“When in danger, when in doubt, run in circles, scream and shout.”

Survey the Scene --mechanism of injury --nature of illness

Survey the Scene --identify hazards --take universal precautions

Survey the Scene --locate all patients --arrange for needed resources

Level of Consciousness AVPU

AVPU  Alert  Verbal  Pain  Unresponsive

Primary Survey: to identify and correct all life threatening problems

AIRWAY  Patent??  Use head-tilt/chin-lift or modified jaw thrust  protect airway  continual reassessment

BREATHING  Look, listen, and feel  slow or rapid?  deep or shallow?  Symmetrical chest rise?  Quiet or noisy?

CIRCULATION  Feel carotid and radial pulses  Fast or slow?  Thready or bounding?  Regular or irregular?

CIRCULATION  notice skin color  CRT: capillary refill time (should be <2 seconds)  major bleeding

DISABILITY  AVPU  CAOx3??  --conscious, alert, and oriented to name, place, and time?

EXPOSE  Remove clothing as needed to look for life threatening problems  also note scars, medic alert bracelets, pacemakers, etc

VITAL SIGNS  Secondary Survey  Heart Rate, Blood Pressure, Respiratory Rate  Temperature, Skin, Pupils

VITAL SIGNS  Heart Rate  Adult  Child  Infant

VITAL SIGNS  Blood Pressure  Adult:  systolic/  diastolic

VITAL SIGNS  + radial = SBP > 80.  + femoral = SBP > 70.  + carotid = SBP > 60.

VITAL SIGNS  Respiratory Rate  Adult:  Child:  Infant: 30-50

VITAL SIGNS  Temperature:  Oral:  Rectal:  Auxiliary:

VITAL SIGNS  Skin:  cool/warm/hot...  dry/moist/diaphoreti c  pale/ashen/flushed ….

VITAL SIGNS  Pupils:  equal? Reactive?  “PEARL”  dilated/constricted?

Head-to-Toe Survey

Methods of Assessment  Inspection  Palpation  Auscultation  Percussion

Head  Palpate skull for bleeding, fractures. Inspect eyes, mouth, nose, ears. Look for CSF, Raccoon Eyes, or Battle Signs.

 Raccoon’s Eyes: periorbital bruising  Battle Signs: mastoid bruising  These two signs are indicative of a basilar skull fracture.

Neck  Check position of trachea.  Assess jugular veins (JVD).  May palpate C-Spine.

Chest  Inspect for bruising, trauma, scars, pacemaker.  Palpate for symmetrical chest rise.  Auscultate breath sounds.

Abdomen (ABD)  Inspect for bruising, trauma, scars, distention.  Palpate for rigidity, masses.  Auscultate bowel sounds.

Pelvis  Inspect for bruising, trauma, scars, deformity.  Palpate for stability.

Lower Extremities  Inspect for bruising, trauma, scars, deformity.  Check each for circulation, sensation, movement (CSM).

Upper Extremities  Inspect for bruising, trauma, scars, deformity.  Check each arm for circulation, sensation, movement (CSM).

Posterior  Inspect and palpate posterior thorax and lumbar region for bruising, trauma, scars, deformity.

Patient Interview SAMPLEOPQRST

Scene/Situation What’s going on? What happened?

Allergies Are you allergic to any medications??

Medications Are you taking any medications daily?? Have you taken anything today?

Past Medical History Do you have any medical problems?

Last….  Meal eaten  menstrual period  bowel movement  Time you used drugs  time you took your insulin  time you took your meds…..

Events leading up to problem… What were you doing when this started?

OPQRST Questions to ask regarding pain or a specific symptom

Onset What were you doing when this started?

Provoke What makes it better or worse?

Quality Is the pain burning, stinging, stabbing, cramping, aching, sharp, dull...?

Radiation Does the pain go to your jaw, shoulder, arm, neck, back….??

Severity On a scale of 1 to 10, ten being the worst pain you’ve ever had, what is the pain now?

Time How long ago did this start?

Documentation: If you didn’t write it, you didn’t do it.

CHART  Chief complaint  history  assessment  RX (treatment)  Transport

SOAP  Subjective  Objective  Assessment  Plan