NSC Chapter 4

CHAPTER 4 Assessing the Victim (Video – Assessing the victim and recovery position)

Lesson Objectives 1. Explain how to check the victim’s responsiveness and normal breathing. 2. Demonstrate how to move a victim into the recovery position and explain when this is done.

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Lesson Objectives continued 3. Explain the importance of each element in the SAMPLE history. 4. Demonstrate how to perform a physical examination of a responsive victim without a life- threatening problem.

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Assess the Victim

• Check scene for safety • Initial assessment for life-threatening conditions • Unresponsiveness • Lack of normal breathing • Severe bleeding • Secondary assessment • Monitor the victim for any changes 4-4

Initial Assessment • Check for life-threatening conditions: • Unresponsiveness • Lack of normal breathing • Severe bleeding

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Initial Assessment continued • Takes just a few seconds • Do not move victim unless: • Imminent danger to victim • Cannot give life-saving care because of victim’s location or position

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Check for Responsiveness • A victim who is speaking, coughing or moving is responsive. • A victim who may be paralyzed may have purposeful eye movements or other signs

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Check for Responsiveness continued

• Tap person on shoulder and shout “Are you OK?”: • A person who is speaking, coughing or moving is responsive. • A person who may be paralyzed may have purposeful eye movements or other signs. • Check the person first in the position found. • Use the AVPU scale.

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Unresponsiveness • A sign of a life-threatening problem • Call 9-1-1 immediately • At same time look for normal breathing

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Check for Normal Breathing • A victim who can speak or cough is breathing. • Gasping is not normal breathing. • Check victim first in position found.

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Breathing Normally? • If victim is breathing normally, continue assessment. • If unresponsive victim is not breathing normally, start CPR. • A person whose heart has stopped beating will also have stopped breathing

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Check for Severe Bleeding • Severe bleeding is life-threatening. • Control with direct pressure.

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Provide Care

Care for life-threatening conditions found: • Immediately care for any threats to life found during the initial assessment. • Move on to secondary assessment only if no life-threatening conditions.

• Position breathing unresponsive person in recovery position.

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Skill: Initial Assessment 1. Ensure scene safety. 2. Check the victim for responsiveness.

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Skill: Initial Assessment continued For a responsive victim: 3. Ask the victim what happened and about his or her condition. 4. Have someone call 9-1-1. If alone, correct any life- threatening conditions you see first (such as severe bleeding) before calling 9-1-1 and continuing to check the victim and providing other care.

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Skill: Initial Assessment continued

For an unresponsive victim: 3. Call for help: a. Shout for someone to call 9-1-1 and get an AED. Keep the phone at the victim’s side. b. If alone, call 9-1-1 from your mobile device if you have one, and follow the dispatcher’s instructions. 4. If alone without a mobile device, find a phone and call 9-1-1, and get an AED if available.*

*Correct any immediate life threats (such as opening the airway or controlling severe bleeding) before leaving an adult victim to call 9-1-1.

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Recovery Position • Helps keep airway open • Allows fluid to drain from mouth • Prevents aspiration • If possible, put victim onto left side • Continue to monitor breathing

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Skill: Recovery Position 1. Position the victim’s arm farthest from you across the victim’s body.

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Skill: Recovery Position continued 2. Grasp the victim at the shoulder and hips, and roll them toward you.

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Skill: Recovery Position continued 3. Bend both legs so the victim’s position is stabilized.

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Skill: Recovery Position continued 4. With victim now in position, check the airway and open the mouth to allow drainage.

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Secondary Assessment

• Performed only for victims without life-threatening conditions • Do not interrupt care for serious problem • Can provide additional information • Usually performed on responsive victims • Includes history and physical examination • Focused primarily on injured area

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Get the Victim’s History • Talk to a responsive victim. • Ask bystanders or family members what happened. • Consider the mechanism of injury.

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SAMPLE History S Signs and symptoms A Allergies M Medications P Previous problems L Last food or drink E Events 4-27

Unresponsive Victim • Ask family or bystanders what happened. • Check the scene for clues. • Consider effects of environmental extremes. • Consider victim’s age.

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Physical Examination • Do the physical examination only if you are not giving first aid for a serious condition!

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Physical Examination continued

• Examine a responsive victim from head to toe for: • Bleeding or other open wounds • Pain, tenderness when victim is touched • Swelling or deformity • Skin color, temperature, condition • Abnormal sensation or movement 4-30

Physical Examination continued • Ask a responsive victim for the consent to do a physical examination (head-to-toe check) and describe what you are going to do before touching him/her

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Position of Victim

• Keep unresponsive victim without possible spinal injury in recovery position. • Monitor victim’s breathing, and observe for bleeding and other signs of serious injury. • Allow responsive victim to remain in position of comfort. • No need to move victim onto his or her back.

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Clothing Removal • Remove some clothing if needed to examine injured area. • Protect victim’s privacy. • Prevent exposure. • Prevent movement of injured area.

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DOTS: What to Look For D Deformities O Open injuries T Tenderness (pain) S Swelling

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Skill: Physical Examination

Check head and neck: • Skull • Eyes • Ears • Nose • Breathing • Mouth • Neck 4-35

Skill: Physical Examination continued Check chest: • Deformity? • Wounds? • Tenderness? • Bleeding? • Even breathing?

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Skill: Physical Examination continued Check abdomen: • Pain/tenderness? • Swelling? • Bleeding/bruising? • Rigidity?

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Skill: Physical Examination continued Check hips and pelvis: • Pain? • Deformity?

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Skill: Physical Examination continued Check upper extremities: • Bleeding? Deformity? Pain? • Medical alert ID? • Normal movement, sensation, temperature?

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Skill: Physical Examination continued Check lower extremities: • Bleeding? Deformity? Pain? • Normal movement, sensation, temperature?

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Examining a Child or Infant

• Use simple questions. • Involve parents or guardians. • Perform physical examination toe to head. • Talk calmly and soothingly.

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Monitor the Victim • Give first aid for any injury or illness. • For unresponsive victim or victim with serious injury: • Make sure condition doesn’t get worse. • Repeat breathing assessment at least every five minutes.

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Chapter – Opening Scenario

Late in the afternoon, you stop by your supervisor’s office to drop off a report. When you knock on the door, it swings open. You look inside and see him slumped over his desk. You call his name as you approach, but he doesn’t respond, so you tap him on the shoulder and shout, “Are you OK?” He still does not respond.

What do you do now?

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Scenario 1

You are driving a coworker home after work when, without warning, he suddenly slumps forward in the seat beside you. As you brake and pull over onto the shoulder, you try to rouse him, but he seems unresponsive.

As soon as you have safely stopped your car, how should you first check this victim?

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Scenario 2

On the job, you encounter a coworker who is lying on the ground on his back, unresponsive, because of an unknown injury or illness. You see that he is breathing normally.

After calling 9-1-1 for help, how should you position this victim? Why?

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Scenario 3

You arrive at work and find a man lying on the ground in the parking lot, surrounded by several other workers and the man’s wife, who had just dropped him off at work. He is unresponsive but breathing evenly and has no obvious signs of injury or illness. Someone has already called 9-1-1. While you are waiting, you ask his wife about what happened. She says he just seemed to suddenly collapse.

What are other questions you could ask to gather more information about the man’s history to give the professional rescuers when they arrive?

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