Simple secondary survey study sheet

Note to on-line users not in my classes: this is a study sheet. It is not complete instruction in first aid. In a formal class you will learn steps for recognizing emergencies, how and when to call 911, protecting yourself, (including how to obtain consent and prevent disease transmission), how to prioritize care and much more. You would always deal with life-threatening situations before you start a simple secondary survey (also known as a secondary assessment).

Students in HLTH57E (CPR) should be familiar with the material down to the section on the names of arteries.

Students in HLTH57A (first aid) and lifeguard training or an enhanced staff first aid class should be familiar with everything.

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Rule #1 Don’t make things worse

-don’t aggravate injuries-(don’t move anything you think
might be broken)

-don’t move victim (especially if you suspect a spinal injury) unless you absolutely must

-don’t
increase danger to victim

-don’t expose others to risk and create more victims

-don’t force first aid on a conscious, sane, sober adult who doesn’t want it (get consent/explain what you are doing and keep getting consent/explaining as you go along)

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Times to suspect a spinal injury: (and use a jaw thrust instead of a head tilt, chin lift).

involved in a motor vehicle, motorized cycle, or bicycle crash as an occupant or rider, (especially with significant intrusion into passenger’s space (side or even the roof).

a pedestrian hurt during the crash of a motor vehicle, motorized cycle, or bicycle

trauma that results in partial or complete paralysis, partial or complete loss of movement of any body part, numbness, tingling or loss of sensation

a fall on land from a height greater than the victim’s height (or some sources say: a fall of greater than ten feet onto head or legs, or injury as a result of a fall greater than standing height). BUT a fall from a lower height still can cause a spinal injury.

a seemingly minor injury might actually be a spinal injury if the victim: appears frail or is older than 65 years of age, is not fully alert, or appears to be intoxicated

a seemingly minor injury might also actually be a spinal injury if the victim is less than three years old

a person holding his or her neck and/or head and/or complaining of weakness, pain, tingling or burning sensation in the extremities

losing balance or stumbling as they try to walk/stand

skiing or sledding or riding a bike into into a fixed object (like a tree) or other sudden and violent deceleration

assault to head/neck with blunt object other than fist or feet

cracked or broken helmet (bicycle, motorcycle, football, surfer’s, ski, industrial hard hat)
or wasn’t wearing one when they should have been

excessive flexion, as in when the chin is forced to the chest

fall on buttocks that transfers force to spine

severe blunt force to head or trunk (hit by car)

injury that penetrates head or trunk including a gunshot, especially to the head, neck, chest, abdomen, back, or pelvis (lower part of the body/spine between the abdomen and the thighs)

has a head or neck injury

stabbing or impalement near the spinal column

thrown from a motor vehicle or horse (as many as 75% of passenger vehicle occupants totally ejected in a crash die)

incident involving a lightning strike or near strike

injury by rockfall or avalanche

found lying on the ground under a tree – assume they fell from the tree until you determine otherwise

found lying on the ground under a ladder – assume they fell from the ladder until you determine otherwise

broken windshield or deformed steering wheel

not wearing a seatbelt

impact with other passengers not seatbelted

deployed airbag and no seatbelt

lap style seatbelt only

infant or child in in front passenger seat and deployed airbag

small driver and deployed airbag

infant or child found with shoulder seatbelt around neck

poorly adjusted or absent headrest in a rear-end collision

snowmobile or motorcycle under rope or wire

motorcycle accident with rider ejected or crushed between the bike and another vehicle

closed vehicle rollover

closed vehicle crash with death of another occupant

pedestrian hit by a vehicle who rolls onto the hood of the vehicle, and often hits the ground head first

hanging or attempted hanging

found under collapsed building material or heavy debris (after and earthquake or…)

tumbling downhill without skis releasing (excessive extension or rotation)

spear tackling in football (using the head)

while participating in any sport, sustained a blow to their head, collided with another player or the ground/equipment

unconscious in water 5 feet deep or less

any injury caused by an entry, especially head first dive, into shallow water

diving mishap or entering water from a height, involving a diving board, water slide, embankment, cliff or tower

diving onto an floating or submerged object/person/sandbar (at the water surface or underwater)

striking the water with a high impact (falling while water skiing or surfing, or impact with water on an imperfect dive from a great height)

hit by a boat, personal watercraft, skier, surfer, ski, or surfboard

receiving a blow to the head, including colliding with another swimmer or when plunging head-first into a breaking wave or shallow water

jumped on by someone entering the pool at the side who did not see the person swimming underwater along the side

any trauma situation where the victim stays unconscious, is not fully alert or you have any doubt

