 Conduct a scene size-up

 Establish rapport & control

 Conduct a primary survey
 Conduct a brief neurologic (i.e., “neuro”)
exam
 Determine the chief complaint
 Assess vital signs
 Look for medical information devices
 Conduct a secondary survey
 Priority when preparing to perform first aid is
to ensure:
◦ Your own personal safety
◦ Never risk your own safety
◦ Ensure the safety of the victim & any bystander at the
scene
 At all possible:
◦ Put on protective glove to guard against exposure to
any blood or body fluids
◦ Quickly scan the scene for any hazards while
approaching the victim
◦ Inspect the victim condition
◦ May request emergency medical services (EMS)
 People who are injured are often frightened, anxious,
angry, or in shock
 To establish rapport with the victim & get control of the
situation:
◦ Competence – having the necessary ability or knowledge
◦ Confidence – a positive feeling (self-assurance)
◦ Compassion – sympathetic pity & concern
 When approach the victim
◦ Ask for the victim’s name
◦ Introduce yourself (name), qualify in first aid
◦ Throughout the assessment & care:
 Continue to call the victim by name
 Maintain eye contact
 Speak calmly & deliberately
 Give orders quickly
 People under stress or in medical shock process
information more slowly, so speak distinctly & allow time
for the victim to respond
 To establish control:
◦ Move smoothly & deliberately
◦ Position yourself at a comfortable level in relation
to the victim. Stay where the victim can see you
without twisting his or her neck
◦ Keep your eye level above that of the victim
◦ Conduct your survey in an unhurried, systematic
way
◦ Emotions shoot up quickly in tense situations, so
keep your voice calm & quiet
 Major goal of the primary survey is to check
for life-threatening problems to the airways,
breathing, & circulation
 The survey should able to complete in

approximately in 60 seconds
PATIENT ASSESSMENT PYRAMID
 3 STEPS in primary survey
◦ If the victim is conscious, ask, “what happened?” –
The response will provide information about the
airway status, the adequacy of breathing, mental
status, & mechanism of injury or nature of illness
◦ Ask, “Where do you hurt?” – The response will
identify the most likely points of injury
◦ Visually scan the victim for general appearance,
pale skin, cyanosis (blueness from lack of oxygen),
& sweating
 The steps provide a quick assessment of the
victim’s overall condition
 The rest of the primary survey consists of
evaluating the:
◦ A – airway
◦ B – breathing
◦ C – circulation (pulse & bleeding)
◦ D – disability (nervous system disability, or altered
responsiveness)
 Always suspect a possible spinal injury in the victim
who is unresponsive or who has an altered mental
status. Do nothing that could aggravate possible
spinal injury.
 Determine whether the airway is open
◦ The victim is conscious & talking without difficulty, the
airway is open
 If the airway is not open
◦ Use either the head-tilt/chin-lift maneuver or the modified
jaw thrust maneuver to open it
◦ Use the modified jaw thrust maneuver if a spine injury is
suspected.

