Chapter 4Finding Out What is Wrong

Assessment Overview

• Assessment: Sequence of actions that helps determine what is wrong

• A primary check will determine:− Illness or injury− Responsiveness or unresponsiveness− Existence of life-threatening condition

Assessment Overview

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Assessment Steps

• Perform a primary check.• Perform a physical exam.• Obtain the person’s SAMPLE history.

Scene Size-up

• Look for hazards.• Be aware of the potential for violence.• Be observant for weapons.• If scene appears hazardous, do not go in.• Reduce exposure.• Determine whether problem is injury or

illness.

Primary Check

• Identify life-threatening conditions so that you can immediately take action to treat the conditions.− Responsiveness− Circulation− Breathing− Severe bleeding

Primary Check

• 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, injured or ill person, or

bystanders?

Primary Check

• Check responsiveness.− Tap the person on the shoulder and ask, “Are

you okay?”• If the person does not respond, call 9-1-1.• If you cannot detect breathing, begin CPR.

Primary Check

• Check for breathing.− Chest movement− Normal and abnormal breath sounds− Cyanosis and skin color

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Primary Check

• Check for severe bleeding.− Check for a large amount of blood.

• Around the person• On the person’s clothing

− Control bleeding.− Wear exam gloves.

Primary Check

• Position the person.− Most people should not be moved.− Exceptions:

• Unsafe location• Person is face down and needs CPR• Person has difficulty breathing from vomit• First aid provider must leave to get help• Signs of shock develop

Placing an Unresponsive Breathing Person in the Recovery Position

• Kneel next to the person’s side.

• Straighten both legs.

• Place the arm nearest you out from the body.

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Placing an Unresponsive Breathing Person in the Recovery Position

• Bring the other arm across the person’s chest.

• Grab and raise the far knee until it is bent.

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Placing an Unresponsive Breathing Person in the Recovery Position

• Grab the person’s bent knee and shoulder and roll the person toward you, onto the side.

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Placing an Unresponsive Breathing Person in the Recovery Position

• Adjust the top leg so that both the knee and the hip are bent at right angles.

• Keep the top hand under the person’s cheek.

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© Jones & Bartlett Learning.

Physical Exam

• Determine whether the cause of injury was significant.− Assume a person with a head injury also has

a spinal injury.

Physical Exam

• For a responsive person− Ask if he or she can feel or wiggle the fingers

and toes.• For an unresponsive person

− If you suspect a spinal injury, do not move the person’s head or neck.

Physical Exam

• Assess the person’s entire body.− Signs—conditions you can see, feel, hear,

and smell− Symptoms—things the person feels and is

able to describe• The chief complaint

Physical Exam

• D = Deformity• O = Open wounds• T = Tenderness• S = Swelling

© American Academy of Orthopaedic Surgeons.

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© American Academy of Orthopaedic Surgeons.

Significant Cause of Injury

• Check the head.• Check the eyes.• Check the ears

and nose.• Check the mouth.

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Significant Cause of Injury

• Check the neck.• Check the chest.

− Gently press inward.

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Significant Cause of Injury

• Check the abdomen.− Gently press on all four quadrants.

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Significant Cause of Injury

• Check the pelvis.− Gently press inward on tops of hips.− Press downward.

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Significant Cause of Injury

• Check all four extremities.− Circulation− Sensation− Movement

• Check the back.© Jones & Bartlett Learning. Courtesy of MIEMSS.

Special Considerations

• Skin condition− Temperature− Color− Moisture

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© Jones & Bartlett Learning.

Special Considerations

• Capillary refill test− Press fingernail or toenail for a few seconds

and release.

© American Academy of Orthopaedic Surgeons. © American Academy of Orthopaedic Surgeons.

Special Considerations

• Expose injury.− Explain what you

are doing.− Maintain privacy.− Prevent exposure

to cold.© American Academy of Orthopaedic Surgeons.

Special Considerations

• Check for medical identification tags.− Wallet− Purse− Necklace to cold.− Bracelet

Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved. MedicAlert® is a federally registered

trademark and service mark.

Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved. MedicAlert® is a federally registered trademark and service mark.

SAMPLE History

• Helps identify what is wrong with the person

• Can indicate what first aid is needed

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What to Do Until Medical Help is Available

• Recheck a serious illness or injury regularly.

• Remaining calm and reassuring the person may be the best treatment you can provide.