The Primary Assessment

Question 1

What things do you keep in mind with the primary assessment

Answer 1

• Focus on life threats
• Airway (A), breathing (B), circulation (C) • May vary depending on
– Patient’s condition
– On the scene resources
– Other
• Order of A-B-C depends on initial impression of patient
• Sequence will vary
– A-B-C if patient has signs of life
– C-A-B if patient appears lifeless, no pulse – Immediate interventions may be needed

Question 2

What are the Primary Assessment Steps

Answer 2

• Forming a general impression •
 Assessing mental status
• Assessing airway
• Assessing breathing
• Assessing circulation
• Determining patient priority

Question 3

What are the steps in forming a General Impression

Answer 3

• Assesses environment, patient’s chief
complaint, and appearance
• Helps determine patient severity
• Helps set priorities for care and transport
• “Look Test”: feeling from environmental observations as well as first look at patient

Question 4

What are the findings during a General Impression that indicate the patient may be critical

Answer 4

– Altered mental status
– Anxiety
– Pale, sweaty skin
– Obvious trauma to head, chest, abdomen, pelvis
– Specific positions indicating distress

Question 5

During the general impression if the patient appears lifeless what do you do

Answer 5

– Resuscitate by beginning CPR compressions

– Prepare AED as soon as possible

Question 6

What do you do while forming a general impression

Answer 6

• Look
– Patient’s age, sex, and position
• Listen
– Moaning, snoring, or gurgling respirations
• Smell
– Fumes, urine, feces, vomitus, or decay

Question 7

Chief Complaint

Answer 7

• Patient’s description of why EMS was
called
• May be specific—“abdominal pain” • May be vague—“not feeling good”

Question 8

What does AVPU stand for

Answer 8

• Alert
– Document orientation to person, place, and time
• Verbal response 
• Painful response 
• Unresponsive

Question 9

During the primary assessment what are situations that require action

Answer 9

• If airway is not open or is endangered, take measures to open
• Situations calling for breathing assistance
– Respiratory arrest
– Not alert, inadequate breathing
– Some alertness, inadequate breathing
– Adequate breathing, but signs suggesting respiratory distress or hypoxia

Question 10

How do you assess circulation

Answer 10

• Assess pulse
• Assess skin
• Assess bleeding

Question 11

What are the three results when assessing pulse

Answer 11

– Within normal limits
– Unusually slow
– Unusually fast

Question 12

Other than pulse what other indicator is used

Answer 12

• Assessing skin
– Good circulation: warm, pink, dry skin
– Shock: pale, clammy (cool and moist) skin

Question 13

During the primary assessment what issues require immediate intervention

Answer 13

• Treat any life- threatening ABC problem as soon as discovered!

Question 14

How do you determine patient priority

Answer 14

• Stable
– Vital signs in normal range
• Potentially unstable
– Potential for deterioration can indicate
potentially unstable category • Unstable
– Threat to ABC’s rules out stability

Question 15

How do you determine the need for a priority transport

Answer 15

• Initiate priority transport if a life-threatening problem cannot be controlled or threatens to recur
• Continue assessment and care en route

Question 16

What characteristic of the Patient determine the form of assessment

Answer 16

– Medical or traumatic problem?
– Altered mental status?
– Child or adult?

Question 17

What do you need to do when assessing a pediatric patient

Answer 17

• Adjust assessment to social and physiological norms of children

Question 18

How might normal findings in a primary assessment differ for a child compared with an adult?

Answer 18

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Question 19

What are the steps of the Primary Assessment

Answer 19

• Despite patient characteristics, follow primary assessment steps systematically
– General impression – Mental status
– ABCs
– Priority for transport

Question 20

Things to keep in mind for the primary assessment

Answer 20

• Primary assessment is a systematic approach to quickly find and treat immediate threats to life.
• General impression, although subjective, can provide extremely useful information regarding urgency of a patient’s condition.
• Determination of mental status follows the AVPU approach.
• Evaluating airway, breathing, and circulation quickly but thoroughly will reveal immediate threats to life that must be treated before further assessment.
• Patient’s priority describes how urgent patient’s need to be transported is and how to conduct the rest of the assessment.

Question 21

During the primary assessment remember

Answer 21

• Determine if a problem is medical or
traumatic in nature.
• Determine if a patient is responsive or unresponsive; an adult, child, or infant.
• Rapidly identify the need for immediate airway intervention.
• Determine if the patient’s condition is stable enough to allow further assessment and treatment at the scene.

Question 22

• What factors will you take into account in

forming a general impression of a patient?

Answer 22

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Question 23

How should you assess a patient’s mental status with regard to the AVPU levels of responsiveness?

Answer 23

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Question 24

• How should you assess airway, breathing, and circulation during the primary assessment?

Answer 24

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Question 25

• What is meant by the term priority decision?

Answer 25

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Question 26

• A middle-aged male is lying on the street after being hit by a car. He appears unresponsive as you approach. You notice that he is bleeding from a laceration on his forearm and making gurgling sounds from his airway.

Answer 26

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Question 27

• If you are alone, what factors do you consider in deciding what to do first? Why?

Answer 27

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