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Chapter 3Chapter 3Victim AssessmentVictim Assessment

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Learning ObjectivesLearning Objectives

When you have mastered the material in this chapter, you will be When you have mastered the material in this chapter, you will be able toable to

1 1 Understand how to properly assess a victimUnderstand how to properly assess a victim 2 2 Describe how to establish rapport with the victimDescribe how to establish rapport with the victim 3 3 Explain how to survey and control the sceneExplain how to survey and control the scene 4 4 Describe and conduct a primary surveyDescribe and conduct a primary survey 5 5 Know how to conduct a neurologic examKnow how to conduct a neurologic exam 6 6 Explain how to determine the chief complaintExplain how to determine the chief complaint 7 7 Understand the significance of vital signs (pulse, respiration, and Understand the significance of vital signs (pulse, respiration, and

relative skin temperature)relative skin temperature) 8 8 Explain how to take a historyExplain how to take a history 9 9 Understand the sequence and practical application of a Understand the sequence and practical application of a

secondary surveysecondary survey

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In most cases, conduct victim In most cases, conduct victim assessment in this order: assessment in this order:

1. 1. Conduct a scene size-up.Conduct a scene size-up.2. 2. Establish rapport and control.Establish rapport and control.3. 3. Conduct a primary survey.Conduct a primary survey.4. 4. Conduct a brief neurologic (i.e., “neuro”) exam.Conduct a brief neurologic (i.e., “neuro”) exam.55. Determine the chief complaint.. Determine the chief complaint.6. 6. Assess vital signs.Assess vital signs.7. 7. Look for medical information devices.Look for medical information devices.8. 8. Take a SAMPLE history.Take a SAMPLE history.9. 9. Conduct a secondary survey.Conduct a secondary survey.

You may need to adapt or change the sequence,You may need to adapt or change the sequence,depending on your experience and the specific emergencydepending on your experience and the specific emergencysituation.situation.

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Conduct a Scene Size-UpConduct a Scene Size-Up

1. 1. Take body substance isolation Take body substance isolation precautions by using personal protective precautions by using personal protective equipment (PPE), if possible.equipment (PPE), if possible.

2. 2. Assess the safety of the scene.Assess the safety of the scene.

33. Determine if the victim is injured or ill.. Determine if the victim is injured or ill.

4. 4. Determine the number of victims.Determine the number of victims.

5. 5. Determine the resources needed.Determine the resources needed.

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Establishing Rapport and Establishing Rapport and ControlControl

Three C’s:Three C’s: CCompetenceompetence CConfidenceonfidence CCompassionompassion

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To establish control of the scene, To establish control of the scene,

do the followingdo the following:: Move smoothly and deliberately.Move smoothly and deliberately. Position yourself at a comfortable level in relation Position yourself at a comfortable level in relation

to the victim. Stay where the victim can see you to the victim. Stay where the victim can see you without twisting his or her neck.without twisting his or her neck.

Keep your eye level above that of the victim.Keep your eye level above that of the victim. Conduct your survey in an unhurried, systematic Conduct your survey in an unhurried, systematic

way.way. Emotions escalate quickly in tense situations, so Emotions escalate quickly in tense situations, so

keep your voice calm and quiet.keep your voice calm and quiet. If there is more than one victim, determine which If there is more than one victim, determine which

victim(s) needs the most immediate care. victim(s) needs the most immediate care.

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Progress CheckProgress Check

1. 1. To establish scene control, use the three Cs—To establish scene control, use the three Cs—competence, confidence, and ____________. competence, confidence, and ____________. (control/charisma/compassion)(control/charisma/compassion)

2. 2. An important part of introducing yourself to the victim An important part of introducing yourself to the victim is obtaining ____________. is obtaining ____________. (the victim’s name/consent (the victim’s name/consent for treatment/a history of what happened)for treatment/a history of what happened)

3. 3. To maintain control, keep your voice __________.To maintain control, keep your voice __________.(calm and deliberate/powerful and authoritative/loud (calm and deliberate/powerful and authoritative/loud

andanddemanding)demanding)4. 4. Position yourself with your eye level ____________Position yourself with your eye level ____________that of the victim. that of the victim. (above/even with/below)(above/even with/below)

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Conducting the Primary SurveyConducting the Primary Survey

1. 1. If the victim is conscious, ask, “What happened?” If the victim is conscious, ask, “What happened?” The response will provide information about the The response will provide information about the airway status, the adequacy of breathing, mental airway status, the adequacy of breathing, mental status, and mechanism of injury or nature of the status, and mechanism of injury or nature of the illness.illness.