USLA, lifeguards at beaches/open water, remind us:

“Signs of a spinal injury can include things other than paralysis, but they require immediate attention. They include:

Bruises, scrapes or cuts to the head or face

Pain or tenderness in the neck or back

Partial or complete paralysis, difficulty breathing

Weakness in the arms and/or legs

Numbness and tingling in the arms and legs”

http://www.usla.org/?page=SPINAL

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Reasons why a person might become unconscious or semi-conscious

(AEIOU TIPS)

Alcohol or other substance abuse or misuse

Epilepsy

Insulin (diabetes, high or low blood sugar)

Overdose

Underdose

Trauma, especially head injury

Infection

Psychological/Poisoning

Stroke

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Altered mental status (and possibly a confused or combative state) can be caused by:

any of AEIOUTIPS above

fever

meningitis

electrolyte imbalance (hyponatremia)

severe dehydration

shock and/or any condition that results in less blood flow (and therefor less oxygen) to the brain

conditions resulting from mental, emotional or behavioral disorders

severe drug withdrawal – (Delirium tremens or other) is sometimes mistaken for an acute psychiatric problem

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Remember that someone with altered mental status might not be able to give you accurate answers to your questions.

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Mental status is also known as Level of Consciousness (LOC).

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SUDDEN Altered mental status, (and possibly a confused or combative state) AKA delirium, which can indicate a life-threatening condition,

can be caused by the above. Note that this can be relatively common in elderly people and might seem like dementia, but is not.

infections including urinary tract infections, a wound, pneumonia

cancer spreading to the brain and causing hallucinations

a stroke

head injury with intracranial bleeding

severe burns

use of or withdrawal from alcohol/drugs

poisoning from lead, mercury, carbon monoxide, pesticides

chronic lung disease

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Note that heatstroke or diabetes can seem like a acutely intoxicated person.

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causes of fainting

fright, stress or excitement

tight clothing at neck

carbon monoxide poisoning

dehydration, especially severe dehydration brought on by diarrhea, vomiting or sweating, especially if the victim has not been drinking enough fluids

slow gastrointestinal bleeding with or without pain

blood volume changes (stood up too fast after prolonged sitting or lying down (more likely for pregnant, elderly), after a large meal (especially with alcohol))

diarrhea

inflammation of inner or middle ear

liquor

panic disorders and hyperventilation

dysrhythmia causing a fast heartbeat

a very slow heart rate

standing too long, especially in the heat

benign hyperventilation: an anxious person (fear of heights, animals, etc.) hyperventilates (breathes rapidly and deeply) which causes dizziness, a sensation of choking, tingling in hands & feet, chest pain &/or tightness, blurred vision and more. These symptoms being close to those of a heart attack or other serious problem can cause more concern and more hyperventilation sometimes leading to fainting. (No, do not have them breathe into a paper bag.)

some medications for high blood pressure or heart disease

recent arrival at high altitude

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arteries:

Arm = brachial

Neck = carotid

Groin = femoral

Wrist = radial

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Students in HLTH57E (CPR) should be familiar with everything above this part.

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Students in HLTH57A (first aid) and lifeguard training or an enhanced staff first aid class should be familiar with everything.

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Hypothermia symptoms: The Umbles: grumbles, mumbles, fumbles, stumbles, tumbles.

Hypothermia causes loss of fine motor skills, so we fumble, stumble and tumble.

Our brains can have ill effects from the cold fairly quickly and we mumble and grumble.

