Scene Size up and Safety
What is the first action taken on every scene before patient contact?
Body Substance Isolation (BSI)
What are the five components of the primary assessment?
General impression, LOC, airway, breathing, circulation
Which history format is most appropriate for a stable medical patient?
OPQRST
When is a focused physical exam appropriate?
When the patient is stable and the complaint is isolated
How often should an unstable patient be reassessed?
Every 5 minutes
Name two scene findings that immediately increase patient priority.
Any two: hazardous scene, high-energy MOI, number of patients, obvious severe injury, patient distress
What breathing findings require immediate intervention even if the patient is talking?
Increased work of breathing, accessory muscle use, abnormal lung sounds, cyanosis, low SpO₂
Which SAMPLE component most often changes treatment decisions?
Medications (especially anticoagulants, insulin, cardiac drugs)
What exam findings suggest internal bleeding?
Abdominal distension/tenderness, pelvic instability, bruising, hypotension, tachycardia
What should reassessment focus on first?
Airway, breathing, circulation
You arrive for “chest pain” but see a damaged steering wheel. What does this change in your assessment approach?
Treat as trauma until proven otherwise and perform a rapid trauma assessment
What circulation findings suggest compensated shock?
Tachycardia, delayed cap refill, cool/clammy skin, narrow pulse pressure, altered mentation
How does anticoagulant use change trauma assessment priorities?
Increases suspicion for internal bleeding and need for rapid transport
What physical exam findings indicate tension pneumothorax?
absent breath sounds, JVD, hypotension, tracheal deviation, respiratory distress
What reassessment findings indicate treatment failure?
Worsening vitals, declining mental status, persistent hypotension, increased work of breathing
What scene clues indicate the need for additional resources before patient contact?
Multiple patients, entrapment, violence, hazardous environment, high-energy mechanism
A patient has normal vital signs but appears ill. What primary findings matter most?
Mental status, skin signs, work of breathing, general impression
What historical red flags suggest aortic pathology?
Sudden onset pain, tearing pain, back pain, hypertension history, unequal pulses
What physical exam is mandatory in an unconscious patient?
Full head-to-toe exam
What reassessment changes require immediate plan modification?
Any change in airway, breathing, circulation, mental status, or vital trends
Mid-assessment the scene becomes unsafe. What are your priorities and actions?
Ensure crew safety, remove patient if possible, withdraw, request resources, re-establish safety
The patient deteriorates during the primary assessment. What is reassessed first and why?
Airway and breathing first because they are immediately life-threatening
You have an altered patient with no witnesses. How do you obtain history?
Bystanders, environment, medication lists, medical alert tags, physical findings
Exam findings don’t match the complaint. What should you do next?
Reassess, broaden differential, upgrade priority, consider occult causes
The patient suddenly deteriorates during transport. What is your reassessment order?
Airway → breathing → circulation → monitor → interventions → transport decision