Physical Assessment

1. Physical Assessment Determining extent of injury Gathering important information

2. Start with 10 Second Survey • What dangers exist? • To victims? • To self – can you safely enter area to help? • Cause of Injury? • How many victims? • Attain consent! • Attend to the more quiet ones first • May not be breathing • Lacking heart rate • Do not move the victim unless it is necessary to support life

3. Then what? • Call EMS, if needed. • Follow 10-s survey w/ initial victim assessment: • Identify life-threatening injury or illness • Correctconditions using ABCs (Airway, Breathing Circulation) • Next, do physical exam and take S.A.M.P.L.E history • Identifies nature of injury and its severity • Determines 1st Aid course of action

4. Initial Victim Assessment: AVPU • If spinal injury is suspected, ask someone to hold head to minimize movement and further injury • Check and determine level of responsiveness (AVPU) • indicator of overall condition • Speak to the victim. Tap them. • Ask/Shout, “Are you okay?” • Ability to talk = breathing w/heartbeat • If not = unresponsive

5. Initial Victim Assessment: AVPU • AVPU Scale: • A = Alert and Aware • Eyes open • Knows name, date, time, place • V = Responds to verbal stimulus • Not oriented to time, place • Responds in a meaningful way • P = Responds to painful stimulus • Eyes do not open • Responds when trapezium muscle is pinched • U = Unresponsive • Eyes do not open • Does not respond to pinching of muscles

6. Initial Victim Assessment: ABC’s Identify life-threatening injuries w/ ABC’s • A: Airway – is it open for breathing? • If crying, speaking, coughing  it is open • If responsive victim cannot do the above  obstruction • Adult: use Heimlich maneuver (abdominal thrusts) • Child: Visual check for blockage, finger-sweep • Unresponsive victims on their back: tilt head, lift chin to open airway. (Tongue blockage, likely) • Unresponsive victims w/suspected spinal injury: jaw thrust maneuver

7. Initial Victim Assessment: ABC’s • B: Breathing • 12-20 breaths/minute is normal. • Lower or higher – immediate care needed. • “Look, Listen, Feel” – place ear next to victim’s mouth • Does chest rise/fall? • Listen for sound, • Feel air coming from mouth. • Note breathing difficulties, unusual sounds. • Rescue breaths, if not breathing…. To be covered later in CPR

8. Initial Victim Assessment: ABC’s • Circulation: blood flowing normally • Signs: breathing, coughing, movement, normal skin color, normal temperature, radial pulse. • Severe bleeding: check and control w/ application of direct pressure (use PPE), elevation, pressure points, tourniquet • Skin condition: temperature, color, condition • Temperature: feel forehead with back of hand for coolness (lower oxygen flow) or fever • Color indicates oxygen status • Pale/gray – cyanosis • In darker skinned people, check nail beds, inside of mouth, check capillary refill by applying pressure to fingertips • Condition: moist? Dry?

9. Physical Exam – (severe injuries) • Stabilize head • Monitor ABC’s • Ask suspected spinal injury victim, • “Can you feel me squeezing your fingers, toes?” • “Can you wiggle your fingers and toes? • “Can you squeeze my hand or push your foot against my hand?” • Unresponsive victim: • Use Babinski reflex test: stroke bottom of foot firmly towards big toe with sharp object – big toe will go down (opposite in infants)

10. Physical Exam (Head to Toe) • Check head, neck, chest, abdomen, pelvis, extremities • Look for DOTS to ascertain extent of injury. • D = Deformity – when bones are broken they move out of place. • O = Open wounds breaking skin • T = Tenderness – sensitive to touch • S = Swelling

11. Physical Exam (Head to Toe) • Head • Stabilize • look/feel for DOTS over entire head. • Check for leakage of fluid from nose & ears (cerebrospinal fluid) • Eyes • check pupils for equal size and reactivity to light. • (PEARL: Pupils Equal And React To Light) • Neck • look/feel for DOTS • Look for medical alert tags

12. Physical Exam (Head to Toe) • Chest • Look/feel for DOTS. • Compress sides of chest for rib pain • Abdomen • Look/feel for DOTS • Gently press all four quadrants for rigidity and tenderness using pads of fingers. • Ask if an area is painful – check that area last.

13. Physical Exam (Head to Toe) • Pelvis • Look/feel for DOTS • Gently squeeze hips downward • Gently press hips towards each other • Extremities • Check entire length/girth of each extremity for DOTS • Check CSM (Circulation, Sensation, Movement) of each hand & foot

14. CSM – checking extremities • Circulation • Pulse • Temperature/color • Sensation • Can victim feel your touch on fingers/toes? • Movement • Ask victim to wiggle fingers/toes, to squeeze your hand and push foot against your hand • Lack of sensation/movement can indicate injury to extremity or spinal injury.

15. Expose the injury • If you can’t see it, it won’t be treated • Remove clothing but try to maintain privacy • Explain what you intend to do and why

16. SAMPLE History • S = Symptoms • “What is wrong?” • A = Allergies • “Are you allergic to anything?” • M = Medications • “Are you taking any medications? What are they for?” • P = Past medical history • “Have you had this problem before? Do you have any other medical problems?” • L = Last oral intake • “When did you last eat/drink something?” • E = Events leading up to injury • “How did you get hurt?”

17. Sudden Illness • For unresponsive ill victim: • check for Medical Identification Tags. • Alerts to allergies • Medications • Medical history • Has contact information • Get SAMPLE from friends, family, bystanders • For responsive ill victim: • get SAMPLE first, then do physical exam • Focus physical exam on chief complaint

18. Until EMS Arrives… • Regularly recheck every 15 minutes for • Responsiveness, ABC’s, Effectiveness of 1st Aid • Provide EMS with • Chief complaint • AVPU scale • ABC status • Physical Exam findings • SAMPLE history • Any first aid given