Overview
This lecture explains the primary assessment process in EMS, focusing on identifying and quickly treating life-threatening conditions using a structured approach.
Purpose of Primary Assessment
- The primary assessment aims to identify and start treating imminent life threats as early as possible.
- It occurs after scene safety and before detailed secondary assessments.
- EMS providers use signs, symptoms, and observation to detect urgent problems.
Steps of the Primary Assessment
- General impression: Visually assess the patient and the scene for immediate threats.
- Assess level of consciousness using the AVPU scale (Alert, Verbal, Painful, Unresponsive).
- Determine airway patency: Is the airway open and clear?
- Assess breathing: Observe, listen, and feel for adequate respirations and lung sounds.
- Assess circulation: Check for major external bleeding and control it immediately.
- Perform a rapid physical exam (head-to-toe scan) for additional threats.
- Determine patient priority for care and transport (stable, potentially unstable, unstable).
General Impression & Approach
- Consider patient age, gender, race, distress level, appearance, and position.
- Kneel to the patient’s level unless safety dictates otherwise.
- Introduce yourself and use the patient’s name to enhance comfort.
Assessing Level of Consciousness & Orientation
- AVPU: Alert (awake), Verbal (responds to voice), Painful (responds only to pain), Unresponsive.
- Orientation: Person (name), Place (location), Time (date), Event (what happened).
- "Alert and oriented x4" means all orientation elements are intact; less may indicate altered mental status.
Immediate Life Threats to Identify
- Cardiac arrest (heart stopped): Start CPR and use AED.
- Respiratory arrest (not breathing): Provide ventilations.
- Shock (hypoperfusion): Organs/tissues lack adequate oxygenated blood.
- Severe bleeding: External (visible) or internal (hidden).
- Airway obstruction: Total block prevents speech/crying.
Airway Management
- Ensure airway is open, clear of obstructions, and maintainable.
- Signs of obstruction: noisy breathing (stridor, snoring, gurgling), shallow/absent breaths, vomiting or blood.
- Steps: open (position), clear (suction/foreign body), keep (adjuncts), ventilate (BVM if necessary).
Breathing Assessment
- Look for equal rise and fall, abnormal positions (tripod), and obvious distress.
- Identify respiratory distress (difficulty, increased effort), failure (inadequate oxygenation), or arrest (not breathing).
- Distress signs: increased rate, accessory muscle use, agitation, cyanosis, low SpO2 (<94%), chest injuries, JVD, tracheal deviation.
Circulation and Bleeding Control
- First priority: scan for and control major external bleeding with direct pressure, dressings, or tourniquet if needed.
- Bleeding types: Arterial (bright red, spurting), venous (dark red, steady), capillary (oozing).
- Uncontrolled major bleeds override airway/breathing steps.
Disability and Exposure
- Assess disability: level of consciousness, stroke exam, Glasgow Coma Scale, pupils, speech, motor function.
- Expose patient fully to reveal hidden injuries, especially posteriorly or beneath clothing.
Rapid Physical Exam & Transport Decision
- Quick head-to-toe scan for deformities, contusions, abrasions, penetrations, burns, tenderness, lacerations, swelling (DCAP-BTLS).
- Decide on urgency of transport and appropriate destination (hospital type, lights and sirens).
- High-priority signs: unresponsiveness, severe pain, difficulty breathing, uncontrolled bleeding, altered mental status, shock, complicated childbirth.
Key Terms & Definitions
- Primary Assessment — Initial evaluation to find and treat life threats.
- General Impression — First visual and situational assessment of the patient.
- AVPU — Scale for measuring responsiveness: Alert, Verbal, Pain, Unresponsive.
- DCAP-BTLS — Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.
- Shock/Hypoperfusion — Inadequate blood/oxygen delivery to organs/tissues.
- Patent Airway — Open and clear airway with no blockages.
Action Items / Next Steps
- Practice primary assessment steps on sample patients.
- Review AVPU scale and how to determine orientation.
- Read about managing airway, breathing, and circulation emergencies.