Also could be the effects of High Altitude Cerebral Edema, and alcohol ingestion / intoxication.

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causes of seizures

most common is epilepsy, especially if medicine is not taken in proper dosage and on time

lack of oxygen

stroke

brain tumor / concussion / increasing intracranial pressure from swelling or internal bleeding in the brain

poisoning

diabetic emergency / low blood sugar

heat stroke

failure to use prescribed anti-seizure medications (often the biggest cause of seizures)

trauma

drug or alcohol use or withdrawl

measles, mumps and other childhood diseases

eclampsia (pregnancy complication)

child with a high fever

child with aspirin poisoning

infection

hit by lightning

high altitude can cause brain swelling

continuing stress from bereavement, divorce, abuse, money/family worries, critical incident stress

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Signs and symptoms of a concussion:

(Symptoms of a concussion may be delayed. They can happen immediately or take several hours or even days to present themselves.)

(Many teams require that an athlete with concussion symptoms be evaluated by a medical staff member with experience in the evaluation of concussions and prohibits them from returning to play on the day of the activity. Mild symptoms can resolve themselves in less than two days, but the victim still needs to be seen by a doctor. See advice for athletes from Clemson University at the end of this section.)

Appears dazed or stunned

Moves clumsily

Answers questions slowly

Loses consciousness (even briefly)

Shows behavior or personality changes / mood changes like feeling sad, anxious or listless or becoming easily irritated or angry for little or no reason. Might resist treatment.

Mental status deteriorates – sometimes moving from disoriented, to irritable, to combative to a coma.

another source says: feeling sluggish, feeling unusually irritable

Sensitivity to light and/or noise

Hearing problems, ringing in ears

goes in and out of responsiveness

Can’t recall events prior to hit or fall and/or after hit or fall

Headache or ‘pressure’ in head

Nausea or vomiting

Balance problems or dizziness

(Often brief) double or blurry/fuzzy vision

Feeling dinged or dazed, sluggish, hazy, foggy, or groggy

Concentration or memory problems

Confusion

Does not ‘feel right’

In later stages pupils may become unequal

Athlete who is confused about assignment or position, forgets sports plays, is unsure of game, score, or opponent

An elderly person can have a concussion from a seemingly minor fall. Sometimes their symptoms are mistaken for a stroke. You might not witness the fall of an elderly person, for example, but after the fact would notice some of the symptoms above and/or:

low-grade headache that won’t go away

having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks or making decisions or solving problems

slowness in speaking, acting, thinking or reading

getting lost or easily confused

changes in sleep patterns, inability to wake up from sleep

sensitive to light or noise

doesn’t recognize people or places

repeated vomiting

seizures (arms and legs jerk uncontrollably)

weak arms or legs, unsteady on feet

slurred speech

Note that confusion in an elderly person that comes on suddenly could be caused by a head injury OR by a medication / improperly taking a medication, OR by pneumonia/infection (sometimes without a fever or coughing).

An infant can’t answer questions or tell you they have symptoms, but you might notice they cry persistently and it is difficult to console them, are not interested in toys they usual are fond of (or might not even reach for a toy offered them), have changes in eating/drinking/nursing.

They might not interact normally with a parent/sibling, give eye contact.

They might not pay their usual attention the their surroundings. Their eyes might not follow a person/object near them, or they could even have a blank or trance-like stare.

NOLS Wilderness Medicine says “evacuation is recommended for any patient who has become unresponsive, even for a minute or two, or who exhibits vision or balance disturbances, irritability, lethargy, or nausea and vomiting after a blow to the head regardless of whether they were knocked out. A patient who exhibits loss of responsiveness but who awakens without any other symptoms may be walked out of the wilderness with a support party capable of quickly evacuating the patient if his or her condition worsens.” This could also apply after an earthquake.

For Athletes:

Clemson University gave this advice in their athletics 2017-8 Concussion Management Protocol

“How can I prevent a concussion?

Basic steps you can take to protect yourself from concussion:

• Do not initiate contact with your head or helmet. You can still get a concussion if you are wearing a helmet.

