Lesson Outlines Chapter 4
LESSON 4: Finding Out What’s Wrong
Lesson Objectives
After completing this lesson, participants should be able to:
· Describe and demonstrate how to assess a victim, including conducting an initial check, physical exam, and SAMPLE history.
· Identify problems that are an immediate threat to life.
Points
Checking the Victim
· Victim assessment is a sequence of actions that helps determine what is wrong and thus ensures safe and appropriate first aid.
· The goals of this identification are to:
o Detect life-threatening conditions rapidly and care for them as quickly as possible.
o Determine other problems needing care.
o Determine if the victim needs medical care, and it so, whether the victim should be transported by ambulance or private vehicle.
Scene Size-Up
· The scene size-up determines the safety of the scene, the cause of injury or nature of illness, and the number of victims.
· If the scene appears hazardous, do not enter the area.
Initial Check
· The initial check determines whether there are life-threatening problems requiring quick care.
· Involves checking the victim’s responsiveness, opening the airway, checking for breathing, and checking for severe bleeding.
· Takes less than a minute to complete, unless first aid is needed at any point.
· During the initial check:
o Determine if the victim is responsive. Tap and shout.
o Ensure that the victim’s airway is open. Perform the head tilt-chin lift maneuver.
o Determine if the victim is breathing. Look, listen, and feel.
o Check for any obvious, severe bleeding.
General Impression of the Victim
· Also known as the first impression, the look test, or a gut reaction.
· Helps determine whether the victim is injured or ill.
· If you are unable to determine whether the victim is ill or injured, treat as though he or she were injured.
Check Responsiveness
· Victims can be responsive or unresponsive.
· Not all responsive victims are fully alert and may respond to different levels of stimulation.
· The AVPU scale describes how responsive a victim is.
o A – Alert
o V – Responsive to verbal stimulus
o P – Responsive only to painful stimulus
o U – Unresponsive to any stimulus
Open Airway
· The airway must be open for breathing.
· Use the head tilt-chin lift method to open the airway.
Check for Breathing
· Check for breathing sounds that might indicate a problem in a responsive victim.
· Check for breathing in an unresponsive victim while opening the airway.
o Look, listen, and feel.
Check for Severe Bleeding
· Check for severe bleeding by quickly looking over the victim’s entire body for blood.
· In most cases, direct pressure with the hand and sterile dressing over the bleeding or a pressure bandage controls the bleeding.
· Avoid contact with the victim’s blood.
Skin Condition
· A quick check of the victim’s skin can also provide information about the victim’s condition.
· Check skin temperature, color, and condition.
o Skin color, especially in light-skinned people, reflects the circulation under the skin.
Expose the Injury
· Clothing may have to be removed to check for injury and to provide first aid.
· Explain what you intend to do and why first.
Physical Exam
· The goal of doing a hands-on physical exam is to identify immediately any potentially life-threatening illness or injury.
· Most victims will not require a complete head-to-toe type of physical exam.
Signs and Symptoms
· A physical exam checks the victim’s entire body from head to toe; you will note the victim’s signs and symptoms.
o Signs are the victim’s conditions that you can see, feel, hear, or smell.
o Symptoms are the things the victim feels and is able to describe; known as the chief complaint.
DOTS
· DOTS is helpful for remembering the signs of injury:
· Deformity
o Abnormal shape of the body part.
· Open wounds
o The skin is broken and there is bleeding.
· Tenderness
o Sensitivity, discomfort, or pain when touched.
· Swelling
o Area looks larger than usual.
Conducting a Physical Exam
· Head: check for DOTS.
· Neck: check for DOTS.
· Chest: check for DOTS.
· Abdomen: check for DOTS.
· Pelvis: check for DOTS.
· Extremities: check both arms and legs for DOTS.
· Back: if no spinal injury is suspected, turn the victim on his or her side and check for DOTS.
SAMPLE History
· The information is a SAMPLE history could help you to identify what is wrong with the victim and can indicate the needed first aid.
· S = Symptoms
· A = Allergies
· M = Medications
· P = Past medical history
· L = Last oral intake
· E = Events leading up to the illness or injury
Medical Identification Tags
· Look for a medical identification tag or a medical information card.
· These are beneficial in identifying allergies, medications, or medical history.
Putting It All Together
· Victim assessment can provide important information about a problem and help you determine how you treat it and whether medical care is needed.
· Provide the following information to EMS or health care providers:
o Victim’s chief complaint
o Responsiveness
o Initial check
o Physical exam findings
o SAMPLE history
o Any first aid that had been provided
Triage
· Triage is the process of prioritizing multiple victims.
· Immediate care
· Urgent care
· Delayed care
· Dead
Advantages of the Left-Side Position
· Also called the recovery position
· Has several advantages:
o Keeps the airway open in an unresponsive, breathing victim without a spinal injury
o Delays vomiting by placing the esophagus above the stomach
o Delays a poison’s effects by retaining the poison in the stomach
o Relieves pressure on a pregnant woman’s vena cava
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