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Steps in scene size-up (PENMAN)
P - Personal protective equipment
E - Ensure scene safety
N - Number of patients
M - Mechanism of Injury/Nature of Illness
A - Additional resources
N - Need for c-spine
Steps of primary assessment
Form a general impression
Level of consciousness/mental status
Establish patient priorities
Assessment following scene size-up to discover and treat immediately life-threatening conditions.
What the patient tells you about what is wrong with him. The patient's answer to the question "Why did you call us today?"
Forming a General Impression includes:
Trauma or Medical
Identify and manage immediate life threats
A force that pierces the skin and body tissues
a force that impacts or is applied to the body but is not sharp enough to penetrate it
Bringing the patient's head into a neutral position in which the nose is lined up with the navel and holding it there manually.
Mnemonic for assessment of mental status.
A - Alert
V - Responds to verbal stimuli
P - Responds to painful stimuli
U - Unresponsive
Used to quickly establish a baseline for mental status during the primary assessment.
Alertness and Orientation
Most often means the patient's eyes are open and he is able to speak as you approach.
Responsiveness to verbal stimulus.
When patient opens his eyes and responds or makes an attempt to respond only when you speak to him.
Responsiveness to painful stimulus.
When the patient responds only when painful stimulus is applied.
Flexion posturing (decorticate posturing).
Back arched, arms flexed inward toward the chest.
Extension posturing (decerebrate posturing).
Back arched, arms extended straight out parallel to the body.
Patient who does not respond to verbal or painful stimuli. Commonly have no gag and cough reflexes.
Clopsed or blocked; not patent, as an occluded airway.
Open; not blocked, as a patent airway.
Rough, snoring-type sound on inspiration and/or exhalation. Indicative of blockage of the upper airway.
Sound similar to air rushing through water on inspiration and/or exhalation. Indicative of a liquid substance in the airway.
A sound like a cawing crow on inspiration. Commonly associated with swelling or muscle spasms.
A harsh high-pitched sound on inspiration. Commonly associated with swelling or muscle spasms.