Victim Assessment
Victim Assessment
is the cornerstone of excellent patient care.
The first goal in assessment is to find out
the patient's condition.
Patient Assessment
2nd, all life-threatening conditions
1.
must rapidly be found and
2.
urgent intervention and
3.
resuscitation must be initiated.
Finally, all conditions needing attention prior to
moving the patient must be done quickly and
efficiently.
Scene assessment
 Look for,
 Identify, or
 Remove any life-threatening hazards if possible
So as to avoid any injury to the rescuers and
any further injury to the injured.
Scene assessment
 Failure to perform preliminary action may put
your life at risk as well as that of your patient.
Aspects of Scene Survey:
Before you approach the victim:
 Assess the scene for hazards. "Is it safe to approach
the victim?"
 Note the mechanism of injury
 Note the number of victims
 Note special equipment needed
 "Do you need additional help?"
Aspects of Scene Survey:
The field of examination consists of:
• Primary Survey
• Secondary Survey
PRIMARY SURVEY
• Is a process carried out to detect life-threatening
problems
• This exam should not take over 2 minutes.
• The emphasis here is on rapid evaluation and
movement to the hospital with critical patients.
The five types of the primary survey are:
•
•
•
•
•
Circulation (Check pulse) and cervical Spine Control
Airway
Breathing
Hemorrhage Control
Disability (Neurological Examination) -see if the patient is alert,
responds to verbal stimulus, responds to painful stimulus and unresponsive
• Expose and Environment (Undress the patient to look for clues to
injury or illness: wounds, skin lesions ….. It's important not to miss blood
loss concealed by clothes or under the patient. Exposure should preserve the
patient dignity where possible, and should protect from the extremes of
temperatures
SECONDARY SURVEY
OBJECTIVE:
To discover medical and injury-related problems
that do not pose an immediate threat to survival
but may if allowed to go untreated.
SECONDARY SURVEY
Assessment:
1. Is a systematic, brief ( 2 to 3 minutes) examination
of the patient from head to toe.
2. The secondary assessment is a head-to-toe
evaluation of the patient.
3. The purpose is to detect and prioritize additional
injuries or to detect underlying medical conditions.
SECONDARY SURVEY
Assessment:
4. All related and significant injuries and identified
in correlation with the physical findings. This is
accomplished on a region-by-region basis
beginning with the extremities concluding with
the neurological examination
EXAMINATION
IN TRAUMA PATIENTS
General Appearance
 Position,
 Level of consciousness,
 Behavior &degree of distress,
 Cooperation,
 Skin condition &Color
EXAMINATION
IN TRAUMA PATIENTS
SCALP
 Check for lacerations and contusions,
 Is there blood in the hair?
 Do not move the patient's head during this
procedure
 Check back of the head for blood
EXAMINATION
IN TRAUMA PATIENTS
SKULL
Palpate for tenderness or depression
Pay attention to the area over the MASTOID
BONE for fracture
EAR/NOSE
Check for discharge of fluids or blood
Clear fluid (CSF) from the nose or
ears indicative of skull fracture
EXAMINATION
IN TRAUMA PATIENTS
EYES
• Check for trauma or swelling about the orbit
• Ecchymoses around the eyes (coon's eyes)
without evidence of direct injury are a clue to
skull fracture
SCLERAE
• Check for icterus (yellowish discoloration)
EXAMINATION
IN TRAUMA PATIENTS
PUPLIS
• Note size and shape
• Equal or unequal
• Reaction to light?
• Observe motion of the eyes
EXAMINATION
IN TRAUMA PATIENTS
NECK
• In the trauma patient, gently palpate the
back of the neck for tenderness.
• If spinal injury is strongly suspected,
immobilization of the neck (spine) should
precede all other maneuvers of the secondary
survey.
EXAMINATION
IN TRAUMA PATIENTS
TRACHEA
• Inspect and palpate to determine whether it is in the midline
• The trachea will deviate an obstructed bronchus from a
simple pneumothorax
• The trachea will deviate away from a tension pneumothorax
or significant hemothorax
EXAMINATION
IN TRAUMA PATIENTS
CHEST
• Check and inspect for minor deformities
• Observe movement
• Check for Contusions and Abrasions
• Palpate chest cage
• Feel each rib and the clavicles individually
• Evaluation of internal structures is best done with the
use of a stethoscope.
EXAMINATION
IN TRAUMA PATIENTS
ABDOMEN
• Look for signs of blunt or penetrating trauma
• Feel for tenderness
• If the abdomen is painful to gentle
pressure…internal bleeding
EXAMINATION
IN TRAUMA PATIENTS
EXTREMITIES
• Examination of the extremities should begin with
clavicle (collar bone) or pelvis and proceed to the most
distal portion of that extremity
• Each bone should be individually evaluated visually
for deformation and surrounding hematoma or
ecchymosis
• X-ray examination …….for fracture
EXAMINATION
IN TRAUMA PATIENTS
NEUROLOGICAL EXAM:
• Pupil response: Are they equal or unequal?
• Eye opening: What stimuli are required to make the
patient open his eyes?
• Vocal? (voice response)
• Tactile? (touch response)
• Pain?
EXAMINATION
IN TRAUMA PATIENTS
Verbal response:
Does the patient talk?
Speech is the highest brain function
Incomprehensible speech or an inability
to speak are indications of brain dysfunction
EXAMINATION
IN TRAUMA PATIENTS
Verbal response:
Motor response: Extremity responses to stimulation
can indicate a number of things about the brain
function. These responses are either purposeful or
not.
Purposeful responses include obeying commands