NREMT EMT 2: Primary Assessment - Circulation Assessment, Pulse, Skin Color/Temperature/Moisture, Capillary Refill

What This Is: Circulation Assessment

Circulation assessment is checking how well blood is flowing through a person's body. This is crucial in emergencies because it can help determine if someone is in shock, has a heart problem, or is bleeding too much. Think of circulation like a water pipe – if the water isn't flowing, the whole system is affected.

Key Steps / Core Facts

• Pulse: A normal pulse is 60-100 beats per minute. Check the pulse in the neck (carotid pulse) or wrist (radial pulse). A weak or absent pulse can indicate shock or cardiac arrest. (AVPU)
• Skin Color: Normal skin color is pink. Pale or blue skin can indicate poor circulation or shock. Check for any changes in skin color, especially in the hands and feet.
• Skin Temperature: Normal skin temperature is around 98°F (36.7°C). Cold skin can indicate poor circulation or shock. Check for any changes in skin temperature, especially in the hands and feet.
• Skin Moisture: Normal skin is moist. Dry skin can indicate dehydration or poor circulation. Check for any changes in skin moisture, especially in the mouth and lips.
• Capillary Refill: Normal capillary refill is less than 2 seconds. Check by pressing on a fingernail bed and releasing – it should return to normal color quickly. Slow capillary refill can indicate poor circulation or shock.
• Pulse Oximetry: A pulse oximeter measures oxygen levels in the blood. Normal oxygen levels are 95-100%. Low oxygen levels can indicate respiratory or cardiac problems.
• Blood Pressure: Normal blood pressure is around 120/80 mmHg. Low blood pressure can indicate shock or dehydration.
• Edema: Normal edema is minimal. Excessive edema can indicate fluid overload or poor circulation.
• Perfusion: Normal perfusion is even and strong. Poor perfusion can indicate shock or cardiac arrest.
• Red Flags: Look for signs of shock, such as pale skin, cool skin, rapid breathing, and weak pulse.

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to see if they respond.
• If someone is bleeding heavily, apply pressure to the wound with a clean cloth or bandage.
• If someone is having a heart attack, call 911 and try to keep them calm.
• If someone is in shock, try to keep them warm and comfortable.
• If someone is having a seizure, try to keep them safe and turn them onto their side.

Common Mistakes

• Mistake: Not checking the pulse in both arms and legs.
• Fix: Check the pulse in both arms and legs to ensure circulation is normal.
• Mistake: Not checking for signs of shock.
• Fix: Look for signs of shock, such as pale skin, cool skin, rapid breathing, and weak pulse.
• Mistake: Not using a pulse oximeter to check oxygen levels.
• Fix: Use a pulse oximeter to check oxygen levels and ensure they are within normal range.
• Mistake: Not checking for edema.
• Fix: Check for edema and look for signs of fluid overload or poor circulation.

Quick Practice Scenarios

• A patient comes in with a weak pulse and pale skin. What should you do first?
• Check for signs of shock and try to keep them warm and comfortable.
• A patient is bleeding heavily from a wound. What should you do first?
• Apply pressure to the wound with a clean cloth or bandage.
• A patient is having a heart attack. What should you do first?
• Call 911 and try to keep them calm.

Last-Minute Exam Cram

• Normal pulse: 60-100 beats per minute.
• Normal blood pressure: 120/80 mmHg.
• Normal oxygen levels: 95-100%.
• Normal capillary refill: less than 2 seconds.
• Agonal breathing is NOT normal breathing – start CPR.
• A weak or absent pulse can indicate shock or cardiac arrest.
• Pale or blue skin can indicate poor circulation or shock.
• Low blood pressure can indicate shock or dehydration.
• Excessive edema can indicate fluid overload or poor circulation.
• AVPU: Alert, Verbal, Pain, Unresponsive.
• SAMPLE: Size, Age, Medical history, Allergies, Last meal, Events leading up to the emergency.