INITIAL ASSESMENT

Finding Out What’s Wrong

Dr. Kristina Agustini
Emergency Medicine Specialist
May 2018
Objectives

• Ensure responder’s safety

• Ensure victim’s safety
• Indentify emergency situation
• Early intervention
• Early transfer
Scene Survey

• Detecting potential harmful situation for both

rescuer and victim
• Identify mode of injury
• Number of victims
• Adequacy of responders  CALL 4 HELP
Personal Protection

Rescuer must put on PPEs

• Gloves
• Mask
• Protective gown
• Gogles

Careful approach during contact with victim’s body

fluid or other contaminated items
Approaching Patient

• Frontal approach, when possible

• Introduce your self & team
• Explain your purpose
• Ask for victim’s cooperation
• Calm and confident manner
Initial Check

• Responsiveness
• Airway & C Spine Protection
• Breathing
• Circulation & Bleeding
• Physical Examination
• Early Intervention
• Early Transfer
Check Responsiveness

• Call loud enough

• Gently tap or shake shoulder
Check Responsiveness (2)

• AVPU method
A = alert
V = verbal
P = pain
U = unresponsive
Open Airway & C-spine Protection
• If victim is alert & able to answer  airway is
open
• If responsive victim can’t talk or cough forcefully
 airway is probably blocked and must be
cleared
Check Breathing
Check Circulation

• Find the carotid artery, palpate for 5-10”

• Start CPR when no pulse detected or uncertain
Check for Severe Bleeding

• Quickly scan for blood up and down the body,

blood-soaked clothing or for blood collecting on the
ground or the floor
• Control active bleeding with pressure
Physical Examination

• Signs
• Condition of the victim that you can see, feel, hear or
smell
• Symptoms
• Thing the victim feels and is able to describe, such as
chest pain
Physical Examination(2)

• Do systematically from head to toe, also the back

• Log roll properly, or log up if pelvic is unstable
• Look for DOTS
• D = deformities
• O = open wound
• T = tenderness: sensitivity, discomfort or pain when
touched
• S = swelling
Skin Color

Skin Color Possible Cause

Pink Normal color inside lower eyelids, inside
lips and fingernail beds
Red (flushed) Dilated blood vessels from emotional
excitement, exposed to heat, high blood
pressure, CO poisoning
White (pale) Constricted blood vessels from blood
loss, shock, emotional distress
Blue (cyanotic) Lack of oxygen in the blood and tissues
from breathing or heart problems
Yellow (jaundice) Liver disease or failure
Skin Temperature & Moisture

Skin Temperature/Moisture Possible Cause

Warm and dry Normal
Hot and moist or dry Excessive body hear (exposed to
heat, high fever, heat stroke)
Cool and moist Poor circulation, shock and blood
loss
Cool and moist or dry Exposed to cold and losing heat
(hypothermia, frostbite)
SAMPLE History
Description Questions
S = Signs What’s wrong?
A = Allergies Are you allergic to anything?
M = Medications Are you taking any medications? What
are they for?
P = Past medical history Have you had this problem before? Do
you have other medical problems?
L = Last oral intake When did you last eat or drink
anything?
E = Events leading up to the Injury: How did you get hurt?
illness or injury Illness: What were you doing before
the illness started?
Examination & Intervention

• DO NOT PULL OUT impaled object. Stabilize and

shorten as much as possible
• Ensure pelvic stability
• When victim’s thighs or leg ‘LOOK WEIRD’ 
immobilize
Early Intervention

• Applying cervical collar

• Give O2 100%
• Rescue breathing
• CPR
• Splinting long bones
What to Do Until HCP Arrives

• Record information found

• Provide the information to arriving health care
personnel
• Recheck the victim’s condition every few minutes
• Record any changes
Early Transfer

• Not fully alert

• Abnormal or no spontaneous breathing
• History of pulselessness
• Cold and clammy extremities
• Deformities of thigh or leg
THANK YOU