2. 2. Ask, “Where do you hurt?” The response will Ask, “Where do you hurt?” The response will identify the most likely points of injury.identify the most likely points of injury.

3. 3. Visually scan the victim for general appearance, Visually scan the victim for general appearance, pale skin, pale skin, cyanosis cyanosis (blueness from lack of (blueness from lack of oxygen), and sweating.oxygen), and sweating.

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BreathingBreathing

Look for chest rise and fall.Look for chest rise and fall. Listen for sounds of air movement at Listen for sounds of air movement at

the mouth and nose.the mouth and nose. Feel on your cheek for air passing in Feel on your cheek for air passing in

and out of the mouth or nose.and out of the mouth or nose.

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CirculationCirculation

To assess for circulation, check the To assess for circulation, check the radial pulse radial pulse (at the wrist on the (at the wrist on the thumb side) thumb side)

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VocabularyVocabulary

Triage- Triage- A system of sorting victims into categories by A system of sorting victims into categories by treatment prioritytreatment priority

Cyanosis- Cyanosis- Bluish discoloration from lack of oxygenBluish discoloration from lack of oxygen ABCDs- ABCDs- Airway, breathing, circulation (hemorrhage) Airway, breathing, circulation (hemorrhage)

and disabilityand disability Radial pulse- Radial pulse- The pulse at the wrist on the thumb The pulse at the wrist on the thumb

sideside Signs- Signs- Things you can observe about the victim, such Things you can observe about the victim, such

as bleedingas bleeding Symptoms- Symptoms- Things the victim describes to you, such Things the victim describes to you, such

as abdominal painas abdominal pain

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DisabilityDisability

There are four general levels of responsiveness:There are four general levels of responsiveness:

AlertAlert—The victim’s eyes are open.—The victim’s eyes are open. Response to verbal stimuliResponse to verbal stimuli—The victim opens his —The victim opens his

or her eyes to verbal commands to do so.or her eyes to verbal commands to do so. Response to painResponse to pain—The victim appears to be —The victim appears to be

asleep and does not respond when spoken to, but asleep and does not respond when spoken to, but winces, grimaces, or jerks away when pinched.winces, grimaces, or jerks away when pinched.

UnresponsiveUnresponsive—The victim appears to be asleep —The victim appears to be asleep and does not respond in any way when pinched.and does not respond in any way when pinched.

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PROGRESS CHECKPROGRESS CHECK1. 1. The major goal of the primary survey is to check for The major goal of the primary survey is to check for

____________. ____________. (breathing/heartbeat/life-threatening (breathing/heartbeat/life-threatening problems)problems)

2. 2. You can determine both the level of consciousness and the You can determine both the level of consciousness and the adequacy of ventilation by ___________. adequacy of ventilation by ___________. (watching for chest (watching for chest movement/checking the pulse/asking if the victim is okay)movement/checking the pulse/asking if the victim is okay)

3. 3. To conduct the primary survey, check the ____________. To conduct the primary survey, check the ____________. (pulse/breathing/ABCDs)(pulse/breathing/ABCDs)

4. 4. Unless you find life-threatening problems, you should be Unless you find life-threatening problems, you should be able to complete the primary survey in ____________. able to complete the primary survey in ____________. (1 (1 minute/2 minutes/5 minutes)minute/2 minutes/5 minutes)

5. 5. The only kind of bleeding you should try to control during The only kind of bleeding you should try to control during the primary survey is ____________. the primary survey is ____________. (major bleeding/bleeding (major bleeding/bleeding from a chest wound/bleeding from the head)from a chest wound/bleeding from the head)

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3.3 Conducting the Neuro 3.3 Conducting the Neuro ExamExam

1. 1. Talk to the victim. Talk to the victim.

2. 2. Note the victim’s speech. Note the victim’s speech.

3. 3. Determine whether he or she can Determine whether he or she can understand by assessing his or her response understand by assessing his or her response to a simple command, such as “Squeeze my to a simple command, such as “Squeeze my hand”.hand”.

4. 4. Determine how easily the victim can be Determine how easily the victim can be aroused. aroused.

