PATIENT ASSESSMENT

1
PATIENT ASSESSMENT

• Primary Assessment

2
The primary assessment

• A rapid, systematic check for life-threatening
  conditions that begins as you get closer to the
  patient
• Includes a systematic check of the vital areas of
  the body

3
Priorities

• Danger
• Airway
• Breathing
• Circulation
• Major bleeding
• Level of consciousness
• Spinal column
• Take action to manage priority problems as they
  are found

4
Part 1 - Approach
5
Approach the patient

• Approach the patient face to face
• Obtain permission.
• "I am a Canadian Ski Patroller trained in first
  aid. May I help you?
• Where do you hurt?
• "Please do not move until I have checked you for
  injuries.
• Assess the patient in the position found
• "I am going to hold your head to remind you not
  to move and prevent further injury.
• Apply manual cervical spine (C-spine) control, if
  indicated

6
Ask

• "What is your name?
• "Can you tell me what happened?
• "When did it happen?
• "Can you take a deep breath? How did that
  feel?
• "Do you hurt anywhere else? Have you had this
  before?

7
C-Spine

• "Do you have any pain or tingling in your neck or
  back?
• "Can you wiggle your fingers and toes?
• Can you feel your fingers and toes?
• With your free hand examine the neck
• Are the muscles rigid?
• Does the exam cause the patient further
  discomfort or anxiety?
• Does touching cause numbness or a tingling
  sensation?
• Treat for a C-spine injury as appropriate

8
A cervical spinal injury is unlikely if

• Freely moving their head without apparent pain
• No loss of consciousness
• Completely alert
• No alcohol or other drugs,
• No tenderness or deformity of the spine
• No other painful injuries which may mask neck or
  back pain
• No loss of sensation or movement in the limbs
• If you are unsure, immobilize
• If you have no concerns for C-spine injury, you
  may remove your hand

9
Approach Unconscious Patient

• If you can hear me, please do not move, I am
  here to help you!
• Ask all the same questions.
• Ask bystanders
• What is the casualtys name?
• What happened?

10
ABCD

• Preliminary check of Airway, Breathing,
  Circulation, and Disabilities
• If the patient is responsive, ABCs are obviously
  present and the patient is conscious
• Quality has yet to be assessed

11
Check the quality of the ABCDs

• A - Check for and establish a clear airway
• B - Look, listen, and feel for presence of
  breathing for at least 10 seconds
• C - Are pulses present? (What is their quality at
  the neck and wrist?)
• What is the patients level of consciousness
  (LOC) and are the spinal functions intact?
• Assess the need for oxygen if breathing or
  circulation seems abnormal

12
Immediate Action

• As you assess the patient during the Primary
  Assessment, take action to correct problems as
  you find them
• If the airway is noisy reposition it with the
  appropriate precautions to try to clear it
• If breathing is absent start AR
• If the pulses are absent start CPR
• If vessels have been cut and there are large
  amounts of blood, control the bleeding

13
Demo Practice
14
Part 2 Core Area
15

• This is a rapid assessment of the core areas of
  the body for life-threatening injuries
• Throughout each step, check for signs and
  symptoms of injury
• A sign is something you observe
• A symptom is something the patient tells you

16
Finding Injuries

• LOOK for
• Deformities
• Contusions
• Abrasions
• Punctures
• Burns
• Lacerations
• Swelling

• FEEL for
• Tenderness
• Instability
• Crepitus

After examining each part of the body, check your
gloves for signs of bleeding and wetness Listen
to what the patient has to say
17
Neck

• Look for DCAP BLS
• Feel for TIC
• Back
• Look for DCAP BLS
• Feel for TIC

18
Chest

• Look for DCAP BLS
• Also look for paradoxical movement
• Feel for TIC
• Also feel for subcutaneous emphysema

19
Abdomen

• Look for DCAP BLS
• Feel for guarding, tenderness, and rigidity
• Also check for distention and evisceration
• Check all four quadrants

20
Pelvis

• Look for DCAP BLS
• Feel for TIC
• Femurs
• Look for DCAP BLS
• Feel for TIC
• Pelvis and femur fractures are high-energy
  injuries
• Potential for large amounts of blood loss

21
Demo Practice