• Avoid striking an opponent in the head. Undercutting, flying elbows, stepping on a head, checking an unprotected opponent,
and sticks to the head all cause concussions.

• Follow your athletics department’s rules for safety and the rules of the sport.

• Practice good sportsmanship at all times.

• Practice and perfect the skills of the sport.

What are the symptoms of a concussion?

You can’t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury.

Concussion symptoms include:

• Amnesia.

• Confusion.

• Headache.

• Loss of consciousness.

• Balance problems or dizziness.

• Double or fuzzy vision.

• Sensitivity to light or noise.

• Nausea (feeling that you might vomit).

• Feeling sluggish, foggy or groggy.

• Feeling unusually irritable.

• Concentration or memory problems (forgetting game plays, facts, meeting times).

• Slowed reaction time.

Exercise or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse

What should I do if I think I have a concussion?

Don’t hide it.

Tell your athletic trainer and coach

Never ignore a blow to the head. Also, tell your athletic trainer and coach if one of your teammates might have a concussion.
Sports have injury timeouts and player substitutions so that you can get checked out.

Report it.

Do not return to participation in a game, practice or other activity with symptoms. The sooner you get checked out, the sooner you may be able to return to play.

Get checked out.

Your team physician, athletic trainer, or health care professional can tell you if you have had a concussion and when you are cleared to return to play.

A concussion can affect your ability to perform everyday activities, your reaction time, balance, sleep and classroom performance.

Take time to recover.

If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death. Severe brain injury can change your whole life.

It’s better to miss one game than the whole season.

When in doubt, get checked out.

For more information and resources, visit www.NCAA.org/health-safety and www.CDC.gov/Concussion.”

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Treatment for closed soft tissue injuries

(RICE)

Rest to allow clots to form. Do not move or straighten the area

Immobilize

Cold: apply plastic bag of ice (with a thin barrier between the ice and skin) 20 minutes on, 20 minutes off

Elevate above heart level unless it causes more pain

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Signs of wound infection

(Older adults are at higher risk for wound infection.)

pain does not get better a few days after the injury, or actually gets worse

increasing pain, swelling or tenderness

small pimple over the wound

swelling beyond what might be considered normal for that wound

pus (with or without a foul odor) coming from the wound (varies from white to pink or light green)

redness spreading from around the edges of the wound, progressing to red streaks extending from the wound up a limb towards the heart

warmth

advanced: chills and fever, swollen glands in the groin, armpit or neck, nausea

(Especially watch punctures for early signs of infection.)

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To care for a victim of stroke, think FAST.

Face – weakness on one side of the face

Arm – weakness or numbness in one arm

Speech – slurred speech or trouble speaking


T
ime – Time to summon EMS personnel (call 911) if any of the above are seen and note the time the signs and symptoms began

If you suspect a stroke:

Ask the person to smile. (Watch their face to see if both sides of their face move the same or if there is drooping or weakness on one side of their face.)

Have them hold up both arms, extended out straight from their body. (Someone who had a stroke might be able to lift both arms up, but not be able to keep both arms at the same height or might not be able to lift both arms up to the same height or might have numbness in one arm.)

Have the person try to repeat something simple you say, example: “The sky is blue.”(Someone who had a stroke might have slurred or distorted speech or trouble speaking or can’t speak at all. They might speak clearly, but say the wrong words.)

If they fail any of these, note the time, call 911 or the local emergency number and tell the dispatcher about the symptoms and what time the symptoms started. (Or tell the dispatcher if the stroke was not witnessed and you do not know when the symptoms started.)

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Normal respiration for an adult is 12 to 20 breaths per minute, children ranges with age, from pre-teens at 12 or 15 to 20 to newborns to about six weeks at 30 to 50

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Normal pulse

Adult 60 to 100

Child 80 to 150

newborn to about six weeks, 100-160

infant 80 to 120 to possibly 150

an athlete may have a pulse of 50 beats per minute or lower

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Normal capillary refill is 2 seconds (not effective on very cold fingers)

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normal body temperature taken at the mouth is 98.6°F (within a range of 97°F to 99°F )

normal rectal temperature is 99.6°F

normal armpit (axillary) temp is 97.6°F

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Levels of consciousness

Person, place, time, event

(their name is the last thing of these they’ll remember).

