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Chapter 4
Finding Out What is Wrong
Assessment Overview
• Assessment: Sequence of actions that
helps determine what is wrong
• A primary check will determine:
− Illness or injury
− Responsiveness or unresponsiveness
− Existence of life-threatening condition
Assessment Overview
© Jones & Bartlett Learning.
Assessment Steps
• Perform a primary check.
• Perform a physical exam.
• Obtain the person’s SAMPLE history.
Scene Size-up
• Look for hazards.
• Be aware of the potential for violence.
• Be observant for weapons.
• If scene appears hazardous, do not go in.
• Reduce exposure.
• Determine whether problem is injury or
illness.
Primary Check
• Identify life-threatening conditions so that
you can immediately take action to treat
the conditions.
− Responsiveness
− Circulation
− Breathing
− Severe bleeding
Primary Check
• Form a first impression.
− Injury or illness?
− Responsive or unresponsive?
− Breathing adequately? Talking?
− Bleeding?
− Chance of exposure to blood or body fluids?
− Danger to you, injured or ill person, or
bystanders?
Primary Check
• Check responsiveness.
− Tap the person on the shoulder and ask, “Are
you okay?”
• If the person does not respond, call 9-1-1.
• If you cannot detect breathing, begin CPR.
Primary Check
• Check for breathing.
− Chest movement
− Normal and abnormal breath sounds
− Cyanosis and skin color
© Jones & Bartlett Learning.
Primary Check
• Check for severe bleeding.
− Check for a large amount of blood.
• Around the person
• On the person’s clothing
− Control bleeding.
− Wear exam gloves.
Primary Check
• Position the person.
− Most people should not be moved.
− Exceptions:
• Unsafe location
• Person is face down and needs CPR
• Person has difficulty breathing from vomit
• First aid provider must leave to get help
• Signs of shock develop
Placing an Unresponsive Breathing
Person in the Recovery Position
• Kneel next to the
person’s side.
• Straighten both
legs.
• Place the arm
nearest you out
from the body.
© Jones & Bartlett Learning.
Placing an Unresponsive Breathing
Person in the Recovery Position
• Bring the other arm
across the person’s
chest.
• Grab and raise the
far knee until it is
bent.
© Jones & Bartlett Learning.
© Jones & Bartlett Learning.
Placing an Unresponsive Breathing
Person in the Recovery Position
• Grab the person’s
bent knee and
shoulder and roll
the person toward
you, onto the side. © Jones & Bartlett Learning.
Placing an Unresponsive Breathing
Person in the Recovery Position
• Adjust the top leg
so that both the
knee and the hip
are bent at right
angles.
• Keep the top hand
under the person’s
cheek.
© Jones & Bartlett Learning.
© Jones & Bartlett Learning.
Physical Exam
• Determine whether the cause of injury was
significant.
− Assume a person with a head injury also has
a spinal injury.
Physical Exam
• For a responsive person
− Ask if he or she can feel or wiggle the fingers
and toes.
• For an unresponsive person
− If you suspect a spinal injury, do not move the
person’s head or neck.
Physical Exam
• Assess the person’s entire body.
− Signs—conditions you can see, feel, hear,
and smell
− Symptoms—things the person feels and is
able to describe
• The chief complaint
Physical Exam
• D = Deformity
• O = Open wounds
• T = Tenderness
• S = Swelling
© American Academy of Orthopaedic
Surgeons.
© Jones & Bartlett Learning. Courtesy of
MIEMSS.
© Johnathan Noden-
Wilkinson/ShutterStock.
© American Academy of Orthopaedic
Surgeons.
Significant Cause of Injury
• Check the head.
• Check the eyes.
• Check the ears
and nose.
• Check the mouth.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Significant Cause of Injury
• Check the neck.
• Check the chest.
− Gently press inward.
© Jones & Bartlett Learning. Courtesy of MIEMSS. © Jones & Bartlett Learning. Courtesy of MIEMSS.
Significant Cause of Injury
• Check the abdomen.
− Gently press on all four quadrants.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Significant Cause of Injury
• Check the pelvis.
− Gently press inward on tops of hips.
− Press downward.
© Jones & Bartlett Learning. Courtesy of MIEMSS.© Jones & Bartlett Learning. Courtesy of MIEMSS.
Significant Cause of Injury
• Check all four
extremities.
− Circulation
− Sensation
− Movement
• Check the back.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Special Considerations
• Skin condition
− Temperature
− Color
− Moisture © Jones & Bartlett Learning.
© Jones & Bartlett Learning.
Special Considerations
• Capillary refill test
− Press fingernail or toenail for a few seconds
and release.
© American Academy of Orthopaedic Surgeons. © American Academy of Orthopaedic Surgeons.
Special Considerations
• Expose injury.
− Explain what you
are doing.
− Maintain privacy.
− Prevent exposure
to cold.
© American Academy of Orthopaedic Surgeons.
Special Considerations
• Check for medical
identification tags.
− Wallet
− Purse
− Necklace to cold.
− Bracelet
Courtesy of the MedicAlert Foundation®. © 2006, All Rights
Reserved. MedicAlert® is a federally registered trademark
and service mark.
Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved.
MedicAlert® is a federally registered trademark and service mark.
SAMPLE History
• Helps identify what is wrong with the
person
• Can indicate what first aid is needed
© Jones & Bartlett Learning.
What to Do Until Medical
Help is Available
• Recheck a serious illness or injury
regularly.
• Remaining calm and reassuring the
person may be the best treatment you can
provide.

