Patient assessment and history taking are crucial skills in first aid. They help identify life-threatening conditions and guide treatment decisions. The primary survey uses the ABCDE approach, while the secondary survey involves a head-to-toe examination.
Vital signs provide key information about a patient's condition. The SAMPLE history gathers essential details about the patient's health and the incident. Understanding the mechanism of injury helps predict potential injuries and tailor the assessment process.
Patient Assessment
Primary and Secondary Surveys
- Primary survey quickly identifies life-threatening conditions using the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure)
- Involves checking for responsiveness, assessing airway patency, evaluating breathing quality and rate, checking pulse and signs of bleeding, determining level of consciousness, and exposing the patient for a thorough examination
- Secondary survey is a head-to-toe assessment performed after the primary survey to identify additional injuries or conditions
- Includes a systematic examination of the patient's body, starting from the head and working down to the toes, looking for signs of injury, deformity, or abnormalities (bruising, swelling, tenderness)
Vital Signs and Body Systems Assessment
- Vital signs provide crucial information about the patient's physiological status and include temperature, pulse rate, respiratory rate, blood pressure, and oxygen saturation
- Temperature can indicate infection, hypothermia, or hyperthermia (normal range: 97.7°F to 99.5°F or 36.5°C to 37.5°C)
- Pulse rate reflects the heart's functioning and can be measured at various pulse points (radial, carotid, femoral) (normal adult range: 60-100 beats per minute)
- Respiratory rate and quality indicate the effectiveness of the patient's breathing (normal adult range: 12-20 breaths per minute)
- Blood pressure measures the force of blood against the arterial walls during systole and diastole (normal adult range: 120/80 mmHg)
- Oxygen saturation measures the percentage of hemoglobin saturated with oxygen and can be assessed using a pulse oximeter (normal range: 95-100%)
- Body systems assessment involves evaluating the functioning of major organ systems, such as the cardiovascular, respiratory, neurological, and gastrointestinal systems
- Assessing the cardiovascular system includes checking for signs of shock, evaluating capillary refill time, and monitoring heart sounds
- Respiratory system assessment involves observing chest wall movement, auscultating lung sounds, and checking for signs of respiratory distress (cyanosis, nasal flaring, retractions)
History Taking
SAMPLE History and Chief Complaint
- SAMPLE is an acronym used to gather essential patient information: Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to the incident
- Obtaining a SAMPLE history helps provide context for the patient's condition and guides treatment decisions
- Signs and symptoms are the patient's subjective complaints and objective findings (pain, nausea, visible injuries)
- Allergies to medications, foods, or environmental factors should be identified to avoid adverse reactions during treatment
- Medications, both prescription and over-the-counter, can impact the patient's condition and treatment options
- Past medical history, including chronic illnesses, surgeries, and hospitalizations, provides insight into the patient's overall health status
- Last oral intake helps determine the risk of aspiration during resuscitation and guides the decision to administer oral medications
- Events leading to the incident, such as the mechanism of injury or onset of symptoms, help establish the cause and severity of the patient's condition
- Chief complaint is the primary reason the patient is seeking medical attention and should be documented in the patient's own words (shortness of breath, chest pain, abdominal pain)
Mechanism of Injury
- Mechanism of injury describes the forces and events that caused the patient's injury or illness
- Understanding the mechanism of injury helps predict potential injuries and guides the assessment and treatment process
- Examples of mechanisms of injury include blunt trauma (motor vehicle accidents, falls), penetrating trauma (stab wounds, gunshot wounds), and medical emergencies (stroke, myocardial infarction)
- Gathering information about the height of a fall, the speed of a vehicle, or the type of weapon involved can provide valuable insights into the severity of the injury
Neurological Assessment
Glasgow Coma Scale and Pain Assessment
- The Glasgow Coma Scale (GCS) is a standardized tool used to assess a patient's level of consciousness and neurological functioning
- GCS evaluates three components: eye-opening response (4 points), verbal response (5 points), and motor response (6 points)
- The total GCS score ranges from 3 (deep coma) to 15 (fully conscious) and helps guide treatment decisions and monitor patient progress
- Pain assessment is a crucial component of patient care, as pain can be a sign of underlying injury or illness
- Pain can be assessed using various scales, such as the numeric rating scale (0-10) or the visual analog scale (line with "no pain" and "worst pain" endpoints)
- Patients should be asked to describe the location, intensity, quality, and duration of their pain, as well as any aggravating or alleviating factors
Neurological Assessment Techniques
- Neurological assessment involves evaluating the patient's cognitive function, motor strength, sensory perception, and reflexes
- Cognitive function can be assessed by asking the patient to state their name, location, and current date/time (orientation) and testing short-term memory
- Motor strength is evaluated by having the patient resist force applied to various muscle groups and comparing strength bilaterally
- Sensory perception is assessed by testing the patient's ability to feel light touch, pain, and temperature in different dermatomes
- Reflexes, such as the patellar and biceps reflexes, are tested using a reflex hammer to evaluate the integrity of the nervous system
- Pupillary response to light is assessed by shining a light into each eye and observing the constriction and dilation of the pupils (normal response is equal and reactive)
- Abnormal neurological findings, such as weakness, numbness, or altered mental status, can indicate underlying conditions (stroke, traumatic brain injury, spinal cord injury) and require prompt intervention