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Initial Assessment

Initial Assessment. Determining extent of injury Gathering important information. What do you do when you approach a scene of an emergency?. Survey Scene Safety in 10 Seconds Check for Response: AVPU Check for Breathing Check for Injuries: DOTS Get a medical history: SAMPLE and OPQRST.

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Initial Assessment

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  1. Initial Assessment Determining extent of injury Gathering important information

  2. What do you do when you approach a scene of an emergency? • Survey Scene Safety in 10 Seconds • Check for Response: AVPU • Check for Breathing • Check for Injuries: DOTS • Get a medical history: SAMPLE and OPQRST * Steps 4 and 5 can be reversed depending on the nature of the injury. Severe cases, step 4 is first. In non-immediate cases, do step 5 first.

  3. 1. Survey Scene Safety in 10 Seconds • What dangers exist? • To victims? To others? • To self? (can you safely enter area to help?) * withdraw/get help when hazards exist • Look for help • Have someone phone or phone yourself • How many victims? • Cause of Injury? • Take Universal Precautions/BSI • Attend to quiet ones first • If victim(s) are alert, attain consent!

  4. 2. Check for Response: AVPU • Tap the person and shout, “Are you OK?” • Determine AVPU • 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 w/ sternal rub or when trapezius muscle is pinched • U = Unresponsive  activate ERS (Emergency Response System) • Eyes do not open • Does not respond to pain A P U V

  5. 3. Check for Breathing (no look, listen and feel!) • Person is crying, speaking, coughing  breathing! • Person uses universal sign for choking: • Adult and Child: Heimlich maneuver • Infants: 5 back blows and 5 chest compressions

  6. 3. Check for Breathing (no look, listen and feel!) • Person is “U”, not breathing, not breathing normally, or is gasping • Activate ERS (Emergency Response System) - 911 • Get AED (Automatic External Defibrillator) • Check pulse simultaneously (5 – 10 seconds) while assessing breathing • No pulse or weak pulse, begin CPR and use AED

  7. 4. Check for Injuries: Use DOTS • Use 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 • DOTS can be rapid and focusedor head to toe. • Rapid and Focused (trauma cases) • Head to toe (medical or non life-threatening cases)

  8. DOTS: Head • Head • Stabilize and maintain cervical spine • DOTS over sides of head, then back of head • Skull depression • Bleeding • Check for leakage of fluid from mouth, nose & ears (cerebrospinal fluid) • Eyes (PEARL: Pupils Equal And React To Light)

  9. DOTS: Neck • Neck • DOTS over back of neck • Check for Jugular Vein Distention (JVD) • Check tracheal deviation (TD) • Medical Alert Tags

  10. DOTS: Shoulders, Chest, Back • Shoulders, Chest, Back • DOTS • Check for symmetry of shoulders • Symmetrical expansion of chest • Compress sides of chest for rib pain

  11. DOTS: Abdomen • Abdomen • DOTS • Check all quadrants for tenderness with overlapping hands and pads of fingers • Note areas of sensitivity (visceral organ damage)

  12. DOTS: Pelvis • Pelvis • DOTS • Incontinence or priapism • Squeeze hips downwards with palms of hands and squeeze hips toward each other

  13. DOTS: Extremities • Extremities (legs then arms) • DOTS • Check both front and back • Check Symmetry • CSM (Circulation, Sensation, Movement)

  14. CSM • Circulation • Pulse (ex. radial and pedal pulse) • Temperature/color (blue = cyanosis) • Capillary refill >2 seconds is normal • Sensation Can person feel your touch on fingers/toes? • Movement Ask person to wiggle fingers/toes, to squeeze your fingers and push foot against your hand.

  15. When an injury is found… • 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. 5. Get a Medical History • OPQRST • Questions about a current injury or complaint • SAMPLE • Questions about past medical history

  17. OPQRST History • O – Onset • What were you doing when this pain started? • Was it gradual? Sudden? • P – Provoking • Does anything make it feel better or worse? • Q – Quality • Describe the pain. Sharp? Burning? Numb? • R – Radiation • Where is the pain, exactly? Does the pain travel? • S – Severity • Rate the pain on a scale of 1 – 10, 10 being the worst • T – Time • How long ago did this pain start?

  18. 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?

  19. Until EMS arrives… • Regularly recheck every 15 minutes: (REx3) • Responsiveness/Breathing, Circulation, Effectiveness of 1st Aid • Manage secondary injuries • Treat for Shock • Provide EMS with • Chief complaint • AVPU scale • DOTS findings • SAMPLE/OPQRST history (*allergies!) • Any first aid given

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