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

AVPUAVPUAlertAlertVerbalVerbalPainPainUnresponsiveUnresponsive

Primary Survey:

to identify and correct all life threatening problems

AIRWAYAIRWAYPatent??Patent??Use head-tilt/chin-lift or Use head-tilt/chin-lift or modified jaw thrustmodified jaw thrust

protect airwayprotect airwaycontinual reassessmentcontinual reassessment

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

CIRCULATIONCIRCULATIONFeel carotid and radial Feel carotid and radial pulsespulses

Fast or slow? Fast or slow? Thready or bounding?Thready or bounding?Regular or irregular?Regular or irregular?

CIRCULATIONCIRCULATIONnotice skin colornotice skin colorCRT: capillary refill time CRT: capillary refill time (should be <2 seconds)(should be <2 seconds)

major bleedingmajor bleeding

DISABILITYDISABILITYAVPUAVPUCAOx3??CAOx3??--conscious, alert, and --conscious, alert, and oriented to name, oriented to name, place, and time?place, and time?

EXPOSEEXPOSERemove clothing as Remove clothing as

needed to look for life needed to look for life threatening problemsthreatening problems

also note scars, medic also note scars, medic alert bracelets, alert bracelets, pacemakers, etcpacemakers, etc

VITAL SIGNSVITAL SIGNS Secondary SurveySecondary Survey Heart Rate, Blood Pressure, Respiratory Heart Rate, Blood Pressure, Respiratory

RateRate Temperature, Skin, PupilsTemperature, Skin, Pupils

VITAL SIGNSVITAL SIGNS

Heart RateHeart RateAdult 60-100Adult 60-100Child 80-120Child 80-120 Infant 100-140Infant 100-140

VITAL SIGNSVITAL SIGNS

Blood PressureBlood PressureAdult: Adult: 100-140 systolic/100-140 systolic/60-90 diastolic60-90 diastolic

VITAL SIGNSVITAL SIGNS

+ radial = SBP > 80.+ radial = SBP > 80.+ femoral = SBP > 70.+ femoral = SBP > 70.+ carotid = SBP > 60+ carotid = SBP > 60..

VITAL SIGNSVITAL SIGNS

Respiratory RateRespiratory RateAdult: 12-20Adult: 12-20Child: 16-30Child: 16-30Infant: 30-50Infant: 30-50

VITAL SIGNSVITAL SIGNS

Temperature:Temperature:Oral: 97.6 - 99.6Oral: 97.6 - 99.6Rectal: 98.6 - 100.6Rectal: 98.6 - 100.6Auxiliary: 96.6 - 98.6Auxiliary: 96.6 - 98.6

VITAL SIGNSVITAL SIGNSSkin:Skin:cool/warm/hot...cool/warm/hot...dry/moist/diaphoreticdry/moist/diaphoreticpale/ashen/flushed….pale/ashen/flushed….

VITAL SIGNSVITAL SIGNS

Pupils:Pupils:equal? Reactive?equal? Reactive?““PEARL”PEARL”dilated/constricted?dilated/constricted?

Head-to-Toe Survey

Methods of Methods of AssessmentAssessment InspectionInspectionPalpationPalpationAuscultationAuscultationPercussionPercussion

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

Raccoon’s Eyes: Raccoon’s Eyes: periorbital bruisingperiorbital bruising

Battle Signs: mastoid Battle Signs: mastoid bruisingbruising

These two signs are These two signs are indicative of a basilar indicative of a basilar skull fracture.skull fracture.

NeckNeckCheck position of trachea.Check position of trachea.Assess jugular veins Assess jugular veins (JVD).(JVD).

May palpate C-Spine.May palpate C-Spine.

ChestChest Inspect for bruising, Inspect for bruising, trauma, scars, pacemaker.trauma, scars, pacemaker.

Palpate for symmetrical Palpate for symmetrical chest rise.chest rise.

Auscultate breath sounds.Auscultate breath sounds.

Abdomen (ABD)Abdomen (ABD) Inspect for bruising, Inspect for bruising, trauma, scars, distention.trauma, scars, distention.

Palpate for rigidity, Palpate for rigidity, masses.masses.

Auscultate bowel sounds.Auscultate bowel sounds.

PelvisPelvis

Inspect for bruising, Inspect for bruising, trauma, scars, trauma, scars, deformity.deformity.

Palpate for stability.Palpate for stability.

Lower ExtremitiesLower Extremities Inspect for bruising, Inspect for bruising, trauma, scars, deformity.trauma, scars, deformity.

Check each for Check each for circulation, sensation, circulation, sensation, movement (CSM).movement (CSM).

Upper ExtremitiesUpper Extremities Inspect for bruising, Inspect for bruising, trauma, scars, deformity.trauma, scars, deformity.

Check each arm for Check each arm for circulation, sensation, circulation, sensation, movement (CSM).movement (CSM).

PosteriorPosterior

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

Patient Patient InterviewInterview

SAMPLESAMPLE

OPQRSTOPQRST

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?

LastLast….….Meal eatenMeal eatenmenstrual menstrual

periodperiodbowel bowel

movementmovement

Time you Time you used drugsused drugs

time you took time you took your insulinyour insulin

time you took time you took your meds…..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.

CHARTCHART

Chief complaintChief complainthistoryhistoryassessmentassessmentRX (treatment)RX (treatment)TransportTransport

SOAPSOAP

SubjectiveSubjectiveObjectiveObjectiveAssessmentAssessmentPlanPlan