suspected spinal injury: jaw thrust maneuver jaw thrust

Initial Victim Assessment: ABC’s B: Breathing breaths/minute is normal. Lower or higher – immediate care needed. “Look, Listen, Feel” – place ear next to victim’s mouth Does chest rise/fall? Listen for sound, Feel air coming from mouth. Note breathing difficulties, unusual sounds. Rescue breaths, if not breathing…. To be covered later in CPR

Initial Victim Assessment: ABC’s Circulation: blood flowing normally Signs: breathing, coughing, movement, normal skin color, normal temperature, radial pulse. Severe bleeding: check and control w/ application of direct pressure (use PPE), elevation, pressure points, tourniquet Skin condition: temperature, color, condition Temperature: feel forehead with back of hand for coolness (lower oxygen flow) or fever Color indicates oxygen status  Pale/gray – cyanosis  In darker skinned people, check nail beds, inside of mouth, check capillary refill by applying pressure to fingertips Condition: moist? Dry?

Physical Exam – (severe injuries) Stabilize head Monitor ABC’s Ask suspected spinal injury victim, “Can you feel me squeezing your fingers, toes?” “Can you wiggle your fingers and toes? “Can you squeeze my hand or push your foot against my hand?” Unresponsive victim: Use Babinski reflex test: stroke bottom of foot firmly towards big toe with sharp object – big toe will go down (opposite in infants)Babinski reflex opposite in infants

Physical Exam (Head to Toe) Check head, neck, chest, abdomen, pelvis, extremities Look for DOTS to ascertain extent of injury. D = Deformity – when bones are broken they move out of place. O = Open wounds breaking skin T = Tenderness – sensitive to touch S = Swelling

Physical Exam (Head to Toe) Head Stabilize look/feel for DOTS over entire head. Check for leakage of fluid from nose & ears (cerebrospinal fluid) Eyes check pupils for equal size and reactivity to light. (PEARL: Pupils Equal And React To Light) Neck look/feel for DOTS Look for medical alert tags

Physical Exam (Head to Toe) Chest Look/feel for DOTS. Compress sides of chest for rib pain Abdomen Look/feel for DOTS Gently press all four quadrants for rigidity and tenderness using pads of fingers. Ask if an area is painful – check that area last.

Physical Exam (Head to Toe) Pelvis Look/feel for DOTS Gently squeeze hips downward Gently press hips towards each other Extremities Check entire length/girth of each extremity for DOTS Check CSM (Circulation, Sensation, Movement) of each hand & foot

CSM – checking extremities Circulation Pulse Temperature/color Sensation Can victim feel your touch on fingers/toes? Movement Ask victim to wiggle fingers/toes, to squeeze your hand and push foot against your hand Lack of sensation/movement can indicate injury to extremity or spinal injury.

Expose the injury If you can’t see it, it won’t be treated Remove clothing but try to maintain privacy Explain what you intend to do and why

SAMPLE History S = Symptoms “What is wrong?” A = Allergies “Are you allergic to anything?” M = Medications “Are you taking any medications? What are they for?” P = Past medical history “Have you had this problem before? Do you have any other medical problems?” L = Last oral intake “When did you last eat/drink something?” E = Events leading up to injury “How did you get hurt?”

Sudden Illness For unresponsive ill victim: check for Medical Identification Tags. Alerts to allergies Medications Medical history Has contact information Get SAMPLE from friends, family, bystanders For responsive ill victim: get SAMPLE first, then do physical exam Focus physical exam on chief complaint

Until EMS Arrives… Regularly recheck every 15 minutes for Responsiveness, ABC’s, Effectiveness of 1 st Aid Provide EMS with Chief complaint AVPU scale ABC status Physical Exam findings SAMPLE history Any first aid given