A person who is oriented to their surroundings and situation should be able to tell you their name, where they are, what time it is (not to the exact hour but at least if it is morning or evening, what month and year it is) and what just happened to them.

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AVPU

Alert: able to respond appropriately to questions (including person, place, time and event)

Verbal: Responds appropriately to verbal stimuli when you speak or shout

Painful: Only responds to painful stimuli, such as a pinch

Unresponsive: Does not respond; no gag or cough reflex

a response could include grimacing, rolling away from your voice, moaning

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Your palm (or another source says palm and fingers) is approximately 1% of your body surface, use this to estimate extent of burns

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Sierra Club wilderness first aid “rule of fours” you can live 4 minutes without oxygen, 4 hours without shelter, 4 days without water, 4 weeks without food (but that may be the limit of any reasonable expectation of survival)

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–see pages 24-28 in American Red Cross First Aid/CPR/AED participant’s manual OR 216 (skill sheet on page 239) in Lifeguarding–

Simple secondary survey , (also known as a secondary assessment) used after the initial assessment after you have ruled out or taken care of any life-threatening conditions. You might or might not have already called 911.

(Remember, don’t have them move any body part you suspect is injured and if you suspect a spinal injury you would be manually protecting the spine/neck from movement and would not want them to tilt their head yes or no in the process of answering questions. You could tell them to not move, and not nod their head yes. Instead of asking “do you have any pain,” you could say “tell me about your pain.”)

Note that elderly victims might not have their hearing aids in, or might not have hearing aids that they need.

If you did not do so already, introduce yourself, ask permission to give care, get victim’s name. (At any point while you are taking this brief history or during the head-to-toe exam, if you find something that requires emergency medical personnel, stop the survey to call 911 immediately, then continue the survey.)

Interview victim (write notes, including negative answers) and give the information to EMS personnel when they arrive.

use SAMPLE as an easy way to remember the questions

Signs and symptoms

What happened to you?

(You might also note if they are anxious or indifferent.)

Do you feel pain anywhere?

Do you feel any numbness, tingling or loss of sensation? (If yes, where?)

Are you experiencing any lightheadedness, nausea?

(If they felt dizzy, was it a spinning feeling, or just lightheaded and did they lose balance?)

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Sometimes ask for details about pain:

OPQRST

Onset (What were you doing when it started hurting? Resting or active? What made it start hurting? Was it severe at first or did it get this bad over time?)

Provokes (What makes it worse/better? Does it only happen after you eat? Does it only hurt when you breathe deeply?)

Quality Ask them to describe the pain. (Don’t use a leading question such as, is your pain a burning pain? Answers could include sharp pain, stabbing, cramping, aching, burning, dull.)

Radiates / or another source says Region/Radiates Referred (Does it start in one place, and move to another? What makes it move? (spleen injury pain can be felt in the left shoulder, heart attack chest pain can radiate to the neck and jaw, kidney stones are associated with severe back/flank pain radiating to the groin, gallbladder pain can be felt in the right shoulder blade, a slowly bleeding abdominal aneurysm can cause abdominal pain radiating to the back)

Severity (Where is the pain on a scale of one (least) to ten (most))

Time (When did it start hurting? How frequently does it occur? How long does it last? Does it come and go? Get better or worse? ) (Intermittent, hard to locate pain is common with problems of the abdomen.)

(If the onset and time categories seem to be redundant, think of the onset as WHY and the time as WHEN.)

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Allergies

Do you have any allergies, (including food, plants/pollen, insects and medications)? What type of reactions have you experienced when you were exposed? Any recent exposure? Tightness in their throat?

Medications / Medical Conditions

Do you have any medical conditions or are you taking any medications? If so, what conditions do you have or what medications are you taking? Have you taken any in the past 12 hours?

(including prescription, over-the-counter, herbal)?

They might not remember the names of their medications, so you could ask what are their medications for, and when did they last take them.

