Author Topic: "The 5 second/quick assessment in detail  (Read 1672 times)

ALPHIE OMEGA

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"The 5 second/quick assessment in detail
« on: October 05, 2009, 05:42:50 PM »
There have been a lot of questions regarding “quick” assessment in emergency situations. At Alphie Omega Training this is just one part of the assessment process that we teach. I Teach what I call the “5 second assessment.”

To begin to understand this process we will start with some normal values and other information so we have a basis for the understanding of the results of the assessment.
1.Pulse: normal pulse is strong and regular with a rate of between 60 and 100 beats per minute. We will be using the pulse at the wrist, the Radial pulse, or the femoral pulse, which is located in the pelvic region and the carotid pulse located on the neck. If we have a radial pulse we can assume a systolic blood pressure of around 90. If we can not feel the radial pulse but can find the femoral pulse the systolic blood pressure is around 80 and if the only pulse we can palpate is the carotid pulse in the neck we can assume a systolic blood pressure of around 70. If the pulse is not regular we can assume the heart is not beating effectively for one reason or another and that there has been damage to the heart and /or the conduction system of the heart causing it to beat erratically and ineffectively which in turn may also effect Systolic blood pressure (lowering it). If the pulse is weak we can assume that the heart is either not beating/pumping blood effectively or for one reason or another there is not enough volume of blood to pump or that the space the blood occupies has expanded.( dilation of the blood vessels has occurred. All these points allow us to make an assumption that some type of shock has occurred. We will talk about the types of shock later as that is a subject in its self.

2 .Capillary refill is another “quick” check item that can help us make educated decisions as to the extent of injury or degree of shock or blood loss, etc. To check capillary refill we “blanch” the nail bed of the finger. What I mean by blanch is to squeeze the nail bed and watch for return of the pink color. The normal color of the nailbed should be pink. So just glancing at the nailbed can provide us with information about cardiac function. When blanching the nailbed we would like to see the color change to pale/white and almost immediately watch the pink color return. A delay of greater than 3 seconds is significant for decreased cardiac function for one reason or another AND thus some form of shock or blood loss etc.

3. Conscious level is another indicator of cardiac function or adequate perfusion of the cells within the brain and therefore adequate oxygenation of the tissues and exchange of nutrients and wastes at the cellular level. Changes in conscious level are easy to obtain/see and no further explanation of normal conscious level should be needed. If we ask some simple questions we can test long term, short term memory and the ability to think straight and accurately. The normal questions are related to knowing name, place and time and asking what happened. What’s your name? Do you know where you are? Do you know the date today? Can you tell me what happened? Other questions can be asked in regards to the injuries, pain, what they are feeling etc as time and condition allows as long as the patient remains alert and oriented and capable of responding.
4. Skin moisture and temperature and color are other quick indicators in the assessment process. Normal skin temperature is warm to touch, the skin should be pink in color and the moisture content should be dry to the touch. Any abnormal changes in the above findings leads us to other diagnostic findings as to the cause of the abnormalities
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5. Respirations should be at a rate of 16 to 20 to 24 times per minute. Slower than 16, in most cases reflects damage to the respiratory drive system and greater than 20 to 24 indicates rapid breathing or tachypnea a need of the body for more air ie: air hunger or some type of difficulty in getting air in and out due to damage of one type or another. Normal respirations are without noise otherwise known as “clear.” Any abnormal noise must be investigated for cause. Abnormal sounds could be high pitched wheezing indicating constriction or obstruction in the bronchial tubes leading to the lungs. Wet sounds identified as rhonci / rales indicate obstruction from fluids.
6.OBSERVE THE SURROUNDINGS!!! Use all your senses as you approach someone who is injured and gather all the intel you can. Are there abnormal smells? Tastes? Visual hazards ie fire, chemical smells, electrical lines, gas fumes, smoke? Is it safe to approach the victim? Gunfire present? Before you even begin to assessment the victim assess the situation and the environment and make sure it is safe before you commit yourself to helping the victim otherwise you to may become a liability and a victim never even getting the opportunity to help the victim

Now we have reviewed the normal values we seek to prove and the abnormals we must identify in order to begin a basis of treatment.
Now back to where this began doing the “5 second assessment.”
First we begin by observing the environment we are entering to help the victim and make sure at all costs that the area is safe to approach. Once we have determined the area is safe we begin by speaking to/at the victim(s) we approach and see if we get a verbal response back from them. If we do hear them speak we know at least that they are breathing, conscious and able to respond. Once we get to the victim we want to reach for the hand, shake it or at least attempt to, checking neurological function and check the pulse from the wrist, at the same time we can continue to speak to the victim asking questions to assess more neuro functions as well as establishing rapport with the victim. At the same time we can assess the rate and quality of the pulse, capillary refill, skin temperature and moisture and respiratory function as we ask questions. After practicing this approach a few times you cab see how quickly you can assess multiple functions of the body almost at the same time and using absolutely no equipment other than our senses. While this quick assessment only provides us with normal versus abnormal findings it does allow us to obtain a lot of info quickly and let us move on to the needed treatment modalities quickly, effectively, and accurately. We can assess all the ABC’s as well as neurological  function and more in a matter of seconds. As time allows we can make a more detailed head to toe assessment and look for other non obvious injuries/ concerns that need attention.
Hope this all makes sense , it is sure a lot easier to teach in person then to detail out in writing for all to understand.