Assessments explained - Primary survey
Primary survey
General impression: Is your patient sick or not sick, injured or not injured. How is your patient presenting; what position were they found in, are they in obvious distress, what is the patient’s current affect or mood.
Level of consciousness / AVPU (Alert, Verbal, Pain, Unconscious):
· Alert: Is your patient immediately aware of your presence upon arrival? If so, your patient is Alert. When you have a patient who is alert, you must establish a level of orientation. This is done by asking 4 objective questions that most people would reasonably be expected to answer correctly. Examples include: who is the current president, what is the current year or month, the city in which the patient currently is, what has happened, how many quarters make a dollar, who a family member present on scene is, etc. Avoid asking questions involving color identification as some patients may be color blind. As well, avoid asking your patient what the current date is. If your patient is able to answer all four questions correctly, they are alert and oriented x 4. This is written out A&Ox4. If your patient is only able to answer 3 questions correctly, they are A&Ox3, and so on. If your patient is unable to answer any questions correctly, they are A&Ox0, or alert and disoriented.
· Verbal: If your patient is not immediately aware of your presence upon arrival, attempt speaking to them to attract their attention. If they respond to your presence when you speak, they are alert to Verbal stimulation.
· Pain: If you patient does not respond to your presence when you speak, attempt to gain their attention by squeezing the trapezius muscle or apply firm pressure to the patient’s fingernail with a pen. If your patient responds to pain, they are alert to Painful stimulation.
· Unconscious: If your patient does not respond to any verbal or painful stimuli, they are Unconscious.
Chief complaint / apparent life threats: The chief complaint differs from the MOI/NOI as this is the complaint that the patient verbalizes to you, as opposed to dispatch’s call nature of illness/mechanism of injury. For example, you are dispatched for chest pain. Upon arrival, the patient states that they are experiencing a burning sensation in their chest. The nature of illness would be chest pain, whereas the chief complaint would be a burning sensation in the chest.
