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Unformatted text preview: Chapter 3 Victim Assessment 1 Learning Objectives
When you have mastered the material in this chapter, you will be able to: 1 Understand how to properly assess a victim 2 Describe how to establish rapport with the victim 3 Explain how to survey and control the scene 4 Describe and conduct a primary survey 5 Know how to conduct a neurologic exam 6 Explain how to determine the chief complaint 7 Understand the significance of vital signs (pulse, respiration, and relative skin temperature) 8 Explain how to take a history 9 Understand the sequence and practical application of a secondary survey 2 Signs vs. Symptoms Signs Things you can observe about the victim, such as bleeding Symptoms Things the victim describes to you, such as abdominal pain 3 Using the Senses Look for deformities, wounds, bleeding, discoloration, penetration, openings in the neck, and unusual chest movement. Listen for unusual breathing sounds, gurgling sounds, or crepitus (a sand paper like noise made by broken bone ends rubbing against each other). Feel for unusual masses, swelling, hardness, softness, mushiness, muscle spasms, pulsations, tenderness, deformities, and temperature. Smell for unusual odors on the victim’s breath, body, or clothing. 4 ABCD’s
Airway: open using head tilt chin lift Breathing: Look for chest rise and fall. Listen for sounds of air movement at the mouth and nose. Feel on your cheek for air. Circulation: Check the carotid or radial pulse Look for signs of circulation Disability: DOTS 5 Assessment Sequence
1. Conduct a scene sizeup. 2. Establish rapport and control. 3. Conduct a primary survey. 4. Conduct a brief neurologic exam. 5. Determine the chief complaint. 6. Assess vital signs. 7. Look for medical information devices. 8. Take a SAMPLE history. 9. Conduct a secondary survey.
You may need to adapt or change the sequence, depending on your experience and the specific emergency situation. 6 Scene Assessment
1. Take body substance isolation precautions, if possible. 2. Assess the safety of the scene. 3. Determine if the victim is injured or ill. 4. Determine the number of victims. 5. Determine the resources needed. 7 Establishing Rapport and Establishing Control Control
Three C’s: Competence Confidence Compassion 8 Establishing Control Move smoothly and deliberately. Position yourself at a comfortable level in relation to the victim. Stay where the victim can see you without twisting his or her neck. Keep your eye level above that of the victim. Conduct your survey in an unhurried, systematic way. Emotions escalate quickly in tense situations, so keep your voice calm and quiet. If there is more than one victim, determine which victim(s) needs the most immediate care.
9 Primary Survey
1. If the victim is conscious, ask, “What happened?” The response will tell you the airway status, the adequacy of breathing, mental status, and mechanism of injury or nature of the illness. 2. Ask, “Where do you hurt?” The response will identify the most likely points of injury. 3. Visually scan the victim for general appearance, cyanosis (blueness from lack of oxygen), and sweating.
10 10 Responsiveness
There are four general levels of responsiveness: Alert—The victim’s eyes are open. Response to verbal stimuli—The victim opens his or her eyes to verbal commands. Response to pain—The victim appears to be asleep and does not respond when spoken to, but winces, grimaces, or jerks away when pinched. Unresponsive—The victim appears to be asleep and does not respond in any way when spoken to or pinched.
11 11 Neurological Exam
1. Talk to the victim. 2. Note the victim’s speech. 3. Determine whether he or she can understand by assessing his or her response to a simple command, such as “Squeeze my hand”. 4. Determine how easily the victim can be aroused. 12 12 Vital Signs Pulse Respiration (Breathing) Temperature and Skin Color Rate Strength Rhythm Paleness Redness Blueness (cyanosis) 13 13 Taking a History
Assess the scene. Ask questions. Whenever possible, ask openended questions, because you don’t want to suggest answers to the victim. Get a history by talking to friends or family members. 14 14 SAMPLE
S What are the signs and symptoms the victim is complaining of? A What is the victim allergic to? M What medications does the victim take, both prescription and overthecounter? P What is the pertinent past medical history of the victim? L When was the last time the victim had something to eat or drink? E What were the events prior to the incident?
15 15 DOTS D Deformity O Open wounds T Tenderness S Swelling 16 16 Face, Mouth, Ears, Nose
Check the following: Deformities, open wounds, tenderness, swelling Forehead, eye orbits, and facial structures for abnormalities Ears and nose for fluid and injury Eyes for pupil size and reactivity to light Eyes for the ability to track a moving object smoothly and evenly in all four quadrants Mouth for internal lacerations, unusual breath odor, and teeth alignment
17 17 Skull and Neck
Check the following: Deformities, open wounds, tenderness, swelling Scalp for depressions and bruises Trachea for position (it should be in the middle of the neck) Neck for depressions, bruises, veins (they should not be distended), pulses (equal carotid pulses), pain, and tenderness 18 18 Chest
Check for the following: Deformities, open wounds, tenderness, swelling Softtissue injuries, such as cuts, bruises, indentations, impaled objects, or open chest wounds Abnormalities or signs of fractures Breathing abnormalities and symmetry of respiration Pain, tenderness, or instability over the ribs
19 19 Abdomen Inspect and palpate for deformities, open wounds, tenderness, and swelling. Look for protrusions, softtissue wounds, lumps, swelling, or bruising. Palpate the four quadrants separately with the pads of your fingers for hardening or abdominal masses. If you suspect injury, feel that quadrant last. Ask about pain.
20 20 Pelvic Region Injury in the pelvic region can cause extreme pain and excessive bleeding, so be gentle Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for tenderness, and instability. Look for loss of bladder control, bleeding, or erection of the penis (a sign of central nervous system injury). Check the strength of the femoral pulse. 21 21 Lower Extremities Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for abnormal position of the legs. Feel for protrusions, depressions, and abnormal movement. Check for tenderness in the calves. 22 22 Upper Extremities Inspect and palpate for deformities, open wounds, tenderness, and swelling. Check for equal grip strength in both hands. Assess for motor function by asking the victim to squeeze your finger or wiggle his or her fingers. Assess for sensation by light touch and by a pinch to each hand. 23 23 ...
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This note was uploaded on 02/17/2011 for the course HK 280 taught by Professor Trembath during the Fall '07 term at Purdue University-West Lafayette.
- Fall '07