The primary examination serves to identify life-threatening conditions and injuries and to implement emergency measures. It is done immediately after approaching the injured person and includes an assessment of the state of consciousness, airway patency and breathing, blood circulation (pulse), and the general condition of the injured person.
Checking the state of consciousness
A conscious person answers loud questions, such as: “Can you hear me?”, “What’s your name?” “Are you okay?” “What happened?” Casualty can talk to the rescuer, answer the call, react to painful stimuli or not react at all, depending on the severity of the pores of the state of consciousness. An unconscious person may or may not have preserved breathing and circulation.
After determining the state of consciousness, the primary examination is performed according to the following principles of the international ABC protocol:
- examination and assessment of airway patency, and manual fixation of the head and sciatic spine (checking whether the tongue is sunken, whether there is accumulated blood in the mouth or deeper airways, vomited stomach contents, foreign body or parts of a broken prosthesis). If there is a fall of the tongue, it is necessary to throw the victim’s head back. If a foreign body has closed the airway, it should be removed.
- assessment of respiration should not last longer than 10 seconds. Breathing check includes the following lifeguard protocol:
> listens to see if the victim is breathing;
> observes whether his chest is raised;
> under his arm he feels the movements of his chest.
The rescuer first approaches the cheek in front of the victim’s mouth and nose. He then turns his head towards his chest and the head he threw away. Breathing is controlled by the principle: “I see, I hear, I feel”. He looks at the frequency of chest movements (fast or slow), the depth of breathing (shallow or deep) and the expansion of the nostrils, listens to the quality of breathing (easy or difficult, hissing / grunting) and feels the flow exhaled air (breath) on the cheek that he placed above the lips of the casualty.
- assessment of circulation (heart rate test) is most often performed by feeling the pulse (was) with the cheekbones of two joined fingers in the following places:
> first on the common carotid artery in the cavity between the Adam’s apple and the neck muscles (lat. a. carotis communis), left or right;
> above the carotid artery (lat. a. radialis), in the area of the wrist and forearm;
> in infants and young children by listening to the heartbeat under the left nipple by pressing the ear against the chest.
Circulation check should take up to 10 seconds. It is not recommended that non-medical staff look for a pulse as this will result in much more than 10 seconds.
Before the secondary, detailed examination, if the injured person is unconscious, but his breathing and pulse are preserved, and provided that there is no spinal cord injury, it is necessary to place him in a lateral coma. A stable lateral position makes it easy to keep the airway open.
Secondary examination depends on the general condition of the injured person and the mechanism of possible injury. In the case of a generalized injury mechanism (eg a car crash), a “quick head-to-toe examination” is performed, searching for information about the event and problems. If the injury mechanism is local (burns, cuts), ” focused review “in addition to searching for information about the event and problems. Removing clothing and removing the cover from the injured / sick person allows unobstructed access and visibility of all parts of the body.
A general examination of the entire body “from head to toe” identifies hidden or hard-to-reach open and closed injuries or conditions, with the rescuer using all his senses. The rescuer should stay with the injured person until the arrival of the ambulance and constantly check the signs of life.
The rescuer examines the left and right sides of the victim’s body with both hands in the following order: head, neck, back and spine, torso, upper and lower extremities, as follows:
> Head and neck – feeling with your hands CAUTION, without much pressure, passes over the scalp and nape of the injured / sick person. whereupon he should watch out for neck injuries
spinal column, especially if the person is unconscious. Gradually and in detail check whether the following parts of the head are injured:
> skull – notices visible swelling, external bleeding, dents, sore spots;
> eyes – observes the size of the pupils (if they are unequal, this is probably a sign of head injury) and the symmetry of the pupils (normal pupils are proportional), assesses the reaction to light (when normal pupils are reduced), checks whether the eye is inflamed a foreign body, looking for hemorrhages or discoloration of the whites;
> nose – seeks bleeding, fracture, foreign body, discharge of cerebrospinal fluid (CSF) from the nose, which are signs of brain damage;
> mouth-controls bleeding and foreign bodies in the mouth, as well as mouth moisture and lip color (paleness indicates bleeding, while the blueness of the lips draws attention to the lack of oxygen); registers the breath of the casualty;
> ear – looks for a foreign body and bleeding that indicates injury to the eardrum or brain damage, checks hearing and leakage of clear fluid or blood;
> face – observes the color of the skin and mucous membranes (normal, pale, red or gray-blue), temperature and humidity of the skin (cold, warm, dry, moist), blood around the eyes, as well as whether the skin is covered with hot or cold sweat.
> Spinal column – first examines painful points and puncture sites and observes wounds, foreign bodies and swelling along the entire length of the spinal column. If he suspects an injury, he avoids touching so as not to aggravate the injury. If there is no presumption of injury to the bony column composed of interconnected vertebrae in which the spinal cord is located, he should pull his hand under the injured person’s back and run his fingers along the vertebrae (as if playing a piano).
> Chest – estimates the frequency, depth and manner of breathing – easy, difficult, loud or inaudible; observes the lifting of the chest, according to whether the chest rises symmetrically and evenly on both sides when breathing, whether the nostrils expand, whether the air hisses through the mouth and nose, whether the victim grunts or his cheeks move. He then looks for a broken rib (sharp pain when inhaling indicates broken ribs) and traces of bleeding with bruises and wounds;
> Abdomen – follows the signs of internal bleeding by feeling the pulse, and examines the painful sensitivity and tension of the muscles of the abdominal wall;
> Examine the protruding parts of the pelvis, hips and lower back with moderate palm pressure to determine closed fractures. It touches the protruding parts of the hips, pelvis and pubic bone, whereby the pelvis should be lightly pressed with the fists inwards to cause a possibly painful response which is a sign of a fracture. Finally, he observes whether there is visible bleeding from the bladder and anal opening.
> Upper extremities – first checks the pulse on the carotid artery, observes visible wounds, looks for foreign bodies (glass, metal shavings, etc.) and large swelling in the injured / sick person. He then examines whether the person feels his touch and whether he has a feeling of tingling and heat. He also demands that the injured person raise his hand, bend it at the elbow and move his fingers. If the fingertips are pale or gray-blue, peripheral circulation is probably disturbed (for example due to bone fractures). In addition, it controls the color of the nails. He especially takes into account whether the person is a drug addict, ie. looking for traces of stings on the veins of the hands.
> Lower extremities – assesses sore spots, the presence of foreign bodies and wounds (active bleeding) on the victim’s legs, without removing shoes. He then checks mobility (bending the leg at the knee and ankle and moving the toes) and sensitivity of the feet, and finally notices the color of the nails and skin on the toes (gray-blue skin may indicate circulatory disorders or cold-related injuries).
It is usually enough to remove clothes only from the injured part of the body. It is usually necessary to release the pressure of tight-fitting clothing against the body of the injured person. If clothes and shoes cannot be removed without moving, or if there is a danger of worsening the existing injury, its parts are removed by tearing along the seams or by cutting (scissors, knife, razor) in the shape of a “window”.
In order to properly remove a coat, jacket, blouse, shirt or sweater, when the upper limbs are injured, the injured arm is supported first. Removing clothes starts from the shoulder of a healthy hand, then gently pulls parts of the clothes from the injured hand.
Proper removal of shoes, socks and pants for injuries of the lower extremities begins with supporting the injured leg. First, loosen the belt or belt on the pants and gently pull off the garments. The shoes are easily removed by holding the ankle. If the injured person has high boots, they are cut.