EMS CHAPTER 7

ASSESSMENT I

SCENE SIZE - UP4 main components of scene size – up: 1. Scene safety 2.Mechanism of injury(MOI)or Nature of

illness(NOI) 3.Number of victims 4.Resources needed * Survey scene to determine the scene is safe t0

approach victims. * Do not approach if environment is unsafe,

you’re not properly trained, don’t have necessary equipment.

* Use (BSI) precautions – gloves, mask, eye protection.

Protect Yourself At Specific Scenes:

*Crash/Rescue scenes requiring special victim extrication.

*Involving toxic substances in confined spaces.*Crime scenes with potential violence.*Unstable, sloping surfaces or environmental

hazards, water or ice.*Protect the victim from the environment when

necessary.*Protect bystanders from injury or illness.

Protect Yourself At Specific Scenes: Cont.

*Determine (MOI) or (NOI). Consider forces that could cause an injury. This helps identify possible injuries.

*Determine how the incident happened & why you were called.

*Determine how many victims are involved.*Determine resources needed – fire, police,

rescue.

INITIAL ASSESSMENT*Initial assessment is performed to identify

immediate threats to life.*5 components of initial assessment: 1. Forming a general impression of victim. 2. Assess levels of consciousness of mental

status. 3. Assess victim’s airway. 4. Assess victim’s breathing. 5. Assess victim’s circulation (movement,

coughing, pulse, severe bleeding & skin characteristics.)

INITIAL ASSESSMENTCONT.

*Begin initial assessment by rapidly forming a general impression of victims condition:

-determine the chief complaint. -determine if the victim is ill or injured. -determine the victim’s gender & approximate

age.*Assess victim’s mental status -can vary among 4 levels: 1. Alert – able to respond to you 2. Verbal – responds to verbal commands

only.

INTITIAL ASSESSMENTCONT.

3. Painful – responds to painful stimulus only.4. Unresponsive*speak to victim to see if he/she is responsive or

not.*infants, young children, people with

disabilities, may not respond (crying) or can’t clearly indentify problem

*responsive victim = ask for consent to help.*unresponsive victim = check ABC’s

AIRWAY*position head & neck to open airway – open mouth &

check for obstruction.*a person who is speaking/crying is conscious, has

open airway, is breathing, and has a pulse.*the tongue can fall back into throat, blocking airway

of unresponsive victim lying on their back.*unresponsive victim – open airway using 1 of 2

methods: 1. illness – use head tilt/chin lift technique. 2. Injury – use jaw thrust without head tilt. Protects

the head and neck.*inspect & clear obvious obstructions blocking airway,

(food or dentures.)

BREATHING*look, listen, feel for breathing.*determine if victim is breathing adequately, is

in breathing distress, or not breathing at all.*Victim is breathing = determine rate & quality. -to determine rate: listen/feel number of

breaths in 30 seconds, times by 2 (number of breaths per minute.)

- to determine quality: any normal sounds – gasping, noisy whistling, crowing, gurgling, snoring, fast, slow, or painful breathing.

BREATHING CONT.*victim not breathing= provide rescue

breathing. - establish airway (head/neck tilt or jaw

thrust) -give 2 short breaths= if breaths go in ,

assess circulation; breaths don’t go in, clear airway obstruction.

*breathing rates: -adults= 12 to 20 breaths per minute -children (1-12) 15 to 30 breaths per minute -infant (under 1 years old) 25 to 50 breathes

per min.*see chart on page 145.

CIRCULATION*Assessing circulation includes: - checking for breathing - checking for coughing - checking for any movement - checking for a pulse -adult 60-100

beats/min. -athlete 50 or under -infant newborn 120-160 (for chart see p.148)

CIRCULATION CONT.*checking for severe bleeding*checking for skin appearance: -color (pale/ashen) -temperature (hot/cold) -moisture (moist/dry)*capillary refill: (most reliable in infants and

children) -technique used to estimate how body is

reacting to injury or illness.

CIRCULATION CONT.*to check pulse for conscious victim: -adult: carotid artery -child: radial (wrist) or brachial (upper arm)

artery -infant: brachial artery*to check pulse on unconscious victim: -adult/child: carotid artery -infant: brachial artery

CIRCULATION CONT.*if a pulse is present, determine rate & quality: -find radial artery, count beats for 30 seconds, times

by 2 = beats per minute.*quality of pulse refers to the strength or weakness of

heart pumping.*A victim who is unresponsive, not breathing, & no

pulse is in CARDIAC ARREST ! Start CPR!!!*record/report findings of initial assessment; Victims

age, gender, chief complaint, level of consciousness, airway, breathing, circulation status.