Don’t ask if they are taking any drugs, as they may misunderstand and think you are accusing them of illegal activities. But if that might be the reason they are having problems, you certainly need to find out.

Diabetic? Heart problems? (may get you a better answer than asking about ‘Cardiac history’?)

Epilepsy? Asthma? Pregnant? Check for medic alert tag.

Example: if they are taking Viagra, giving them nitroglycerin could have serious side effects. Some antibiotics may decrease the effectiveness of hormonal birth control such as the pill.

Pertinent past medical history

Have you experienced any recent falls, accidents or blows to the head? Have you ever been in any medical, surgical or trauma incidents? (If you didn’t get the answer to this in the medical conditions questions): Are you under a doctor’s care for anything?

If appropriate: Have you experienced anything like this before?

(history of high blood pressure? recent surgery/illness? (complications?) Dehydrated? Didn’t eat
any breakfast? Lack of sleep? Substance abuse? Previous injury to same site? Same type of pain previously – was there a diagnosis? Same location of pain previously – is the pain the same this time?)

Last oral intake

(also referred to as Last food or drink OR Last Ins and Outs.)

When did you last eat or drink anything? What did you last eat or drink? You could also ask the amount. This includes solids, liquids and medications. (Don’t ask the victim “when was your last oral intake?”).

Changes in diet that might have caused that stomach upset.

In the wilderness it can take more time to get drinkable water and people sometimes choose to be regularly dehydrated.

Perhaps notice if they smell of alcohol.

Perhaps ask if oral intake over the past few days has been normal for them. When did you last defecate and urinate and were they normal? Example, was urine clear or dark. No recent diarrhea? Any blood?

Events leading to the incident

What were you doing before the accident happened? What were you doing when the incident occurred?

OR How did you get hurt?

OR Why do you think this happened? (As in, why do you think you just fainted?)

Try to not phrase the questions in a negative manner that could cause concern / embarrassment for the victim,
as in “What did you do?”

Finally, you could ask: Is there anything else I should know?

Write down all the answers.

Then do a head to toe exam, starting by telling the victim what you are going to do. Keep explaining as you go along.

Head to toe exam

(in a simple secondary survey you hardly touch the victim, they do the moving around, but only if you do not suspect a spinal injury)

Visually inspect the body, including the scalp, face, ears, eyes, nose and mouth for cuts, bumps bruises and depressions.

(DOTS: Deformity, Open injuries, Tenderness, Swelling) Compare the injured body part to the opposite uninjured part (injured right hand to uninjured left hand).

(DCAP BLTS deformities, contusions, abrasions, penetrations (another source says punctures/penetrations),

burns, lacerations, tenderness, swelling)

Look at face and lips (unusually wet or dry, pale, bluish, jaundice (yellow skin combined with yellow whites of the eyes = liver problems) flushed, ashen; note abnormalities).

Check eyes (pupils – big, tiny, uneven size, both react the same to light?) ears, nose,
ask them to open mouth; look for fluid or blood (don’t try to control fluid coming from ears)

A significant percentage of people normally have pupils of slightly different size, but both should react to light the same way if, for example, you shine a flashlight in their eyes.

Determine skin appearance and temperature. Feel person’s forehead with back of your hand to determine if it is cold or hot.

Write down all observations, including anything that does not look right.

Don’t do the following if you suspect a spinal injury or move any body part you suspect was injured.

– Ask person to move head from side-to-side if there is no discomfort and if an injury to the neck is not suspected.

Note pain, discomfort or inability to move the neck.

– Ask person to shrug shoulders.

– Ask person to take a deep breath and blow out air.

Listen for changes in breathing and ask victim if he or she is experiencing pain during or right after breathing.

Breathing (gasping, unusual noises, fast or slow, labored, noisy, gurgling, shallow or deep, pain
when breathing, dry or productive cough, difficulty swallowing, difficulty speaking in full sentences/using phrases or partial sentences, example: can’t say more than one or two words before they need to take another breath)

Stridor = high pitched noise when breathing in; wheezing = high pitched noises when breathing out.

