Lesson Outlines
Chapter 4
LESSON 4: Finding Out What’s Wrong
Lesson Objectives
After completing this lesson, participants should be able to:
 Describe and demonstrate how to assess a victim, including conducting an initial
check, physical exam, and SAMPLE history.
 Identify problems that are an immediate threat to life.
Points
Checking the Victim
 Victim assessment is a sequence of actions that helps determine what is wrong
and thus ensures safe and appropriate first aid.
 The goals of this identification are to:
o Detect life-threatening conditions rapidly and care for them as quickly as
possible.
o Determine other problems needing care.
o Determine if the victim needs medical care, and it so, whether the victim
should be transported by ambulance or private vehicle.
Scene Size-Up
 The scene size-up determines the safety of the scene, the cause of injury or
nature of illness, and the number of victims.
 If the scene appears hazardous, do not enter the area.
Initial Check
 The initial check determines whether there are life-threatening problems requiring
quick care.
 Involves checking the victim’s responsiveness, opening the airway, checking for
breathing, and checking for severe bleeding.
 Takes less than a minute to complete, unless first aid is needed at any point.
 During the initial check:
o Determine if the victim is responsive. Tap and shout.
o Ensure that the victim’s airway is open. Perform the head tilt-chin lift
maneuver.
o Determine if the victim is breathing. Look, listen, and feel.
o Check for any obvious, severe bleeding.
General Impression of the Victim
 Also known as the first impression, the look test, or a gut reaction.
 Helps determine whether the victim is injured or ill.
 If you are unable to determine whether the victim is ill or injured, treat as
though he or she were injured.
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Lesson Outlines
Chapter 4
Check Responsiveness
 Victims can be responsive or unresponsive.
 Not all responsive victims are fully alert and may respond to different levels of
stimulation.
 The AVPU scale describes how responsive a victim is.
o A – Alert
o V – Responsive to verbal stimulus
o P – Responsive only to painful stimulus
o U – Unresponsive to any stimulus
Open Airway
 The airway must be open for breathing.
 Use the head tilt-chin lift method to open the airway.
Check for Breathing
 Check for breathing sounds that might indicate a problem in a responsive victim.
 Check for breathing in an unresponsive victim while opening the airway.
o Look, listen, and feel.
Check for Severe Bleeding
 Check for severe bleeding by quickly looking over the victim’s entire body for
blood.
 In most cases, direct pressure with the hand and sterile dressing over the
bleeding or a pressure bandage controls the bleeding.
 Avoid contact with the victim’s blood.
Skin Condition
 A quick check of the victim’s skin can also provide information about the
victim’s condition.
 Check skin temperature, color, and condition.
o Skin color, especially in light-skinned people, reflects the circulation
under the skin.
Expose the Injury
 Clothing may have to be removed to check for injury and to provide first aid.
 Explain what you intend to do and why first.
Physical Exam
 The goal of doing a hands-on physical exam is to identify immediately any
potentially life-threatening illness or injury.
 Most victims will not require a complete head-to-toe type of physical exam.
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Lesson Outlines
Chapter 4
Signs and Symptoms
 A physical exam checks the victim’s entire body from head to toe; you will note
the victim’s signs and symptoms.
o Signs are the victim’s conditions that you can see, feel, hear, or smell.
o Symptoms are the things the victim feels and is able to describe; known as
the chief complaint.
DOTS

DOTS is helpful for remembering the signs of injury:
 Deformity
o Abnormal shape of the body part.
 Open wounds
o The skin is broken and there is bleeding.
 Tenderness
o Sensitivity, discomfort, or pain when touched.
 Swelling
o Area looks larger than usual.
Conducting a Physical Exam
 Head: check for DOTS.
 Neck: check for DOTS.
 Chest: check for DOTS.
 Abdomen: check for DOTS.
 Pelvis: check for DOTS.
 Extremities: check both arms and legs for DOTS.
 Back: if no spinal injury is suspected, turn the victim on his or her side and check
for DOTS.
SAMPLE History
 The information is a SAMPLE history could help you to identify what is wrong
with the victim and can indicate the needed first aid.
 S = Symptoms
 A = Allergies
 M = Medications
 P = Past medical history
 L = Last oral intake
 E = Events leading up to the illness or injury
Medical Identification Tags
 Look for a medical identification tag or a medical information card.
 These are beneficial in identifying allergies, medications, or medical history.
Putting It All Together
 Victim assessment can provide important information about a problem and help
you determine how you treat it and whether medical care is needed.
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Lesson Outlines

Triage
Chapter 4
Provide the following information to EMS or health care providers:
o Victim’s chief complaint
o Responsiveness
o Initial check
o Physical exam findings
o SAMPLE history
o Any first aid that had been provided

Triage is the process of prioritizing multiple victims.
 Immediate care
 Urgent care
 Delayed care
 Dead
Advantages of the Left-Side Position
 Also called the recovery position
 Has several advantages:
o Keeps the airway open in an unresponsive, breathing victim without a
spinal injury
o Delays vomiting by placing the esophagus above the stomach
o Delays a poison’s effects by retaining the poison in the stomach
o Relieves pressure on a pregnant woman’s vena cava
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