Chapter 3
First Aid for Colleges
and Universities
10 Edition
Victim
Assessment
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Learning Objectives
• Understand how to properly assess a victim.
• Describe how to establish rapport with a victim.
• Explain how to survey and control the scene.
• Describe and conduct a primary survey.
• Know how to conduct a neurologic (neuro)
exam.
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Learning Objectives
• Explain how to determine the chief complaint.
• Understand the significance of vital signs.
• Explain how to take a history.
• Understand the sequence and practical
application of a secondary survey.
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Introduction
• Victim assessment is one of the most critical
aspects of providing first aid.
• Assessment is conducted to identify and care for
immediate life threats to the airway, breathing,
and circulation.
• Some injuries are obvious; some are hidden.
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Introduction
• The main goals of victim assessment are to
– Protect yourself from injury.
– Identify and correct life-threatening problems.
– Render proper first aid care.
– Prepare the victim for transport.
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The Victim Assessment Routine
• Size-up the scene.
• Establish rapport and control.
• Conduct a primary survey.
• Conduct a brief neurologic (neuro) exam.
• Determine the chief complaint.
• Assess vital signs.
• Look for medical information devices.
• Take a SAMPLE history.
• Conduct a secondary survey.
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Conducting a Scene Size-Up
• First: ensure your personal safety
• Next: ensure the safety of the victim and
bystanders
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Conducting a Scene Size-Up:
Five Components
• Take body substance isolation precautions by
using personal protective equipment (PPE).
• Assess the safety of the scene.
• Determine whether the victim is injured or ill.
• Determine the number of victims.
• Determine the resources needed.
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Establish Rapport and Control
• To establish critical rapport with a potentially
scared, anxious, angry or in-shock victim, use
the Three C’s
– Competence
– Confidence
– Compassion
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Establish Rapport and Control
• Observe clues at the scene.
• Ask the victim’s name, and use it .
• Identify yourself.
• Provide your credentials.
• Tell the victim what you want to do.
• Obtain the victim’s consent, if possible.
• Maintain eye contact.
• Speak calmly and deliberately.
• Give orders quietly.
• Speak slowly and distinctly.
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Conducting the Primary Survey
• Major goal of the primary survey is to check for
life-threatening problems to the airway,
breathing, and circulation.
• Every second the body is without breath it’s
closer to death.
• Compression and defibrillation are the most
valuable tools to use when a victim appears
lifeless. See Chapter 5 for details on these
procedures.
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Conducting the Primary Survey
• The CAB approach to resuscitation: Circulation,
Airway, Breathing
• Alternative is ABC: Airway, Circulation,
Breathing
• Look for any signs of life/breathing;
movement, speech, other indications of life
• Breathing should be purposeful and adequate
• Agonal respirations = dying breaths; occasional,
gasping, ineffective breaths
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Conducting the Primary Survey
• If victim is conscious, ask what happened. This
will reveal airway status, adequacy of breathing,
mental status, mechanism of illness.
• Ask the victim where it hurts. This will reveal
likely points of injury.
• Visually scan the victim for general appearance,
pale skin, blueness (cyanosis), and sweating.
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Conducting the Primary Survey
• ABCDs =
– Airway
– Breathing
– Circulation
– Disability
• These constitute the rest of the primary survey
after you’ve completed the previous steps and
determined whether the victim has a serious
medical or trauma condition.
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ABCDs
• Airway (and spine stabilization): Determine
whether the airway is open
• Suspect spinal injury if the victim
– Has a head or neck injury
– Is involved in any type of crash
– Falls from a height greater than their own height
– Complains of pain to the neck or back
– Complains of tingling, numbness, or unusual
sensation in the extremities
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ABCDs
• Breathing: a person who is responsive and
talking with ease is breathing adequately
• Two measures determine breathing adequacy
– Rate: must not be too slow or too fast
– Depth: Victim must breath deeply enough to move air
to all parts of the lungs.