If coughing, increased frequency and severity? If sputum, increased production and/or changes in character?

If nasal discharge, what color? (Clear, yellow, green, reddish, brownish?)

Ask if any pain in abdomen (which quadrant?) (Causes of abdominal pain include trauma, ectopic pregnancy, perforating ulcer, appendicitis, gall bladder infection or as simple as digestive system problems such as intolerance to some types of food, a viral illness, constipation.)

(If they are vomiting, describe what is vomited, if diarrhea, describe the consistency.)

– Ask person to move hands, fingers, bend arm. Compare grip strength.

– Ask person to move feet, ankles, bend leg. Check one limb at a time.

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If you need to move or remove clothing it can be helpful to explain why not only to the victim, but also to bystanders.

Explain to bystanders and get a witness to your taking out someone’s wallet to identify them.

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Next, a brief lesson in electricity. When you plug an appliance into a wall outlet and turn it on, it does not use up all the electricity coming to it. The electricity returns into the wall outlet. A special type of outlet, a ground fault circuit interrupter (GFCI), constantly monitors the returning current. If the current does not return because it goes to ground… (for example through you or other people), because you:

put a boom box on a starting block next to a swimming pool and it falls in, then sending the electricity into the pool water and the aqua aerobics class members

or

work out in the rain with a power tool that has a frayed wire and the wet ‘hot’ wire sends the electricity into you

or

don’t have a long enough ‘suitable for use with outdoor appliances’ extension cord, so you string together a few that are not labeled for outdoor use, and not suitable for the distance/wattage of the mega-bright decorating lights you want to use, and the cord comes in contact with puddles and sends electricity into the water/people

… the GFI can prevent electrical shock by noticing the difference in the current and shutting off the current to the appliance/power tool (in as little as one-thirtieth of a second!).

ground fault interrupter: ground fault interrupter safety outlet Please note that GFIs can be damaged by lightning or other electrical surges and need to be tested regularly. Since they might not always be functional, putting that boom box/radio/hairdryer where it can fall in the swimming pool/spa/hot tub/bathtub/kitchen sink full of water is never a good idea.. . . as in “E” in the acronym below.

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STOPEATS is an acronym to help people learn some of the reasons why a victim could have a decreased level of consciousness or some causes of a seizure

Sugar – diabetic – (or low blood sugar – hypoglycemia or hyperglycemia) (When did they last eat or drink?)

Temperature – extreme high or cold temperature (hypothermia, hyperthermia)

Oxygen – abnormal levels of oxygen, (see also the A for altitude below)

Pressure – increasing intracranial pressure (ICP) (brain swelling) due to head trauma / concussion / traumatic brain injury (TBI), bleeding in the brain, high-altitude cerebral edema (HACE), stroke, heat stroke or prolonged lack of oxygen example: near drowning. Symptoms can include loss of memory as to the event that caused the concussion, especially persistent disorientation. More severe injury and more ICP if the victim does is not oriented to person, place, time and event.

Electricity – trauma from electric shock (household current from a loose or bare wire, boom box falls into a pool when not connected to a GFI plug), lightning or problems in the brain

Altitude – high-altitude pulmonary edema (HAPE) (and see high-altitude cerebral edema (HACE) in the Pressure section above)

Toxins – drugs, alcohol, poisons, overdose on common pain relievers, intentional overdose, mushrooms, carbon monoxide, food poisoning, chlorine gas, bites/stings

Salts – low sodium or potassium levels can change the brain’s conductivity

AGAIN . . . remember that someone with altered mental status might not be able to give you accurate answers to your questions.


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See also:

What the AED says as you use it

CPR quick facts

AED quick facts

Common mistakes in Professional Rescuer CPR skills

How to pass a Red Cross written test

Why did they change CPR?

CPR Pro skills review questions

Bloodborne Pathogens quick facts

fast, basic neurological exam

Oxygen administration quick facts

cultural issues in first aid

wilderness first aid outline

injuries quick facts

http://www.wildmed.com/pdf/WMA-Field-Protocols.pdf