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Ch04 presentation finding_out_what_is_wrong

  • 1. Chapter 4 Finding Out What is Wrong
  • 2. Assessment Overview • Assessment: Sequence of actions that helps determine what is wrong • A primary check will determine: − Illness or injury − Responsiveness or unresponsiveness − Existence of life-threatening condition
  • 3. Assessment Overview © Jones & Bartlett Learning.
  • 4. Assessment Steps • Perform a primary check. • Perform a physical exam. • Obtain the person’s SAMPLE history.
  • 5. Scene Size-up • Look for hazards. • Be aware of the potential for violence. • Be observant for weapons. • If scene appears hazardous, do not go in. • Reduce exposure. • Determine whether problem is injury or illness.
  • 6. Primary Check • Identify life-threatening conditions so that you can immediately take action to treat the conditions. − Responsiveness − Circulation − Breathing − Severe bleeding
  • 7. Primary Check • Form a first impression. − Injury or illness? − Responsive or unresponsive? − Breathing adequately? Talking? − Bleeding? − Chance of exposure to blood or body fluids? − Danger to you, injured or ill person, or bystanders?
  • 8. Primary Check • Check responsiveness. − Tap the person on the shoulder and ask, “Are you okay?” • If the person does not respond, call 9-1-1. • If you cannot detect breathing, begin CPR.
  • 9. Primary Check • Check for breathing. − Chest movement − Normal and abnormal breath sounds − Cyanosis and skin color © Jones & Bartlett Learning.
  • 10. Primary Check • Check for severe bleeding. − Check for a large amount of blood. • Around the person • On the person’s clothing − Control bleeding. − Wear exam gloves.
  • 11. Primary Check • Position the person. − Most people should not be moved. − Exceptions: • Unsafe location • Person is face down and needs CPR • Person has difficulty breathing from vomit • First aid provider must leave to get help • Signs of shock develop
  • 12. Placing an Unresponsive Breathing Person in the Recovery Position • Kneel next to the person’s side. • Straighten both legs. • Place the arm nearest you out from the body. © Jones & Bartlett Learning.
  • 13. Placing an Unresponsive Breathing Person in the Recovery Position • Bring the other arm across the person’s chest. • Grab and raise the far knee until it is bent. © Jones & Bartlett Learning. © Jones & Bartlett Learning.
  • 14. Placing an Unresponsive Breathing Person in the Recovery Position • Grab the person’s bent knee and shoulder and roll the person toward you, onto the side. © Jones & Bartlett Learning.
  • 15. Placing an Unresponsive Breathing Person in the Recovery Position • Adjust the top leg so that both the knee and the hip are bent at right angles. • Keep the top hand under the person’s cheek. © Jones & Bartlett Learning. © Jones & Bartlett Learning.
  • 16. Physical Exam • Determine whether the cause of injury was significant. − Assume a person with a head injury also has a spinal injury.
  • 17. Physical Exam • For a responsive person − Ask if he or she can feel or wiggle the fingers and toes. • For an unresponsive person − If you suspect a spinal injury, do not move the person’s head or neck.
  • 18. Physical Exam • Assess the person’s entire body. − Signs—conditions you can see, feel, hear, and smell − Symptoms—things the person feels and is able to describe • The chief complaint
  • 19. Physical Exam • D = Deformity • O = Open wounds • T = Tenderness • S = Swelling © American Academy of Orthopaedic Surgeons. © Jones & Bartlett Learning. Courtesy of MIEMSS. © Johnathan Noden- Wilkinson/ShutterStock. © American Academy of Orthopaedic Surgeons.
  • 20. Significant Cause of Injury • Check the head. • Check the eyes. • Check the ears and nose. • Check the mouth. © Jones & Bartlett Learning. Courtesy of MIEMSS.
  • 21. Significant Cause of Injury • Check the neck. • Check the chest. − Gently press inward. © Jones & Bartlett Learning. Courtesy of MIEMSS. © Jones & Bartlett Learning. Courtesy of MIEMSS.
  • 22. Significant Cause of Injury • Check the abdomen. − Gently press on all four quadrants. © Jones & Bartlett Learning. Courtesy of MIEMSS.
  • 23. Significant Cause of Injury • Check the pelvis. − Gently press inward on tops of hips. − Press downward. © Jones & Bartlett Learning. Courtesy of MIEMSS.© Jones & Bartlett Learning. Courtesy of MIEMSS.
  • 24. Significant Cause of Injury • Check all four extremities. − Circulation − Sensation − Movement • Check the back. © Jones & Bartlett Learning. Courtesy of MIEMSS.
  • 25. Special Considerations • Skin condition − Temperature − Color − Moisture © Jones & Bartlett Learning. © Jones & Bartlett Learning.
  • 26. Special Considerations • Capillary refill test − Press fingernail or toenail for a few seconds and release. © American Academy of Orthopaedic Surgeons. © American Academy of Orthopaedic Surgeons.
  • 27. Special Considerations • Expose injury. − Explain what you are doing. − Maintain privacy. − Prevent exposure to cold. © American Academy of Orthopaedic Surgeons.
  • 28. Special Considerations • Check for medical identification tags. − Wallet − Purse − Necklace to cold. − Bracelet Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved. MedicAlert® is a federally registered trademark and service mark. Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved. MedicAlert® is a federally registered trademark and service mark.
  • 29. SAMPLE History • Helps identify what is wrong with the person • Can indicate what first aid is needed © Jones & Bartlett Learning.
  • 30. What to Do Until Medical Help is Available • Recheck a serious illness or injury regularly. • Remaining calm and reassuring the person may be the best treatment you can provide.