Chapter 4Finding Out What’s Wrong

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.

Victim Assessment Overview (2 of 2)

Assessment Steps

• Scene size-up• Primary check• Secondary check• SAMPLE history• Reassessment

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 .

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

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?

Check Responsiveness

• Tap the victim on the shoulder and ask, “Are you okay?”

• Use the AVPU scale.

Alert Victim

• Evaluate ability to remember.• What is your name?• Do you know where you are?• What are the month and year?• What happened?

An Unresponsive Victim RAP-CAB (1 of 4)

R = Responsive? Tap shoulder and shout, “Are you okay?”

Courtesy of Berta A. Daniels, 2010

An Unresponsive Victim RAP-CAB (2 of 4)

A = Activate emergency medical services (EMS)

Courtesy of Berta A. Daniels, 2010

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

An Unresponsive Victim RAP-CAB (4 of 4)

A = AirwayOpen the airway.

B = BreathsGive two breaths and continue CPR. Courtesy of Berta A. Daniels, 2010

A Responsive VictimRAP-ABC

R = ResponsivenessA = Activate EMSP = PositionA = AirwayB = BreathingC = Circulation

Check for Breathing

• Chest movement• Normal and

abnormal breath sounds

• Feeling adequate air movement

Check for Severe Bleeding

• Check for a large amount of blood. • Around the victim• On the victim’s clothing

• Control bleeding. • Wear exam gloves.

Position the VictimMost 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.

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.

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.

Left Side Advantages

• Keeps the airway open• Delays vomiting• Delays a poison’s effect• Relieves pressure on a pregnant

woman’s vena cava

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.

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.

Signs and Symptoms

Signs • See• Feel• Hear• Smell

Symptoms• Things the victim

feels• Things the victim

can describe• Chief complaint

DOTS

D = DeformityO = Open woundsT = TendernessS = Swelling

© Johnathan Noden-Wilkinson/ShutterStock, Inc.

Significant Cause of Injury (1 of 5)

• Check the head.• Check eyes

(PERRL).• Check the ears.• Check the nose.• Check the mouth.

Significant Cause of Injury (2 of 5)

• Check the neck.• Check the chest.

• Gently press inward.

Significant Cause of Injury (3 of 5)

• Check the abdomen.• Gently press on

all four quadrants.

Significant Cause of Injury (4 of 5)

• Check pelvis. • Gently press

downward on tops of hips.

• Press downward.

Significant Cause of Injury (5 of 5)

• Check extremities.• Circulation• Sensation• Movement

• Check back.

Special Considerations (1 of 4)

• Skin condition• Color• Temperature• Moisture

Special Considerations (2 of 4)

• Capillary refill test• Press fingernail or

toenail for a few seconds and release.

Special Considerations (3 of 4)

• Expose injury.• Explain what you

are doing.• Maintain privacy.• Prevent exposure

to cold.

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 ®

SAMPLE History

Recheck

• Serious illness or injury: every 15 minutes

• Unresponsive victim: at least every 5 minutes

Triage

Process of prioritizing multiple victims

• Immediate care• Delayed care• “Walking wounded”• Dead