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Vital SignsVital Signs

PulsePulse RateRate Strength Strength Rhythm Rhythm

Respiration (Breathing)Respiration (Breathing)

Temperature and Skin ColorTemperature and Skin Color Paleness Paleness Redness Redness Blueness (cyanosis)Blueness (cyanosis)

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PROGRESS CHECKPROGRESS CHECK

1. 1. A neuro exam checks both motor and ____________ function.A neuro exam checks both motor and ____________ function.(visual/sensory/psychological)(visual/sensory/psychological)2. 2. Slurring of speech, garbled speech, or vagueness in Slurring of speech, garbled speech, or vagueness in

answering questions indicates deteriorating ____________.answering questions indicates deteriorating ____________.(mental status/motor control/speech ability)(mental status/motor control/speech ability)3. 3. If a victim can’t speak, give a simple ___________ to assess If a victim can’t speak, give a simple ___________ to assess

mental status. mental status. (stimulus/test/command)(stimulus/test/command)4. 4. Determine how easily victims can be aroused from an Determine how easily victims can be aroused from an

altered mental status by using either verbal or ____________ altered mental status by using either verbal or ____________ stimuli. stimuli.

(touch/painful/sound)(touch/painful/sound)

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When taking a history:When taking a history:

Assess the scene. Assess the scene. Ask questions. Whenever possible, Ask questions. Whenever possible,

ask open-ended questions, because ask open-ended questions, because you don’t want to suggest answers to you don’t want to suggest answers to the victim.the victim.

Get a history by talking to friends orGet a history by talking to friends or

family members. family members.

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SAMPLESAMPLE

S S What are the What are the signs signs and and symptoms symptoms the victim is the victim is complaining of?complaining of?

A A What is the victim What is the victim allergic allergic to?to?M M What What medications medications does the victim take, both does the victim take, both

prescription and over-the-counter?prescription and over-the-counter?P P What is the What is the pertinent past pertinent past medical history of themedical history of the victim?victim?L L When was the When was the last time last time the victim had somethingthe victim had something to eat or drink?to eat or drink?E E What were the What were the events events prior to the incident? prior to the incident?

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During the survey, use the During the survey, use the following approach:following approach:

Look forLook for deformities, wounds, bleeding, deformities, wounds, bleeding, discoloration, penetration, openings in the neck, discoloration, penetration, openings in the neck, and unusual chest movement.and unusual chest movement.

Listen forListen for unusual breathing sounds, gurgling unusual breathing sounds, gurgling sounds, or sounds, or crepitus crepitus (a sandpaperlike noise made (a sandpaperlike noise made by broken bone ends rubbing against each other).by broken bone ends rubbing against each other).

Feel forFeel for unusual masses, swelling, hardness, unusual masses, swelling, hardness, softness, mushiness, muscle spasms, pulsations, softness, mushiness, muscle spasms, pulsations, tenderness, deformities, and temperature.tenderness, deformities, and temperature.

Smell forSmell for unusual odors on the victim’s breath, unusual odors on the victim’s breath, body, or clothing. body, or clothing.

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DOTSDOTS

D D DeformityDeformity O O Open woundsOpen wounds T T TendernessTenderness S S Swelling Swelling

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PROGRESS CHECKPROGRESS CHECK1. The chief complaint is the victim’s assessment of where he or she 1. The chief complaint is the victim’s assessment of where he or she

____________. ____________. (is injured/is compromised/hurts)(is injured/is compromised/hurts)

2. You can rely on your ____________ to assess vital signs; you do not 2. You can rely on your ____________ to assess vital signs; you do not need specialized equipment. need specialized equipment. (intuition/senses/wristwatch)(intuition/senses/wristwatch)

3. Take the pulse of an unconscious victim at the ____________ 3. Take the pulse of an unconscious victim at the ____________ artery. artery. (carotid/brachial/radial)(carotid/brachial/radial)

4. Take the pulse of a conscious victim at the ____________ artery. 4. Take the pulse of a conscious victim at the ____________ artery. (carotid/brachial/radial)(carotid/brachial/radial)

5. Use the back of your hand to check the victim’s relative _________.5. Use the back of your hand to check the victim’s relative _________.

(respiration/pulse/temperature)(respiration/pulse/temperature)

6. When possible, ask the victim ____________ questions. 6. When possible, ask the victim ____________ questions. (yes-no/open-ended)(yes-no/open-ended)

7. The sample history should be taken ____________ the 7. The sample history should be taken ____________ the primary survey. primary survey. (before/after/during)(before/after/during)

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Face, Mouth, Ears, NoseFace, Mouth, Ears, Nose

Check the following:Check the following: Deformities, open wounds, tenderness, Deformities, open wounds, tenderness,

swellingswelling Forehead, eye orbits, and facial structures for Forehead, eye orbits, and facial structures for

abnormalitiesabnormalities Ears and nose for blood or clear fluid and injuryEars and nose for blood or clear fluid and injury Eyes for pupil size and reactivity to lightEyes for pupil size and reactivity to light Eyes for the ability to track a moving object Eyes for the ability to track a moving object

smoothly and evenly in all four quadrantssmoothly and evenly in all four quadrants Mouth for lacerations, unusual breath odor, and Mouth for lacerations, unusual breath odor, and

teeth alignmentteeth alignment

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Skull and NeckSkull and Neck

