NREMT EMT 2: Primary Assessment - Forming a General Impression, Level of Consciousness, AVPU Scale, Alert, Verbal, Pain, Unresponsive

What This Is

Forming a general impression, also known as assessing the level of consciousness, is a crucial step in emergency care. It helps determine how alert and responsive a person is after an injury or illness. Think of it like checking the dashboard lights on your car – if the warning lights are flashing, you need to take action. In emergency medicine, the AVPU scale is used to quickly assess a person's level of consciousness: Alert, Verbal, Pain, Unresponsive.

Key Steps / Core Facts

• AVPU Scale: A simple way to assess level of consciousness (AVPU, Alert, Verbal, Pain, Unresponsive).
  • Why it matters: Helps determine the severity of the situation and guide treatment.
  • Example: A person who is Alert can talk and respond to questions, while someone who is Unresponsive doesn't react at all.
• Level of Consciousness: A person's awareness of their surroundings and ability to respond.
  • Why it matters: Affects treatment decisions, such as administering medications or starting CPR.
  • Example: A person who is Alert can follow commands, while someone who is Unresponsive can't.
• Pupils: The black dots in the center of the eyes that control light entry.
  • Why it matters: Abnormal pupil size or reactivity can indicate a serious condition.
  • Example: A person with Pupils that are constricted (small) may be experiencing a serious head injury.
• Airway: The passage through which air enters and leaves the lungs.
  • Why it matters: A blocked airway can lead to respiratory failure.
  • Example: A person who is Unresponsive may have a blocked airway.
• Breathing: The process of taking in oxygen and expelling carbon dioxide.
  • Why it matters: Abnormal breathing patterns can indicate a serious condition.
  • Example: A person who is Breathing abnormally (e.g., gasping, wheezing) may need oxygen.
• Circulation: The flow of blood through the body.
  • Why it matters: A person with poor circulation may be at risk for cardiac arrest.
  • Example: A person who is Cold to the touch may have poor circulation.
• Pulse: The rhythmic expansion and contraction of the arteries.
  • Why it matters: A person with a weak or absent pulse may be at risk for cardiac arrest.
  • Example: A person who is Pulseless may need CPR.
• Blood Pressure: The force of blood pushing against the walls of the arteries.
  • Why it matters: Abnormal blood pressure can indicate a serious condition.
  • Example: A person with Hypotension (low blood pressure) may be at risk for shock.

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 the person is unresponsive, call 911 or your local emergency number.
• If the person is breathing, but not responding, try to keep them calm and comfortable until help arrives.
• If the person is not breathing, start CPR (if you're trained) or use an automated external defibrillator (AED) if available.

Common Mistakes

• Mistake: Assuming someone is Alert just because they're talking.
  • Fix: Look for other signs of alertness, such as responsiveness to questions or commands.
• Mistake: Failing to check for Danger before approaching an unresponsive person.
  • Fix: Always check for potential hazards before trying to help someone.
• Mistake: Not using the AVPU Scale to assess level of consciousness.
  • Fix: Use the AVPU scale to quickly and accurately assess a person's level of consciousness.

Quick Practice Scenarios

1. A person is found unresponsive on the floor. What should you do first?

Call 911 or your local emergency number.

1. A person is breathing, but not responding to questions. What should you do first?

Try to keep them calm and comfortable until help arrives.

1. A person is pulseless and not breathing. What should you do first?

Start CPR (if you're trained) or use an AED if available.

Last-Minute Exam Cram

• Normal blood pressure: 90-120/60-80 mmHg
• Normal pulse: 60-100 beats per minute
• Normal breathing rate: 12-20 breaths per minute
• AVPU scale: Alert, Verbal, Pain, Unresponsive
• OPQRSTI: Onset, Provocation, Quality, Region, Severity, Timing, Insurance (for pain assessment)
• Agonal breathing is NOT normal breathing – start CPR
• A person with a weak or absent pulse may be at risk for cardiac arrest
• A person with abnormal pupil size or reactivity may have a serious head injury
• A person with poor circulation may be at risk for shock