Let’s Focus on Early Steps

1. First Impressions Level of Consciousness ABC Let’s Focus on Early Steps LOR What are we looking for?

2. Viability of the ABCs Airway – is airway patent? can be maintained? Breathing – is patient breathing? Circulation – is there a pulse? Evidence of internal or external bleeding? 2. Indications of Life Threatening Trauma or Medical Condition MOI (eg yard sale, big fall, collision) Body position and appearance Blood, exposed bone, depressions, etc

3. 3. Signs and Symptoms of Shock Shock is HypoPerfusion – the inability to deliver oxygen and nutrients to the organs and tissues of the body Shock progresses from compensated, to decompensated, to irreversible

4. Head Heart Lungs Skin What Are These S&S? They provide a Perfusion Picture

5. Head – Level of Consciousness [C]  [UnC]  A(lert) V(erbal) P(ain) U(nresponsive) Level Of Response P – Person (what is your name) P - Place (where are you) T - Time (what day is it?) E - Event (what happened?)

6. Heart – What is the pulse rate? What is the quality – fast, slow, thready, strong, weak? What is the blood pressure? Lungs – What is the respiration rate? What is the quality – deep, shallow, labored, cannot speak in full sentences,…? Are there lungs sounds – wheezing, barking,..?

7. Skin – What is the color, temperature, & moisture? Normal skin is warm, pink, and dry. Abnormal skin is moist, cool, flushed, etc. Cap Refill – (in a non-ski environment) Squeeze base of thumb – color should return within 2 seconds Much more effective in peds < 6 Not much good in cold environment

8. When to check the Perfusion Picture * When you first make contact feel for pulse, look at skin, assess breathing * After focused or Rapid Body survey  do counted check of pulse & respiration * Every 5 mins for unstable patient, every 15 mins for stable patient Always be alert for changes in the perfusion picture

9. TV = tidal volume NPA = nasopharyngeal airway OPA = oropharyngeal airway PPV = positive pressure ventilation NRB = non rebreather mask BVM = bag-valve-mask PM = pocket mask LOC [AVPU] ALERT [A] (has pulse, is breathing, and can maintain own airway) UNRESPONSIVE [U] (not sure of airway, pulse, or breathing status SEMICONSCIOUS [V,P] (has pulse, is breathing, but cannot maintain own airway) Check breathing (Look, Listen, Feel for 10 secs).If YES breathing, MOVE ON If NO breathing, open airway with jaw thrust - If breathing starts Hold Airway. DONE! - If breathing not starts, do two rescue breaths Rescue breaths fail? start obstructed airway procedure Rescue breaths go in? MOVE ON A I R W A Y Airway is openand can maintain Airway is open but cannot reliably maintain; insert adjunct (NPA) B R E A T H I N G Apply O2 if pain or breathing difficulty. Assess Breathing (rate and TV). If inadequate, use PPV with PM or BVM. If adequate, but pain or breathing difficulty, use NRB. Always apply O2. Assess Breathing (rate and tidal volume). If inadequate, use PPV with PM or BVM. If adequate, use NRB. If Breathing, insert OPA and Assess Breathing (rate and tidal volume). If inadequate, use PPV with PM or BVM. If adequate, use NRB. If not Breathing (airway is open), MOVE ON C I R C U L A T I O N If breathing, assess pulse rate and quality (about 5 beats) Check for signs of external bleeding or internal bleeding (signs of shock) Control any external bleeding. If NOT breathing, check if carotid pulse exists If pulse exists, insert OPA, start Rescue Breathing If pulse NOT exist, start CPR and get AED insert OPA when time allows after initial shock Assess pulse rate and quality (about 5 beats) Check for signs of external bleeding or internal bleeding (signs of shock) Control any external bleeding. Assess pulse rate and quality (about 5 beats) Check for signs of external bleeding or internal bleeding (signs of shock) Control any external bleeding.