Secondary examination of a person at an accident scene

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:

You see a person sitting near the wall of a house and calling for help.

Equipment for the practical skill:

• protective medical gloves;
• full body human mannequin (patient care simulator).

The procedure for performing a practical skill

• Establish psychological contact with a person:
  • introduce yourself;
  • obtain consent to help;
  • state the type and level of training that you have;
  • explain what you think is wrong;
  • explain what you plan to do;
• Interview the person:
  • S = Signs and symptoms. Take note of signs (which you can observe for yourself, using your senses) and ask the person about symptoms (feelings that only the person can describe to you, such as pain, shortness of breath or nausea).
  • A = Allergies. Ask the person about allergies, noting causes of allergic reactions in the past and whether the allergic reaction was severe or life threatening.
  • M = Medications. Ask the person about over-the-counter and prescription medications that he or she is taking. Ask about the name of the medication and when the person last took it.
  • P = Pertinent medical history. Ask the person whether he or she has any medical conditions.
  • L = Last food or drink. Ask the person when he or she last had something to eat or drink, what the person ate or drank, and how much.
  • E = Events leading up to the incident. Ask the person what was happening and what he or she was doing just prior to when he or she began to feel ill or was injured.
• Check the person from head to toe:
  • Check the breathing
    • rate (fast or slow);
    • depth (shallow or deep);
    • nature (is it easy or difficult, noisy or quiet).
  • Check the pulse
    • rate (fast or slow);
    • rhythm (regular or irregular);
    • strength (strong or weak).
  • Start the physical examination at the casualty's head: run your hands carefully over the scalp to feel for bleeding, swelling, or depression, which may indicate a fracture. Be careful not to move the casualty if you suspect that she may have injured her neck.
  • Examine both ears.
    • Speak clearly to the casualty in both ears to find out if she responds or if she can hear.
    • Look for clear fluid or watery blood coming from either ear. (These discharges may be signs of a serious head injury).
  • Examine both eyes.
    • Note whether they are open.
    • Check the size of the pupils (the black area). If the pupils are not the same size it may indicate head injury.
    • Look for any foreign object, or blood in the whites of the eyes.
  • Examine the nose.
    • Check the nose for discharges as you did for the ears. Look for clear fluid or watery blood (or a mixture of both) coming from either nostril.
    • Soot around the nostrils or singed nasal hairs might indicate serious airway burns.
  • Examine the mouth.
    • Look in the mouth for anything that might obstruct the airway. If the casualty has dentures that are intact and fit firmly, leave them.
    • Look for mouth wounds or burns and check for irregularity in the line of the teeth.
  • Look at the lips, ears, and face skin.
    • Note the color and temperature: is it pale, flushed, or gray-blue (cyanosis); is it hot or cold, dry or damp? Pale, cold, sweaty (clammy) skin suggests shock; a flushed, hot face suggests fever or heatstroke. A blue tinge indicates lack of oxygen.
  • Loosen clothing around the neck, and look for signs such as a medical warning necklace or a hole (stoma) in the windpipe.
  • Run your fingers gently along the spine from the base of the skull down as far as possible without moving the casualty; check for irregularity, swelling, tenderness, or deformity.
  • Examine the chest.
    • Ask the casualty to breathe deeply, and note whether the chest expands evenly, easily, and equally on both sides.
    • Feel the rib cage to check for deformity, irregularity, or tenderness.
    • Ask the casualty if she is aware of grating sensations when breathing, and listen for unusual sounds. Note whether breathing causes any pain.
    • Look for any external injuries, such as bleeding or stab wounds.
  • Examine the collarbones, shoulders, arms and hands.
    • Feel along the collarbones, shoulders, upper arms, elbows, hands, and fingers for any swelling, tenderness, or deformity.
    • Check the movements of the elbows, wrists, and fingers by asking the casualty to bend and straighten each joint.
    • Check that the casualty has no abnormal sensations in the arms or fingers.
    • Check the fingertips color. If the fingertips are pale or gray-blue there may be a problem with blood circulation.
    • Look out for needle marks on the forearms, or a medical warning bracelet.
    • If there is any impairment in movement or loss of sensation in the limbs, do not move the casualty to examine the spine, since these signs suggest spinal injury. Otherwise, gently pass your hand under the hollow of the back and check for swelling and tenderness.
  • Examine the abdomen.
    • Gently feel the casualty’s abdomen to detect any evidence of bleeding, and to identify any rigidity or tenderness of the abdomen’s muscular wall, which could be a sign of internal bleeding.
    • Compare one side of the abdomen with the other.
    • Note any bruising on the abdomen or pelvis.
  • Examine the legs.
    • Look and feel for bleeding, swelling, deformity, or tenderness.
    • Ask the casualty to raise each leg in turn, and to move her ankles and knees.
    • Feel both sides of the hips, and examine the pelvis for signs of fracture.
    • Check clothing for any evidence of incontinence, which suggests spinal or bladder injury, or bleeding from orifices, which suggests pelvic fracture.
    • Check the movement and feeling in the toes.
    • Check that the victim has no abnormal sensations in her feet or toes. Compare the feet.
    • Look at the skin color: gray-blue skin may indicate a circulatory disorder or an injury due to cold.
• Reassure the person by telling him or her that you will help and that EMS personnel have been called (if appropriate).
• Provide care for any conditions found.
• Help the person rest in a comfortable position.
• Continue to watch for changes in the person's condition until arrival of the ambulance.