Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section I: General Principles

Check for a pulse and perform a quick sweep for severe bleeding or other problems capable of causing shock. While you are doing this, assess brain function by noting mental status and level of consciousness.

with circumstance. It is not necessary or efficient to stop and treat problems as you find them. Get the whole picture, complete your list, and then return to treat each problem in order of priority.

General Principles

Secondary Assessment

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General Principles

Primary Assessment

Complete Then Treat

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Stabilize the Patient

Physical Exam SAMPLE History

Secondary Assessment

Circulatory Respiratory

Pulse Bleeding

Airway Breathing

Primary Assessment

Vital Signs

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Nervous

“Get the whole picture, complete your list, then return to treat each problem in order of priority.”

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AVPU Spine

“The initial assessment is your quick-check on the status of the patient's three critical body systems.”

©2018WMA

©2018WMA

Most practitioners in the civilized setting are accustomed to patients sitting quietly on an exam table and prefer to start their exam with the head and neck and then move to the chest, abdomen, pelvis, legs, arms, and back. It is comforting to have a routine, making the process more efficient and reassuring for both the examiner and the patient. A well-rehearsed routine will be even more valuable in the backcountry situation when you are challenged by wind, cold, radio traffic, and scene management. You may not yet know what the problem is, but you know what to do: exam- ine the patient. Conducting your exam will calm you down, focus your attention, and give you the information that you need. Your exam should be as comprehensive as the situation requires and allows. Realistically, the order in which you perform your exam makes no difference. Start where it makes sense to start. If the patient is lying face down, examine the back first. It is not necessary to see or feel every body part in every patient. If no symptom or MOI sug- gests involvement, exposure and examination are not important in the field. It is important that the rescuer go through a complete head-to-toe checklist, mentally if not physically. The complaint of a sprained thumb by an oth- erwise healthy person does not warrant a com- plete survey with vital signs and a full physical

Your primary assessment might be as simple as asking, “How do you do?” and getting a “Fine” and a smile. Or, you might be on belay in a crevasse lis- tening for breath sounds and looking inside bulky clothing for blood on an unresponsive climber. Whatever form it takes, the primary assessment is a critical step in your organized approach to the situation. Any serious problems encountered in the primary assessment must be immediately stabilized before worrying about anything else. Your immediate treatment of life-threatening problems found in the primary assessment is referred to as Basic Life Support (BLS) and may include cardiopulmonary resuscitation (CPR), airway control, bleeding control, and protection from extremes of heat or cold. Advanced life sup- port (ALS) adds medications and specialized tools to manage these same critical system problems. You may not get any further than BLS or ALS with your assessment and treatment if the injury or illness is severe. In most cases, however, you will be able to rule out or stabilize life-threatening problems and go on to the secondary assessment. The Secondary Assessment The secondary assessment involves gathering a relevant medical history, investigating the patient’s chief complaint, and systematically assessing the patient. Speed and detail change