The circulation assessment consists of evaluating the pulse and skin and controlling hemorrhage

Capillary refillMay provide information regarding the

patient’s cardiovascular status.Refill time greater than 2 seconds is caused

by shunting and capillary closure to peripheral capillary beds and suggests inadequate circulation and impaired cardiovascular function.

Treat for and anticipate shockElevate lower extremitiesKeep patient warmFollow local protocols regarding use of PASGFluid replacement

Once the initial assessment is completed, determine the patient’s priority.

If serious injury or illness is indicated by the initial assessment, conduct rapid head-to-toe assessment for other potential life-threats and initiate transport.

Poor generalimpression

Unresponsive Conscious but

cannot followcommands

Difficultybreathing

Hypoperfusion

Complicatedchildbirth

Chest pain and BP below 100 systolic

Uncontrolledbleeding

Severe pain Multiple injuries

© Glen Jackson

Trauma patient with significant mechanism of injury

Trauma patient with isolated injury Responsive medical patient Unresponsive medical patient

Sustained significant injury Exhibits altered mental status from the

incident

© Robert J. Bennett

Ejection fromvehicle

Death in samepassengercompartment

Fall from higherthan 20 feet

Rollover of vehicle

High-speed motorvehicle collision

Vehicle-passengercollision

Motorcycle crash Penetration of the

head, chest, orabdomen

Fall from higher than ten feet Bicycle collision Medium-speed vehicle collision

with resulting severe vehicle deformity

Courtesy of Edward T. Dickinson, MD

Not a detailed physical exam Fast, systematic assessment for

other life-threatening injuries Findings may influence transport

decision

Deformity Contusion Abrasion Penetration

Burns Tenderness Lacerations Swelling

Inspect the anterior neck

Tracheal deviation Jugular venous

distension Subcutaneous

emphysema

InspectAccessory muscle useFlail chest

PalpateStability

AuscultateEqual and adequate air movement

InspectExaggerated abdominal motionBruising or discoloration

Cullen’s sign Grey-Turner’s sign

PalpateRigidityTenderness

Assess all four extremities Stability Circulation Sensation Motor function

No significant mechanism of injury Shows no signs of systemic

involvement Does not require an extensive history Does not require a comprehensive

physical exam

History takes priority when assessing the medical patient.

Initiate treatments as you are assessing.

Chief complaint History of the present illness Past history Current health status

The pain, discomfort, ordysfunction causing patient tocall for help

“What seems to be the problem?”

Onset Provocation

or Palliation

Quality Region/Radiation Severity Time

Associated Symptoms

Pertinent Negatives

Symptoms Allergies Medications Past medical history Last oral intake Events preceding the incident

General state of health Childhood and adult diseases Psychiatric illnesses Accidents and injuries Surgeries and hospitalizations

Currentmedications

Allergies Tobacco use Alcohol and

substance abuse Diet Screening exams Immunizations

Sleep patterns Exercise and

leisure activities Environmental

hazards Use of safety

measures Family history Social history

Use exam techniques relative to your patients situation or complaint.

Common presentations:Cardiac chest pain/respiratory distressAltered mental statusAcute abdomen

Blood pressure Pulse Respiration Temperature Pupils Orthostatic vitals

(if possibly hypovolemic)

Pulse oximetry Capnography Cardiac monitoring Blood glucose determination

Initial assessment Rapid medical assessment

Similar to the rapid trauma assessment except you will look for signs of illness rather than injury

Brief history

Mental status and speech Cranial nerves Motor system Reflexes Sensory system

Biceps Triceps Brachioradialis Quadriceps Achilles Abdominal plantar

Pain Light touch Temperature Position Vibration Discriminative

Pulse rate and quality Blood pressure Respiration rate and quality Skin condition Temperature

Detects trends Determines changes Assesses intervention’s effects

Mental status Airway patency Breathing rate

and quality Pulse rate and

quality Skin condition

Transportpriorities

Vital signs Focused

assessment Effects of

interventions Management

plans

The Scene Size-Up The Initial Assessment The Focused History and Physical Exam The Detailed Physical Exam Ongoing Assessment