Head-tilt / Jaw thrust

chin-lift maneuver
maneuver
Airway & Spine Stabilization
 Suspect the victim has any possibility of spinal
injury:
◦ Establish manual in-line spinal stabilization by
bringing the victim’s head & neck into a neutral in-
line position
◦ Have someone hold the victim’s head so that the
nose is in line with the navel (belly button) & neck is
not bent forward or backward
◦ Instruct the victim not to move his or her head or
neck.
Airway & Spine Stabilization
 Suspect possible spine injury if the
victim :
◦ Is involved in any type of crash
◦ Falls greater than the height of the
victim
◦ Complains of pain to his neck or back
◦ Complains of tingling, numbness, or
unusual sensation in his extremities
◦ Has an altered mental status
◦ Is older than 65 years of age
◦ Has an injury to the head or neck
Breathing
 To determine whether a victim with an altered
mental status is breathing:
◦ Look for chest rise & fall
◦ Listen for sounds of air movement at the mouth &
nose
◦ Feel on your cheek for air passing in & out of the
mouth or nose
 if the victim is not breathing spontaneously or
not breathing adequately, begin artificial
breathing immediately
◦ Continue until the victim is breathing spontaneously
or until you are relieved by trained emergency
personnel
Breathing
Circulation
 To assess for
circulation:
◦ Check the radial
pulse (at the wrist
on the thumb side)
◦ Check the carotid
pulse (in the
groove of the
neck) –
unconscious
victim
Circulation
 If the patient is pulseless, not breathing, &
unresponsive (shows no sign of life) :
◦ Begin cardiopulmonary resuscitation (CPR) immediately
◦ If an automated external defibrillator (AED) becomes
available, immediately attach the device & follow the
prompts
◦ Continue CPR until circulation resumes
 If the victim is breathing and has a pulse:
◦ Continue by checking for serious or profuse bleeding
◦ Inspect for pools of blood or blood-soaked clothing
◦ If there a major bleeding, control it by direct pressure
Disability
 Injuries to the brain generally result in an
altered mental status or unresponsiveness
◦ Indicates decreased oxygen to the brain or brain injury
 Four (4) general levels of responsiveness:
◦ Alert – the victim’s eyes are open
◦ Response to verbal stimuli – the victim opens his/her
eyes to verbal commands to do so
◦ Response to pain – the victim appears to be asleep &
does not respond when spoken to, but winces,
grimaces, or jerks away when pinched
◦ Unresponsive – the victim appears to be asleep & does
not respond in any way when pinched
Disability
 If the victim has an altered mental status:
◦ Place victim in a lateral recumbent position to
protect the airway
 If a spine injury is suspected:
◦ Keep the victim in a supine position, maintaining
the head & neck in a neutral in-line position
 Danger – Check the area & make sure it safe
 Response – Check for signs of consciousness

in the casualty
 Airway – blockage throat
 Breathing – can the casualty breathe clearly?
 Circulation – pulse (pulse weak / strong /

racing), heart beating

 A neuro exam checks
◦ Mental status
◦ Motor function (such as voluntary movement)
◦ Sensory function (what the victim can feel)
 Four (4) steps to conduct neuro exam:
◦ Talk to victim
 A person who can’t answer general questions such as
“what is your name?” is disoriented
◦ Note the victim’s speech
 Vagueness, slurring of speech, or garbled speech
indicates a decreasing mental status or possible brain
injury
◦ If the victim can’t speak
 Determine whether he/she can understand by assessing
his/her response to a simple command, such as “squeeze
my hand”
◦ If the victim has an altered mental status
 Determine how easily the victim can be aroused
 If the victim doesn’t respond to your voice
 Try a pain stimulus (pinch) to the muscle at the base of the
neck
 Most chief complaints are characterized by
pain or abnormal structure or function & can
be pinpointed using observations made by the
victim
 Even if injury is obvious, it’s important to ask
◦ Ask, “tell me where you hurt” the answer is the chief
complaint
◦ The specific questions aimed at discovering the
symptoms – what the victim feels & describe to you
 Scenario (example)
◦ A soccer player fell down while another player on top
of him after heading the ball may have an obvious
sprain on his lower back, but if the chief complaint is
“I can’t breathe,” you may discover an unsuspected
chest injury
 Use TOTAPS principles
◦ Talk
 Ask the player what happened
 Where does it hurt?
 What kind of pain is it?
◦ Observe
 Look at the affected area for redness or swelling
 Is the injured side different from the other side?
◦ Touch
 Touch will indicate warmth for inflammation – touch
also assesses pain
 Use TOTAPS principles
◦ Active movement
 Ask the injured player to move the injured part without
any help
◦ Passive movement
 If the player can move the injured part, carefully try to
move it yourself through its full range of motion
◦ Skill test
 Did the active & passive movement produce pain?
 If no, can the player stand & demonstrate some of the
skills from the game carefully
 If an injury is identified, remove the player from the
activity immediately
 Pulse – the pressure wave generated when the
heart beats; it reflects the rhythm, rate, &
relative strength of the heart.
 When take the pulse note its:

