Emergency response: Assessing the patient from head to toe

This is the last in a series of articles on what to do when you encounter an injured person and you want to help them.

After you've initially assessed the patient, you can go into greater detail.

When doing head to toe assessment, you start from the head down to the toe, looking for the following:

• Deformity
• Contusion (bruise)
• Abrasion
• Puncture
• Burn
• Tenderness
• Laceration
• Swelling

Say something like:

Hi so-and-so, my name is so-and-so and I am part of the Emergency Response Team. Respond to me verbally only. Do not move your head at any time, OK? I am going to do a head-to-toe assessment, where I am going to prod around your body. Is that OK? (Ask another person to do Cspine)

Check the following in the main body:

1. Eyes - Pupil dilating?
2. Mouth - Nothing obstructing or bleeding.
3. Fluid - Saliva or spinal fluid, which has no color. 
4. Neck
   
   • No tracheal deviation, it's central. If you injured your lungs, trachea deviates to the good lung. 
   • No medical alert necklace 
   • No jugular vein bulging out. If there is, blood flow is backing up.
5. Chest
   
   • See if entire chest is moving in unison. 
   • Intercostal bulging or depression (shirt off, if needed).
   • Check for punctures
   • Barrel hoop (underneath the nipple line, you squeeze the rib cage and see if there's pain. 
   • Another barrel hoop, this time ask them to breathe in and out.
6. Abdomen - Palpitate in each quadrant. Ask patient to tell you if they feel pain when you push down and release.
7. Pelvis - Barrel hoop; no need to do second time with deep breathing. 



Now that we are done with the core of the body, we'll move on to extremities.

1. Leg - Squeeze all the way down.
2. Feet
   
   • Take shoes and socks off
   • Take PMS - pulse, movement, and sensation. For movement, make them wiggle toes. For sensation, touch only the extremes, big toe and little toe, and ask them which one you are touching. Ignore the in-between toes, most people can't tell them apart.
3. Arms - Look for track marks, needle marks, and do PMS.
4. Back - Roll the person with at least three people. With one person on Cspine and doing the call and count (they're the one who should be ready!). Look for bruising or pooling of blood.

Emergency response: Assessing the patient

This is the second in a series of articles on what to do when you encounter an injured person and you want to help them.

After you have introduced yourself and asked the right questions, you can start assessing the patient.

Look for the following:

• Signs and symptoms
  Signs are things you can see; symptoms are what they tell you.
Note: You don't really demand, "What are your signs and symptoms?" Instead, observe. Don't get lost with medical history.
• Allergies
  Even when people say they haven't ingested their allergen, don't discount it, because sometimes things are accidentally mixed in. 
Manage their airway, keep them sitting up, keep them relaxed so their heart rate doesn't go up.
• Check vital signs.
• Do head-to-toe-assessment.
• Ask assessment questions. 

When checking for vital signs periodically, so you can track how it is changing across time. Do the the following. 

• Check for respiration every 12-20 minutes. The pulse should be within 60-90 per minute, unless they were just exerting effort. 
• Check for blood pressure every 15 minutes, but every five minutes for unstable patients.  The pressure should be 120/80 systolic over diastolic. 
• Check for skin signs. It should be pink, warm, and dry. 

Emergency response: Asking the patient

This is second in a series of articles on what to do when you encounter an injured person and you want to help them.

After you have introduced yourself and asked the right questions, you can start asking more detailed questions.

Ask the following questions:

• Medications
  What they take? When was the last time they took it? Do they want someone to go get it for them?
• Past
- Last oral intake. Ask for everything, not just meals. - Events. What lead up to the action. Even though ou asked AO, it's worth asking a second time, because sometimes more details. 




If in pain, ask the following questions:

• Onset. Ask about events leading up to the injury or trauma. 
• Provocation. "What makes your pain better or worse?" Ask both ends, not just one.
• Quality. "Describe your pain with adjectives." But don't suggest adjectives, they'll say yes to everything
• Radiation. "Where do you hurt? Where else?" Sometimes, patients tell you the most painful one and forget the others. Intensity of pain does not indicate severity. Don't ask, "Do you hurt anywhere else?
• Severity. Ask for an intensity of 1-10. 10 is the worst pain you can imagine. Don't just hear what they say, but also how they say. Sometimes they wanna act macho.

For the next article in this series, see Assessing the Patient.

Emergency response: Approaching the patient

This is the first in a series of articles on what to do when you encounter an injured person and you want to help them.

When you encounter a patient, do the following:

1. Introduce yourself.  Hi, my name is X and I am part of the Emergency Response Team. 
2. Get consent for your help. 
3. Ask what the chief complaint is. 
4. Ask the A and O questions. This is to to assess how reliable their other answers are
   
   • Name
   • Place
   • Time of Day
   • Event
5. Get their medical history.
6. Check for vital signs. 

For the next article in this series, see Asking the Patient.