*Quick Patient Assessment*
1. Level of consciousness:
A. Alert Ė are they awake and alert? Are they oriented to where and when they are?
B. Verbal Ė do they wake when you talk to them?
C. Pain Ė do wake when you give them pain, like a sternal rub or ear pinch?
D. Unresponsive - are you unable to wake them up?
Does the patient maintain their own airway? In other words, are they able to keep their mouth or nose open, expel any vomit or secretions? Do they have a gag reflex? You can check by flicking them on the bridge of the nose between the eyes with your finger. If they blink, they usually have a gag reflex. (This is good.)
Is the patient breathing on their own? Are they getting adequate volume with each breath? Are they cyanotic (turning blue)? If they are breathing, is there paradoxical movement on the chest indicative of broken ribs? This means that when they inhale and the chest expands, a portion of it collapses inward.
Do they have a pulse? Donít bother checking the wrist, check the carotids on the neck to the outside of the trachea. A radial pulse (wrists) generally means the blood pressure is at least 80 mm/Hg systolic. A femoral pulse (the groin) is 70 mm/Hg systolic. A carotid pulse is 60 mm/Hg systolic. If you canít find a carotid pulse, they are either in profound shock and are going to die or theyíre dead already. Now is time to start CPR.
These are the steps we use on the ambulance to check on how a person is doing. If they can talk to me appropriately, Iím not too worried. As things go down the list, thereís more concern. Once you check airway, you donít go to the next step until you have that one secured. Itís irrelevant if they have a pulse but their airway is obstructed because of a facial injury or choking on a piece of meat.
These are the basics. Obviously as an EMT or
Paramedic, the exam will be much more in depth, but
this is where our exams start also.
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