◦ Rate – normal heart rate range 60 to 100 beats/min

for an adult, 80 to 150 for a child, & 120 to 160 for
a newborn
◦ Strength – a normal pulse is full & strong
◦ Rhythm – a normal pulse is regular
 1 respiration consists of 1 inhalation & 1
exhalation
 Normal respirations are easy & spontaneous,
without pain or effort
 Normal range of breathing:
◦ Adult – 12 to 20 / min
◦ Child – 15 to 30 / min
◦ Newborn – 30 to 50 / min
 Place hand on the victim’s chest & feel for
chest movement
◦ Do not tell the victim while assessing the respiration
since this may alter the rate
◦ Chest should move up with each breath
 Cardinal signs of respiratory distress:
◦ Flaring of the nostrils
◦ Use of accessory muscle in the neck, chest, &
abdomen
◦ Fast breathing
◦ Increased heart rate
◦ Pale & cool skin
◦ Sweating
◦ Decreasing mental status
 Secondary survey is conduct a full-body head-
to-toe assessment by inspection & using hand
(touch):
◦ Checking for swelling
◦ Depression
◦ Deformity
◦ Bleeding
◦ Other problems
 Explain to the victim what are you doing, &
keep talking calmly throughout the survey.
 Keep the victim’s head & neck alignment, &
don’t move the victim unnecessarily if suspect
spinal injuries on victim
 During the survey, use the following approach:
◦ Look for deformities, wounds, bleeding, discoloration,
penetration, openings in the neck, & unusual chest
movement.
◦ Listen for unusual breathing sounds, gurgling sounds,
or crepitus (a sandpaperlike noise made by broken
bone ends rubbing against each other).
◦ Feel for unusual masses, swelling, hardness, softness,
mushiness, muscle spasms, pulsations, tenderness,
deformities, & temperature.
◦ Smell for unusual odors on the victim’s breath, body,
or clothing
 Face, Mouth, Ears, Nose

◦ Deformities, open wounds, tenderness, swelling

◦ Forehead, eye orbits, & facial structures for
abnormalities
◦ Ears & nose for blood or clear fluid & injury
◦ Eyes for pupil size & reactivity to light
◦ Eyes for the ability to track a moving object
smoothly & evenly in all four quadrants
◦ Mouth for lacerations, unusual breath odor, & teeth
alignment
 Face, Mouth, Ears, Nose
 Skull & Neck

◦ Deformities, open wounds,

tenderness, swelling
◦ Scalp for depressions &
bruises
◦ Trachea for position (it
should be in the middle of
the neck)
◦ Neck for depression,
bruises, wounds, pain, &
tenderness
◦ The victim should be able
to swallow without
discomfort, & the voice
should not be hoarse
 Chest

◦ Deformities, open
wounds, tenderness,
swelling
◦ Soft-tissue injuries, such
as cut, bruises,
indentations, impaled
objects, or open chest
wounds
◦ Signs of fractures
◦ Respiratory distress &
symmetry of chest rise &
fall
◦ Pain, tenderness, or
instability over the ribs
 Abdomen

◦ Inspect & palpate for

deformities, open wounds,
tenderness, rigidity (hard &
contracted abdominal
muscles) & swelling
◦ Look for protrusions, soft-
tissue wounds, lumps,
swelling, or bruising
◦ Palpate the four quadrants
separately with the pads of the
fingers for hardening or
abdominal masses. If suspect
injury, feel that quadrant last
◦ Ask about pain
 Pelvic Region

◦ Inspect & palpate for

deformities, open wounds,
tenderness, & swelling
◦ Put your hands each side of
the hips & compress inward.
Check for tenderness,
crepitus, & instability
◦ Look for loss bladder control,
bleeding
◦ Check the strength of the
femoral pulse
 Back

◦ If spine injury is suspected,

do not move the victim.
◦ Without moving the victim,
slip your hand beneath the
back & feel for possible
deformities, pain or
tenderness, & bleeding
◦ Check for strength &
sensation in all extremities
 Lower Extremities

◦ Inspect & palpate for deformities, open wounds,

tenderness, & swelling
◦ Check for abnormal position of the legs (a leg that is
turned away, shortened, or rotated)
◦ Feel for protrusions, depressions, & abnormal
movement. Check for tenderness in the calves
◦ Check each foot for a pulse (on top of the foot on
the big toe side), sensation (by light touch & a pinch
to each foot), motor function (by asking the athlete
to move his/her toes), & warmth
 Lower Extremities
 Upper Extremities
◦ Inspect & palpate for deformities, open wounds, tenderness,
& swelling
◦ Check for equal grip strength in both hands
◦ Assess for motor function by asking the victim to squeeze
your finger or wiggle his/her fingers
◦ Assess for sensation by light touch & by a pinch to each
hand