Primary Assessment Priorities
What is the main purpose of a primary assessment?
To identify and treat immediate life-threatening conditions
What do the letters AVPU stand for?
Alert, Verbal, Painful, Unresponsive.
What does it mean when an airway is “patent”?
It is open and clear
What is perfusion?
Blood circulation through the body’s tissues to deliver oxygen and nutrients and remove wastes
What three responses does the Glasgow Coma Scale assess?
Eye, Verbal, Motor Response
What must you complete before beginning the primary assessment?
A scene size-up, beginning with scene safety
A patient’s eyes are closed. They open their eyes when you speak, but stop responding when you stop speaking. Which AVPU category fits?
V — responds to verbal stimuli
Which maneuver opens an unresponsive patient’s airway when no head, neck, or spinal injury is suspected?
Head-tilt/chin-lift
Which pulse site do you check in an unresponsive adult? Which site in an infant?
Carotid - adult, brachial - infant
What are the lowest and highest possible total GCS scores when all three components can be assessed?
Lowest: 3, Highest: 15
You notice a patient’s approximate age, position, breathing effort, and visible bleeding as you approach. What are you forming?
A general impression of the patient
A patient does not respond to your voice but moves in response to a painful stimulus during assessment. Which AVPU category fits?
P — responds to painful stimuli
An unresponsive patient may have a spinal injury. Which airway-opening maneuver should you attempt first?
Jaw-thrust
You count 24 pulse beats in 15 seconds. What is the patient’s pulse rate?
96 BPM
A patient opens their eyes spontaneously, speaks clearly and is oriented, and follows motor commands. Calculate their GCS.
E4 + V5 + M6 = 15
A patient reports nausea and has visible bleeding from their arm. Which finding is a sign, and which is a symptom?
Bleeding is a sign because it is observable. Nausea is a symptom because the patient reports it.
Give one question for each of these four areas of orientation: person, place, time, and event.
Examples: “What is your name?” “Where are you?” “What month is it?” “What happened?”
An adult’s respiratory rate is 16 breaths per minute, but their breaths are shallow and their lips look blue. A classmate says breathing is adequate because the rate is normal. Explain the problem with that reasoning.
Rate alone does not establish adequate breathing. Shallow breaths and blue discoloration suggest inadequate oxygenation
A patient has pale, cool, clammy skin and a rapid, weak pulse. What serious circulation problem should you suspect?
Shock
A patient does not open their eyes, makes no sounds, and shows no motor response. All three components can be assessed. What is their GCS score?
E1 + V1 + M1 = 3
During your primary assessment, you discover life-threatening bleeding. Your partner says to finish the assessment before providing care. Explain what you should do and why.
Control the bleeding immediately. Life-threatening conditions must be treated as they are found
An older patient gives confused answers. Their family says they have dementia. Why should you ask whether this confusion is normal for them?
To establish their baseline and determine whether there is a new change in mental status
An unresponsive adult has occasional gasps. You cannot definitely feel a pulse within 10 seconds. What should you do?
Recognize possible cardiac arrest, begin CPR, and use an AED as soon as available. Occasional agonal gasps are not normal breathing
A child has delayed capillary refill after being outside in cold weather. Why should you avoid using this finding alone to conclude that the child has poor circulation from shock?
Cold temperature can slow capillary refill
Two patients have a GCS of 10. Patient A scores E3 V3 M4. Patient B scores E2 V2 M6. Which patient follows motor commands, and why should you report the individual components along with the total?
Patient B