Check the following:Check the following: Deformities, open wounds, tenderness, Deformities, open wounds, tenderness,

swellingswelling Scalp for depressions and bruisesScalp for depressions and bruises Trachea for position (it should be in the middleTrachea for position (it should be in the middle

of the neck)of the neck) Neck for depressions, bruises, wounds, pain, Neck for depressions, bruises, wounds, pain,

and tenderness and tenderness

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ChestChest

Check for the following:Check for the following: Deformities, open wounds, tenderness, Deformities, open wounds, tenderness,

swellingswelling Soft-tissue injuries, such as cuts, bruises, Soft-tissue injuries, such as cuts, bruises,

indentations, impaled objects, or open chest indentations, impaled objects, or open chest woundswounds

Signs of fracturesSigns of fractures Respiratory distress and symmetry of chest Respiratory distress and symmetry of chest

rise and fallrise and fall Pain, tenderness, or instability over the ribsPain, tenderness, or instability over the ribs

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AbdomenAbdomen

Inspect and palpate for deformities, open wounds, Inspect and palpate for deformities, open wounds, tenderness, rigidity (hard and contracted tenderness, rigidity (hard and contracted abdominal muscles) and swelling.abdominal muscles) and swelling.

Look for protrusions, soft-tissue wounds, lumps, Look for protrusions, soft-tissue wounds, lumps, swelling, or bruising.swelling, or bruising.

Palpate the four quadrants separately with the Palpate the four quadrants separately with the pads of your fingers for hardening or abdominal pads of your fingers for hardening or abdominal masses.masses.

If you suspect injury, feel that quadrant last.If you suspect injury, feel that quadrant last. Ask about pain.Ask about pain.

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Pelvic RegionPelvic Region

Injury in the pelvic region can cause extreme Injury in the pelvic region can cause extreme pain and excessive bleeding, so be gentlepain and excessive bleeding, so be gentle

Inspect and palpate for deformities, open Inspect and palpate for deformities, open wounds, tenderness, and swelling.wounds, tenderness, and swelling.

Check for tenderness, crepitus, and instability.Check for tenderness, crepitus, and instability. Look for loss of bladder control, bleeding, or Look for loss of bladder control, bleeding, or

erection of the penis (a sign of central nervous erection of the penis (a sign of central nervous system injury).system injury).

Check the strength of the femoral pulse.Check the strength of the femoral pulse.

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Lower ExtremitiesLower Extremities

Inspect and palpate for deformities, open Inspect and palpate for deformities, open wounds, tenderness, and swelling.wounds, tenderness, and swelling.

Check for abnormal position of the legs.Check for abnormal position of the legs. Feel for protrusions, depressions, and Feel for protrusions, depressions, and

abnormal movement. Check for tenderness in abnormal movement. Check for tenderness in the calves.the calves.

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Upper ExtremitiesUpper Extremities

Inspect and palpate for deformities, open Inspect and palpate for deformities, open wounds, tenderness, and swelling.wounds, tenderness, and swelling.

Check for equal grip strength in both hands.Check for equal grip strength in both hands. Assess for motor function by asking the Assess for motor function by asking the

victim to squeeze your finger or wiggle his or victim to squeeze your finger or wiggle his or her fingers.her fingers.

Assess for sensation by light touch and by a Assess for sensation by light touch and by a pinch to each hand.pinch to each hand.

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PROGRESS CHECKPROGRESS CHECK

1. 1. During the secondary survey, conduct a full-During the secondary survey, conduct a full-body assessment ____________. (from head-to-body assessment ____________. (from head-to-toe/from toe-to-head)toe/from toe-to-head)

2. 2. Never move the victim unnecessarily until Never move the victim unnecessarily until you are sure ____________. (emergency you are sure ____________. (emergency personnel are on the way/there are no spinal personnel are on the way/there are no spinal injuries/the victim is not in pain)injuries/the victim is not in pain)

3. 3. During the secondary survey, keep the head During the secondary survey, keep the head and neck ____________. and neck ____________. (aligned/immobile/comfortable)(aligned/immobile/comfortable)

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KEY TERMSKEY TERMS

Make sure you understand the following key terms:Make sure you understand the following key terms: triagetriage cyanosiscyanosis radial pulseradial pulse ABCDsABCDs carotid pulsecarotid pulse signssigns symptomssymptoms crepituscrepitus