Taking Action In An Emergency: Initial Assessment

1. Taking Action In An Emergency:Initial Assessment

2. You have just arrived at the site of an emergency. What should you do first?

3. Step 1: Survey The Scene(check the scene) • Piece together the puzzle • Look for dangerous hazards • Quickly determine: • The number of victims • The cause of injury • Are there witnesses?

4. Survey The Scene #2 • Do not approach the victim if threatexists

5. Survey The Scene #3 • Attain consent • Gain victim’s confidence • Identify problems • Don’t assume that the injury you see is the only one • Gather info that will be helpful to EMS

6. Survey The Scene #4 • Remain calm • Call EMS if needed • Do not move the victim unless it is necessary to support life or life threat exists

7. Step 2: The Initial Victim Assessment • Identify and correct life threatening conditions related to • Airway • Breathing • Circulation • Disablity

8. Goal of the Initial Assessment • To assess heart, lung, brain and spinal cord functioning (address life support – does the victim need CPR?) • Cardio Pulmonary Resuscitation • Cardio refers to heart • Pulmonary refers to lungs • Resuscitate refers to revival

9. How To Proceed Through The Initial Assessment:RAPABCD • R - check for responsiveness • A – alert • V – responds to voice • P – responds to pain • U – unconscious, no responses • A - activate EMS (911) • P - position victim on the back

10. How To Proceed #2: RAP ABCD(checking for vital signs - pulse and respiration) • A - Airway • B - Breathing • C - Circulation • D – disability

11. Airway • Open the airway by “head tilt, chin lift” • If spinal cord injury is suspected, be more cautious

12. Breathing • Look, listen, and feel for breathing (no more than 10 seconds)

13. Circulation • Check for major bleeding • No longer required to check for pulse

14. Secondary Assessment: History and Physical Exam • Head to toe for major injury or unresponsive • Minor injury, examine complaint only • More regarding head to toe exam will follow

15. The Secondary Assessment • Identify yourself • Obtain consent • Ask and use the victim’s name • Ask about chief complaint • Use SAMPLE to help you remember questions to ask the victim

16. Questions To Ask: SAMPLE • S - symptoms • symptom: something the victim tells the first aider • sign: something the first aider sees, hears, or feels • A - Allergies

17. Sample #2 • M - Medication • P - Pre-existing illnesses • L - Last food (food poisoning? hypoglycemia?) • E - Events prior to the injury

18. The Secondary Assessment • Systematically look and feel (LAF) • Look for: DOTS • D - deformity • O - open wounds • T - tenderness • S - swelling • Start with the head for adults, feet for children

19. Check The Head • DOTS • Feel both sides of the head • CSF fluid (clear fluid from ear or nose / halo effect)

20. Check Eyes: PEARL • Are pupils equal and react to light? • Use flashlight or cover one eye with a hand • Pupils normally contract in one second • No pupil reaction could mean death, coma, cataracts, artificial eye

21. Check Eyes #2 • Pupil dilation occurs within 30-60 seconds of a cardiac arrest • Look for unequal pupils (stroke, head or brain injury) • Check inner eye lid: it should be pink

22. Check Neck and Chest • Check for cuts, bruises, compare sides • Apply slight pressure to sides of chest (checking for broken ribs)

23. Abdomen • Ask if pain is present • If pain is present, gently press on opposite side of pain site to help determine area affected • Feel for lumps • Feel the 4 abdominal quadrants

24. Pelvis • Gently press downward and squeeze inward

25. Extremity Assessment • Check arms and legs • deformity • tenderness • Check for : • C - Circulation (pulse sites) • S - Sensation • M - Movement

26. Extremity Assessment #2 • Compare extremities • Check temperature of the extremity • Check nail bed • instant refilling means good circulation • normal refill time is < 2 seconds

27. Spine and Back • Ask victim about movement in extremities • Wiggle fingers, toes • Have victim press foot against your hand • Have victim squeeze your hand • Babinski reflex test • Injured? Big toe flexes upward

28. Check for a Medical Alert Tag • 24 hour emergency phone number • Do not remove tag unless absolutely necessary

29. Reassess ABC’s: • Every 5 minutes if unconscious or serious injury • Otherwise, every 15 minutes if conscious

30. Role Play Secondary Survey • Lab Activity

31. Is There a Head or Spinal Injury? • Always stabilize the head immediately • Signs of Spinal Cord Injuries • Painful movement of arms and legs • Numbness, tingling, weakness, burning, lessened sensation in arms or legs • Loss of bowel or bladder control • Paralysis of arms or legs • Deformity

32. Always Remember! RAPABCD

33. Post Emergency Numbers Near The Telephone • Fire department • Police • Ambulance or EMS (paramedics) • Physician • Poison Control Center

34. Have You Ever Called 911?

35. Calling Emergency Medical Services (EMS - 911) • A two minute delay in calling EMS can be deadly • If in doubt, call EMS • Questions by dispatchers are not to question the need of the call but to determine the level of need

36. What To Tell 911 Dispatcher • First, speak slowly and clearly • When calling from a cell phone, give the address immediately • Listen carefully to the dispatcher

37. Tell The Dispatcher : • Location • Telephone number • What has happened • Number of persons needing help • Special conditions • Your assessment of the victim • Do not hang up unless the dispatcher instructs you to