Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials.

I. INITIAL ASSESSMENT

This assessment is to discover and treat immediately life-threatening conditions.

Airway

• Open airway if needed:
• Medical - head tilt chin lift
• Trauma - jaw thrust
• Look for airway obstructions - vomit, bleeding, facial trauma, etc.
• Identify and correct any existing or potential airway obstruction or problems.
• Consider oxygen therapy at this time.
• Consider Oropharyngeal Airway (OPA) or Nasopharyngeal Airway (NPA).

• Check adequacy of ventilation - should be done by quickly observing chest rise/fall, approximate rate and listening to patient talk.
• Expose chest and observe chest wall movement.
• Consider oxygen therapy at this time.

• Palpate for pulse
• Radial pulse not present indicates systolic blood pressure < 80 mm Hg.
• Carotid pulse no present indicates systolic blood pressure < 60 mm Hg.
• Note skin temperature, color, and condition.
• Note capillary refill in children.
• Identify and treat life threatening conditions or injuries and control bleeding, as needed.

Determine level of consciousness by:

• A - Alert
• V - Responds to voice
• P - Responds to pain
• U - Unresponsive
• Check pupils for size and reaction time.

• Age
• Sex
• Injury or illness
• Immediate environment

This section will identify any additional injuries or conditions that may also be life threatening.

Re-evaluate the mechanism of injury (trauma) or nature of illness (medical).

Trauma patients with significant mechanism of injury should be assessed as follows:

Rapid head to toe assessment (inspect, palpate, and ausculate)

Assess baseline vital signs to include:

• Respirations
• Pulse
• Skin color, temperature, and condition
• Pupils
• Blood pressure

Signs and Symptoms
Allergies
Medications (prescribed and over the counter)
Pertinent past medical history
Last oral intake
Events prior to injury

Focused assessment

Focuses primarily on the injury site, rather than head to toe.

Assess baseline vital signs (as listed above)

Obtain SAMPLE history

Medical patients who are unresponsive should be assessed as follows:

Rapid head to toe assessment

Assess baseline vital signs (listed above)

Obtain SAMPLE history

Assess patient's complaints (OPQRST)

• Onset When and how did the symptom begin?
• Provocation What makes the symptom worse?
• Quality How would you describe the pain?
• Radiation Where do you feel the pain?
• Severity How bad is the pain?
• Time How long have you had the symptoms?

Focused assessment

Assessment of specific complaint area unless general "I don't feel well," which would require head to toe exam.

Assess baseline vital signs

III. ONGOING ASSESSMENT

Reassess interventions.