CHAPTER 27

EMERGENCY OR
LIFE-THREATENING
SITUATIONS

Slide 1
THE ABCS OF PRIMARY
ASSESSMENT

Slide 2
• The ABCs of Primary Assessment

Emergencies
 Requires alterations in usual sequence of history
taking and examination
 Rapid identification and management of injury
 Assessment with treatment priorities based on
physiologic conditions and stability of vital signs
 Logical and sequential priority system implemented for
overall assessment

Slide 3
• The ABCs of Primary Assessment

Emergencies
 Recommended approach for treatment
 Rapid primary assessment
 Secondary assessment
 Definitive care

Slide 4
• The ABCs of Primary Assessment

Primary Assessment
 A = Airway is maintained and cervical spine
control is performed.
 B = Breathing is assessed.
 C = Circulation is assessed and hemorrhage
controlled.
 D = Disability is assessed with patient’s
degree of responsiveness.
 E = Exposure: Undress patient to identify all
injuries.

Slide 5
• The ABCs of Primary Assessment

Secondary Assessment (1)

 General
 Vital signs
 Head-to-toe survey
 Glasgow coma scale

Slide 6
• The ABCs of Primary Assessment

Secondary Assessment (2)

 Abbreviated history (AMPLE)
 A = Allergies
 M = Medications currently taken
 P = Past illnesses
 L = Last meal
 E = Events preceding the incident

Slide 7
• The ABCs of Primary Assessment

Secondary Assessment (3)

 Head and neck  Rectum and perineum
 Chest  Neurologic examination
 Abdomen  Reevaluation
 Back  Urgent or emergent
 Extremities threat

Slide 8
INJURY ASSESSMENT

Slide 9
• Injury Assessment

Injury Assessment
 Trauma
 Blunt
 Penetrating
 Burns

Slide 10
• Injury Assessment

Infants and Children

 Secondary assessment in children
 Weight
 Approximated systolic blood pressure
 Patent airway in crying child
 Capillary refill time
 Responsiveness

Slide 11
• Injury Assessment

Infants and Children

 Intervention
 Establish rapport.
 Obtain history (AMPLE) with additional questions
about mother’s pregnancy and delivery.
 Get as much history as possible from child.
 Evaluate with deliberate speed.

Slide 12
RECORDS AND LEGAL
CONSIDERATIONS

Slide 13
• Records and Legal Considerations

Records
 Meticulous record keeping is essential.
 Memory unreliable
 Recording of observations, evaluations, orders, and
what was and was not done
 Thorough, concise, clear, and accurate
 Chronologic order of events
 Legibility

Slide 14
 • Records and Legal Considerations

Consent for Treatment

 Life threatening: Treat first, get consent later.
 Forensic trauma: Preserve evidence.

Slide 15
• Records and Legal Considerations

Advance Directives
 Advance directives
 Living wills
 Durable power of attorney for health care

Slide 16
 Summary (1)
 Evaluation and care are divided into four phases:
 Primary assessment: assessment of ABCs
 Airway assessment and management when C-spine control is
performed.
 Breathing is assessed and ventilation is assisted as needed.
 Circulation is assessed, with hemorrhage control or shock
management.
 Disability: neurologic function is briefly evaluated.
 Exposure: completely undress the patient whenever possible
but keep the patient warm, particularly an infant or child.

Slide 17
Summary (2)
 Resuscitation
 The management of life-threatening problems
identified in the primary survey is continued.
 Mechanical monitoring is implemented.

Slide 18
 Summary (3)
 Secondary assessment
 Take vital signs.
 Develop the history, guided by the mnemonic AMPLE.
 Total evaluation of the patient is performed in the following
areas: head and skull, neck, chest, abdomen, rectum and
perineum, and extremities (for fractures).

Slide 19
 Summary (4)
 Secondary assessment - continued
 Complete neurologic examination is performed, along
with appropriate x-ray examinations, laboratory tests,
and special studies.
 “Tubes and fingers” are in every orifice.

Slide 20
 Summary (4)
 Definitive care
 Diagnosis and treatment specific to the condition
can begin after:
 Identifying and ascertaining patient’s injuries
 Managing life-threatening problems
 Obtaining special studies

Slide 21
 Summary (5)
 Definitive care - continued
 The following factors must return to comfortable levels
before you can relax:
 Heart rate
 Respiratory rate
 Level of consciousness
 Capillary refill time
 Assessment of central versus distal pulses

Slide 22
 Summary (6)
 Definitive care - continued
 Positive assessments of the following issues are
essential until the clinical situation stabilizes:
 100% oxygen
 Cervical immobilization
 Maintenance of core temperature

Slide 23
Thank You for a Great Semester