Scene Size Up, Primary Assessment, Vital Signs

danger zone

area around incident where special precautions should be taken

no apparent hazards- 50 ft radius

spilled fuel- 100 ft radius

vehicle on fire- 100 ft

downed wires- one full span of wires away from pole

hazmat- 50 to 2000 ft, park upwind; uphill if liquids, same level if gases

severe fall heights

adults: >20 ft

kids under 15: >10 ft

transport recommended

primary assessment steps

form general impression

mental status (AVPU)

airway

breathing

circulation

determine priority

assessing mental status

AVPU

Alert- patient is awake, aware of their surroundings, can open eyes spontaneously

Verbal- patient’s eyes closed, but open or the patient speaks/moves in response to verbal command

Painful- patient only reacts to painful stimulus (squeeze shoulder)

Unresponsive

assessing airway

if patient not alert or breathing noisily, open airway by jaw-thrust or head-tilt, chin-lift; suction; insert oral/nasal airway

assessing breathing

once airway is opened, look for rise/fall of chest, listen/feel for rate/depth/effort of breathing

if no breathing but pulse- rescue breaths

if not alert and adequate breathing- provide positive pressure ventilations with O2

if somewhat alert and inadequate breathing- assist ventilations with 100% O2

if adequate breathing but signs of distress or hypoxia- provide O2 as needed

assessing circulation

if patient lifeless, begin CPR first thing

assess pulse- if too fast or too slow, serious

check for/control severe bleeding

check skin- if light skin, wrist should be warm/pink/dry; if dark skin, lips/nail beds should be pink; pale/clammy indicates shock

determining priority

stable- vital signs in normal range

unstable- poor general impression, unresponsive, not following commands, difficulty breathing, shock, complicated childbirth, cardiac problems, uncontrolled bleeding, severe pain anywhere, etc.

vital signs

pulse, blood pressure, skin, respirations, pupils, pulse oximetry

repeat every 5 mins for unstable, 15 for stable

normal pulse rates

adult/adolescent (11+ years): 60-100

child (6-10 years): 65-120

preschoolers: 70-120

toddler (1-3 years): 80-140

infant (0-12 months): 90-160

newborn: 100-170

pulse quality

rhythm (regularity) and force (pressure)

find radial pulse (wrist) if 1 year or older

find brachial pulse (upper arm) for infants

if cannot find radial/brachial, use carotid (neck)

count pulsations for 30 seconds and multiply by 2 for bpm

normal respiratory rates

adult (13+ years): 12-20 (above 24 or below 10 is serious)

child (6-12 years): 18-30

preschooler (3-5 years): 22-34

infant (6-12 months): 24-30

newborn (0-6 months): 30-60

don’t tell patients you are counting their respiratory rate

respiratory quality

look for shallow/labored/noisy breathing

snoring- airway blocked, open airway

wheezing- medical problem (asthma), give meds

gurgling- fluids in airway, suction

crowing (harsh sound on inhale)- medical problem, transport

skin color

pink- normal

pale- constricted blood vessels

cyanotic (blue/gray)- lack of oxygen, inadequate breathing/heart function

flushed- exposure to heat, emotions

jaundiced- abnormalities of liver

blotchy- occasionally in shock patients

skin temperature/condition

cool/clammy- shock, anxiety

cold/moist- body losing heat

cold/dry- exposure to cold

hot/dry- fever, heat exposure

hot/moist- fever, heat exposure

goosebumps- chills, disease, cold, pain/fear

cold in extremities- lack of circulation

pupils

look at them before, then shine light into each + check for reactivity

dilated- fright, blood loss, drugs

constricted- drugs

unequal- stroke, head injury, eye injury

lack of reactivity- drugs, lack of oxygen to brain

normal systolic blood pressure

adult: <= 120

adolescent: 107-117

1-10 years: average is 90 + 2(age)

infant: ~90

at birth: 50-70

blood pressure abnormalities

high: medical condition, exertion, fright, emotions

low: athlete, blood loss, late sign of shock

none: ventricular assist device

pulse oximetry

displays oxygen saturation in blood

96-100% is healthy

91-95% is mild hypoxia

86-90% is moderate hypoxia

<85% is severe hypoxia

administer oxygen if below 94%

capnography

measures how much CO2 exhaled

35-45 mmHg is normal

systolic vs diastolic blood pressure

systolic- top number, pressure in arteries when heart beats

diastolic- bottom number, pressure in arteries when heart rests between beats