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Assessing Respiration
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Signs of Respiratory Distress
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ABCDs
• Circulation
– Check the radial pulse; pulses that are weak, too fast,
or too slow, are of concern.
– Check the carotid pulse if the victim is unresponsive
or you can’t find the radial pulse.
– If you find major bleeding control it via direct
pressure. Spurting blood or flowing hemorrhage is the
only type of bleeding that should be treated during
this stage.
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ABCDs
• Disability: There are four general levels of
consciousness that can determine a victim’s
mental disorientation or disability
– Alertness (victim’s eyes are open)
– Responsiveness to verbal stimuli
– Responsiveness to pain
– Unresponsiveness
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Conducting the Neuro Exam
• A neuro (neurologic) exam checks
– Mental status
– Motor function (e.g., voluntary movement)
– Sensory function
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Conducting the Neuro Exam
• Talk to the victim. Can he answer the question
“What time is it?” If the victim is a child, observe
their voluntary movements and interest in
surroundings.
• Monitor the victim’s speech for vagueness,
slurring, or garbled words.
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Conducting the Neuro Exam
• If the victim can’t speak, determine whether he
can understand simple commands.
• If the victim has an altered mental status,
determine how easily he can be aroused
with a small pain stimulus (such as a pinch
on the wrist).
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Chief Complaint and Vital Signs
• The answer to the question “Tell me where you
hurt” is the chief complaint.
• Vital signs (pulse, respiration, relative skin
temperature) should be taken repeatedly at five-
minute intervals.
• Inspect the victim for medical devices such as
Medic Alert tags or bracelets. These are often
worn by people with hidden medical conditions.
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Taking a History
• Assess the scene; note the placement of the
victim or objects for clues.
• Ask questions, preferably open-ended ones
unless the situation is urgent.
• If the victim is unresponsive, confused, or a
child, talk to family, friends, or others
accompanying the victim.
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Taking a SAMPLE History
• S = Signs and symptoms the victim complains of
• A = What is the victim allergic to?
• M = What medications does the victim take?
• P = What is the victim’s pertinent past
medical history?
• L = When was the last time the victim had
something to eat or drink?
• E = What were the events prior to the incident?
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Conducting the Secondary Survey
• The secondary survey is a closer look at the
victim once life-threatening conditions are
controlled and vital signs are recorded.
• Conduct a full-body inspection of the victim. Use
your senses to collect additional information.
• Explain your actions. Speak calmly. Keep the
victim’s head and neck aligned.
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Conducting the Secondary Survey
• Look for deformities, wounds, bleeding,
discoloration, penetrations, neck openings,
unusual chest movement.
• Listen for unusual breathings, sounds, or
sensations.
• Feel for unusual masses, swelling, hardness,
stiffness, muscle spasms, pulsations,
tenderness, temperature.
• Smell for unusual odors on the victim’s breath,
body, or clothes.
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Primary and Secondary Surveys
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Sequence of the Secondary Survey
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Conducting the Secondary Survey
• Inspect the following
– Face
– Mouth
– Ears
– Nose
– Skull and neck
– Chest
– Abdomen
– Pelvic region
– Back
– Lower and upper extremities
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Summary
• To begin victim assessment, establish rapport
and obtain the victim’s consent, if possible.
• During the primary survey, check for life-
threatening injuries involving the airway,
breathing, and circulation.
• During the primary survey, only control bleeding
that is spurting or is a steady flow hemorrhage.
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Summary
• In the brief neuro exam check for mental status,
motor function, and sensory function.
• The chief complaint (the answer to the question
“where does it hurt?”) points to the most likely
area of injury.
• Use your senses (look, listen, feel, smell) to
assess vital signs, including pulse, respiration,
temperature, and skin color.
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Summary
• When taking a history, use open-ended
questions unless the circumstances are urgent.
Remember to use the SAMPLE approach.
• The secondary survey is a full-body assessment
to check for less obvious injuries and medical
problems.
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