Primary assessment.

What is the primary assessment?

• General impression.

• Assess level of consciousness.

• Assess airway: Identify and treat life threats.

• Assess breathing: Identify and treat life threats.

• Assess circulation: Identify and treat life threats.

• Perform rapid exam.

• Determine priority for patient care and transport.

General impression.

• A visual assessment of patient focusing on quick identification of life-threats present.

• Observe patients age, gender, race, distress level, and appearance.

• Observe patients positioning (moving or still)

• Avoid standing over the patient.

• Refer to the patient by their name. Introduce yourself and determine what the chief complaint is.

Avpu scale.

• Awake and alert.

• Verbal stimuli response.

• Painful stimuli response.

• Unresponsive.

Steps for airway.

• Open the airway. (Head tilt chin lift, jaw thrust)

• Clear the airway. (Suction the airway if needed)

• Keep the airway open. (NPA or OPA)

• Ventilate the airway. (BVM and oxygen)

Assess level of consciousness.

• If patient is alert or responsive to verbal stimuli, assess their orientation.

• Orientation: Assessing memory and thinking skills.

• Person: Remembering their name.

• Place: Identifying their current location.

• Time: Identify correct year, month, and day of the week.

• Event: Describing what happened, their chief complaint (MOI, NOI).

Conditions that cause sudden death.

• Cardiac arrest.

• Respiratory arrest.

• Shock.

• Severe bleeding.

• Airway obstruction.

• You are often able to manage these conditions, but need to recognize them rapidly and early to correct them.

• Begin identifying and treating life threats with airway, breathing, then circulation. (ABC)

Factors that may indicate the life threats for airway.

• Airway obstruction. (Complete or partial.)

• Tongue obstructing airway in unconscious patient.

• Vomit.

• Epiglottitis.

• Facial structure.

• Facial and oral bleeding.

• Soft tissue trauma to face/neck.

• Loose teeth or foreign objects in patient’s mouth.

• Blocks movement of air into and out of lungs, decreasing perfusion of the body.

• Make sure airway is always open and adequate.

Managing airway threats.

• Position airway. (Head-tilt chin lift or jaw thrust maneuver) to help open it.

• Suctioning secretions from airway.

• Removing obvious foreign body from patients mouth.

• Abdominal or chest thrusts to remove foreign body in airway.

• Too slow: Less than 8 breaths/min.

• Too fast: Greater than 28 breaths/min.

Types of breathing.

• Respiratory distress: Difficulty breathing causing increased work of breathing.

• Typically has increased respiratory effort and rate.

• Respiratory failure: Blood is inadequately oxygenated or ventilation is poor so it is unable to meet the oxygen demands of the body.

• Respiratory arrest: Results of respiratory failure if left untreated.

Signs that indicate life threats for breathing.

• Accessory muscle use.

• Cyanosis.

• Retractions.

• Nasal flaring.

• Stridor.

• Respiratory distress with signs of dyspnea or hypoxia.

• Asymmetrical chest wall movement.

• Chest injury (ex: Flail chest, tension pneumothorax, open chest wound.)

• Tracheal deviation.

• Distended neck veins.

Managing breathing.

• Maintain oxygen saturation at 94% or higher.

• Administer supplemental oxygen.

• Provide bag-valve mask (positive pressure) ventilations. When respiratory rate is too slow or too fast.

• Place advanced airway, when necessary.

Assess and control external bleeding.

• First concern when scanning a patient.

• If external bleeding is present start with CAB. Immediately control the external bleeding.

Types of blood loss.

• Arterial: Bright red, spurting.

• Venous: Dark red, steady stream.

• Capillary: Dark red, oozing.

Assess pulse

• Responsive patients older than 1 year: Palpate radial pulse.

• Unresponsive patient older than 1 year: Palpate carotid pulse.

• Patients younger than 1 year (Infants): Palpate brachial pulse.

Assess skin condition.

Skin functions:

• Insulates and protects body from infection (first line of defense.)

• Maintains water content in body.

• Regulates body temperature.

• Perfusion of body assessed by:

• Skin color, Skin temperature, Skin moisture, Capillary refill time.

DCAP-BTLS

• Deformities.

• Contusions.

• Abrasions.

• Punctures.

• Burns.

• Tenderness.

• Lacerations.

• Swelling.

OPQRST

• Onset: What were you doing when symptoms began?

• Provocation: What makes the symptoms better or worse?

• Quality: Describe the symptom, what does it feel like?

• Region/radiation: Where do you feel the symptoms? Does it move anywhere?

• Severity: On a scale 1 to 10, where is the pain at right now?

• Time: How long have the symptoms been present? When did they start?

Sample

• Signs and symptoms.

• Allergies.

• Medications.

• Past medical history.

• Last oral intake.

• Events leading up to the injury or illness.

Normal lung sounds.

Clear and quite during inspiration and expiration.

Wheezing.

• High pitch whistling sound most heard on expiration.

• Lower airway sound suggestive of bronchoconstriction/narrow airway.

Rales

• Wet, crackling sound heard on end of inspiration.

• May indicate fluid in small airways and/or alveoli of lungs.

• Sound is caused by alveoli popping open on inspiration.

Rhonci

• Low pitched rumbling sound most heard on expiration.

• Best heard over trachea and bronchi.

• May indicate mucus or fluid in lungs.

• Often associated with productive cough.

Stridor

• Brassy, crowing sound most heard on inspiration.

• May hear with or without stethoscope.

• May indicate upper airway obstruction.

Snoring breath sounds.

• Typically does not require stethoscope to be heard.

• May indicate upper airway obstruction caused by tongue falling back in mouth and blocking airway.