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““When in When in danger, when danger, when in doubt,in doubt, run in circles, run in circles, scream and scream and shout.”shout.”
Survey the Scene
--mechanism of injury
--nature of illness
Survey the Scene
--identify hazards
--take universal precautions
Survey the Scene
--locate all patients
--arrange for needed resources
Level of Consciousness
AVPU
AVPUAVPUAlertAlertVerbalVerbalPainPainUnresponsiveUnresponsive
Primary Survey:
to identify and correct all life threatening problems
AIRWAYAIRWAYPatent??Patent??Use head-tilt/chin-lift or Use head-tilt/chin-lift or modified jaw thrustmodified jaw thrust
protect airwayprotect airwaycontinual reassessmentcontinual reassessment
BREATHINGBREATHING Look, listen, and feelLook, listen, and feel slow or rapid?slow or rapid? deep or shallow?deep or shallow? Symmetrical chest rise?Symmetrical chest rise? Quiet or noisy?Quiet or noisy?
CIRCULATIONCIRCULATIONFeel carotid and radial Feel carotid and radial pulsespulses
Fast or slow? Fast or slow? Thready or bounding?Thready or bounding?Regular or irregular?Regular or irregular?
CIRCULATIONCIRCULATIONnotice skin colornotice skin colorCRT: capillary refill time CRT: capillary refill time (should be <2 seconds)(should be <2 seconds)
major bleedingmajor bleeding
DISABILITYDISABILITYAVPUAVPUCAOx3??CAOx3??--conscious, alert, and --conscious, alert, and oriented to name, oriented to name, place, and time?place, and time?
EXPOSEEXPOSERemove clothing as Remove clothing as
needed to look for life needed to look for life threatening problemsthreatening problems
also note scars, medic also note scars, medic alert bracelets, alert bracelets, pacemakers, etcpacemakers, etc
VITAL SIGNSVITAL SIGNS Secondary SurveySecondary Survey Heart Rate, Blood Pressure, Respiratory Heart Rate, Blood Pressure, Respiratory
RateRate Temperature, Skin, PupilsTemperature, Skin, Pupils
VITAL SIGNSVITAL SIGNS
Heart RateHeart RateAdult 60-100Adult 60-100Child 80-120Child 80-120 Infant 100-140Infant 100-140
VITAL SIGNSVITAL SIGNS
Blood PressureBlood PressureAdult: Adult: 100-140 systolic/100-140 systolic/60-90 diastolic60-90 diastolic
VITAL SIGNSVITAL SIGNS
+ radial = SBP > 80.+ radial = SBP > 80.+ femoral = SBP > 70.+ femoral = SBP > 70.+ carotid = SBP > 60+ carotid = SBP > 60..
VITAL SIGNSVITAL SIGNS
Respiratory RateRespiratory RateAdult: 12-20Adult: 12-20Child: 16-30Child: 16-30Infant: 30-50Infant: 30-50
VITAL SIGNSVITAL SIGNS
Temperature:Temperature:Oral: 97.6 - 99.6Oral: 97.6 - 99.6Rectal: 98.6 - 100.6Rectal: 98.6 - 100.6Auxiliary: 96.6 - 98.6Auxiliary: 96.6 - 98.6
VITAL SIGNSVITAL SIGNSSkin:Skin:cool/warm/hot...cool/warm/hot...dry/moist/diaphoreticdry/moist/diaphoreticpale/ashen/flushed….pale/ashen/flushed….
VITAL SIGNSVITAL SIGNS
Pupils:Pupils:equal? Reactive?equal? Reactive?““PEARL”PEARL”dilated/constricted?dilated/constricted?
Head-to-Toe Survey
Methods of Methods of AssessmentAssessment InspectionInspectionPalpationPalpationAuscultationAuscultationPercussionPercussion
HeadHeadPalpate skull for bleeding, Palpate skull for bleeding, fractures. Inspect eyes, fractures. Inspect eyes, mouth, nose, ears. Look mouth, nose, ears. Look for CSF, Raccoon Eyes, for CSF, Raccoon Eyes, or Battle Signs.or Battle Signs.
Raccoon’s Eyes: Raccoon’s Eyes: periorbital bruisingperiorbital bruising
Battle Signs: mastoid Battle Signs: mastoid bruisingbruising
These two signs are These two signs are indicative of a basilar indicative of a basilar skull fracture.skull fracture.
NeckNeckCheck position of trachea.Check position of trachea.Assess jugular veins Assess jugular veins (JVD).(JVD).
May palpate C-Spine.May palpate C-Spine.
ChestChest Inspect for bruising, Inspect for bruising, trauma, scars, pacemaker.trauma, scars, pacemaker.
Palpate for symmetrical Palpate for symmetrical chest rise.chest rise.
Auscultate breath sounds.Auscultate breath sounds.
Abdomen (ABD)Abdomen (ABD) Inspect for bruising, Inspect for bruising, trauma, scars, distention.trauma, scars, distention.
Palpate for rigidity, Palpate for rigidity, masses.masses.
Auscultate bowel sounds.Auscultate bowel sounds.
PelvisPelvis
Inspect for bruising, Inspect for bruising, trauma, scars, trauma, scars, deformity.deformity.
Palpate for stability.Palpate for stability.
Lower ExtremitiesLower Extremities Inspect for bruising, Inspect for bruising, trauma, scars, deformity.trauma, scars, deformity.
Check each for Check each for circulation, sensation, circulation, sensation, movement (CSM).movement (CSM).
Upper ExtremitiesUpper Extremities Inspect for bruising, Inspect for bruising, trauma, scars, deformity.trauma, scars, deformity.
Check each arm for Check each arm for circulation, sensation, circulation, sensation, movement (CSM).movement (CSM).
PosteriorPosterior
Inspect and palpate Inspect and palpate posterior thorax and posterior thorax and lumbar region for lumbar region for bruising, trauma, scars, bruising, trauma, scars, deformity.deformity.
Patient Patient InterviewInterview
SAMPLESAMPLE
OPQRSTOPQRST
Scene/Situation
What’s going on?
What happened?
Allergies
Are you allergic to any medications??
Medications
Are you taking any medications daily??
Have you taken anything today?
Past Medical History
Do you have any medical problems?
LastLast….….Meal eatenMeal eatenmenstrual menstrual
periodperiodbowel bowel
movementmovement
Time you Time you used drugsused drugs
time you took time you took your insulinyour insulin
time you took time you took your meds…..your meds…..
Events leading up to problem…
What were you doing when this started?
OPQRST
Questions to ask regarding pain or a specific symptom
Onset
What were you doing when this started?
Provoke
What makes it
better or worse?
Quality
Is the pain burning, stinging, stabbing, cramping, aching,
sharp, dull...?
Radiation
Does the pain go to your jaw, shoulder,
arm, neck, back….??
Severity
On a scale of 1 to 10, ten being the worst
pain you’ve ever had, what is the pain now?
Time
How long ago did this start?
Documentation:
If you didn’t write it, you didn’t do it.
CHARTCHART
Chief complaintChief complainthistoryhistoryassessmentassessmentRX (treatment)RX (treatment)TransportTransport
SOAPSOAP
SubjectiveSubjectiveObjectiveObjectiveAssessmentAssessmentPlanPlan