1 Scene Assessment BSI/SAFETY/Number of Patient, Additional Help and MOI, Location
PENMAN – PPE, Environmental Hazards, Number of pts, MOI/NOI, Available resources, Need back up?
2
Primary Assessment
(LOOK AND MANAGE LIFE THREATENING CONDITION)
Steps Action
General Impression Age, Sex, position, Life threating bleeding, etc.
Identify you self HI, I am Mr. ______from _________, Please do not move, how can I help you?
Look for Massive Bleeding. This is crucial for identifying and managing exsanguination.
X. Exsanguination D. Detection
D. Direct pressure dressing – for 10 minutes if using plain gauze/ for 3 minutes if using gauze with hemostatic
agent or as per the manufacturer instruction.
D. Device – CA Tourniquet / Junctional Tourniquet
D. Do not dilute - Restrictive fluid resuscitation (Maximum 2 liters)
A. Air way Assess for patency (openness) and signs of obstruction (difficulty breathing, noisy breathing, abnormal chest
movements).
Airway with C-Collar
AMS: Open the air way by Jaw thrust, chin lift, or insertion of an airway adjunct (oral or nasal).
Snoring: Open the air way by Jaw thrust
Gurgling: Suction in less than 10 seconds
Stridor, Hoarseness: patient need intubation< Assist ventilation< Intubate en-route to hospital
Most common cause of airway obstruction – Tongue, blood, dentures & foreign body object.
B: Breathing Look for adequate chest rise, listen for breath sounds, and assess respiratory rate and effort.
Management may involve supplemental oxygen or interventions like chest decompression for pneumothorax.
LOOK, LISTEN & FEEL
Look: chest rise (slow, fast), contusion, abrasions, sucking chest wound, paradoxical movement, and
asymmetrical movement.
Listen: Auscultate: if decreased or diminished breathe sounds:
Feel: Palpate: for Tenderness, Crepitus, Instability
Percussion: if suspected Tension pneumothorax
Dull: Blood/fluid
Hyperresonance: Tension pneumothorax: (AMS, Shock, RD): Needle decompression. Preferred site
(Anterior mid axillary line at 5 th intercostal space above the 6 th rib. Alternative mid clavicular line, 2 nd
intercoastal space. Above 3 rd rib).
Pulse oximeter: Oxygen saturation above 94%
Open Chest wound: Occlusive dressing “3 sides”
Flail Chest: Assists ventilation if needed & Pain management
Shallow, fast and labored breathing: assisted by BVM.
RR – more than 30: Assist ventilation
RR – less than 8:1 breathe every 6 sec.
Other wise use NRM:10-15 L/M
C: Circulation Check for pulse presence, quality, and rate. Assess for signs of shock (pale skin, cold sweat).
Management may involve controlling mild to moderate bleeding with direct pressure, dressings. (IV fluids in the
ambulance).
Pulse CTC
Pulse: (Bilateral) Rate, Quality and Rhythm
Skin: Color (Pale, cyanotic) pinkish
Condition (moist, diaphoretic or dry)
Temperature (warm or cold & clammy).
Signs of Shock: Load and Go, IV end-route to hospital.
No signs of shock – IV KVO
D: Disability Assess level of consciousness using AVPU (Alert, Verbal, Pain, Unresponsive) scale. Check pupillary size and
(Neurologic assessment) equality.
LOC: AVPU or GCS
A – Alert
V – Response to VOICE
P – Response to PAIN
U – Unresponsive
Pupil: PERRLA
Signs of Traumatic Brain Injury (TBI)
Decrease LOC, unequal Pupil (anisocoria), Decerebrate, Decorticate, Cushing Phenomena(Triads – High BP,
Low HR and irregular Respiration). Managed Mild Hyperventilation with BVM – 20 bpm. Treat Hypoxia, Treat
hypotension maintains 110 SBP.
Signs of Spinal injury:
o Pain in the neck or back
o Pain on movement of the neck or back
o Pain on palpation of the posterior neck or midline of the back
o Deformity of the spinal column
o Guarding or splinting of the muscles of the neck or back
o Paralysis, paresis, numbness, or tingling in the legs or arms at any time after the incident
o Signs and symptoms of neurogenic shock
o Priapism
Management: Spine Motion Restriction (SMR) treat shock, use scoop stretcher.
E: Expose and Remove clothing to fully examine the patient for hidden life-threatening injuries and maintain body temperature
Environment to prevent hypothermia.
Quick Inspection to the whole body and any clues form environment then cover the patient
Decision Stable – Stay & Play – (XABCDE non compromise) You may proceed to secondary assessment if no other threat.
Critical – Load & Go (XABCDE compromise) (Maximum time on the scene 10-15 mins).
Patient Priority (Load and Go) and Destination, C. collar and Log Roll, Check Back and strap pt. on LBB Then load
pt. inside the Ambulance.
3
Secondary Assessment
VITAL SIGNS
1. TEMPERATURE
2. PULSE
3. RR
4. BP: Insert IV line, KVO
a. uncontrolled bleeding: keep BP from 80 to 90 or maintain peripheral Pulse. 110 for TBI.
b. Controlled Bleeding gives bolus (look for signs of shock)
5. RBS
6. GCS
7. CARDIAC MONITORING / ECG
8. Spo2
SAMPLER History Sign and Symptoms
Allergy
Medications
Past Medical History
Last oral intake
Event
Risk Factors
Head to Toe Exam Mnemonics – DCAPBTLS
Deformities
Contusions
Abrasions
Punctures/Penetration
Burns/Bleeding
Tenderness
Lacerations
Swelling
Head: pupils (PERRLA), EARS and Nose and Mouth (Raccoon eyes, Battle sign, anisocoria)
Neck: JVD, Trachea, Palpate Neck for TIC
Chest: Percuss IF Absent or decrease BS, Paradoxical movement, palpate for deformity
Abdomen: (IAPPal), Palpate gently for tenderness, guarding, distention, indicating potential internal injuries.
Pelvis: Assess for stability and pain with gentle palpation. (Gentle Down & IN) Unstable – Pelvic binder or any
sheets to support pelvic. If unstable pelvis Do not repeat the assessment
Genitals: Priapism for male, Looks for any bleeding and tenderness
Lower and Upper extremities: DCAPBTLS +PMS, Check for fractures, dislocations, or signs of compartment
syndrome. Splint any Fracture.
Back: DCAPBTLS -Can be checked while log rolling to move to spinal board.
PAIN MANAGEMENT Pain management is important for patient comfort and may also help identify injuries. (AS PER COMPANY
PROTOCOL)
Other Management Intubation if needed, IV and fluid if needed, Medications if needed, etc.,
COMMUNICATION Hand over report to Receiving Hospital
SBAR:
Situation
Background
Assessment
Recommendation
ASH-ICE:
Age
Sex
History of presenting illness- Brief history
Injury or illness- MOI or NOI
Condition - Stable or Critical
ETA – Estimated Time of Arrival
4 Reassess Patient Vital Signs and all Interventions
Critical Patient every 5 minutes
Non-Critical every 15 minutes
Focus on the problem – continuous Close monitoring during the way to hospital
