SIGNS

A sign is what you observe using your senses (i.e. sight, touch, smell & hearing).

Reassessment of the Vital Signs

The vital signs that you obtain serve two important functions. The first set is to establish a baseline of the patient’s neurological, respiratory and cardiovascular systems and the quality of perfusion and oxygenation of the brain and other vital organs.

The second set is to determine whether the treatment that you are providing has restored the vital signs to an acceptable range or is at least preventing further deterioration.

In an unstable patient the vital signs should be taken and recorded every 5 minutes or after a medical intervention and with stable patients every 15 minutes

Other Signs

• Bleeding: Type and volume. 
• Fractures: Crepitus, deformity, swelling, bruising. 
• Incontinence, vomiting, groans, reflexes, smell of breath (acetone).
• Needle marks, suspicious articles (OD's). 
• Medic - Alert bracelet or medallion. 

SYMPTOMS

 A symptom is what the patient complains about.  

Problems with patient assessments

• Type of injury:

- More than one serious injury. 

- Severe traumatic injury which taxes the emotional stability of the first aider. 

• Type of patient: 

- More than one. 

- Special (blind, deaf, dumb, drunk, uncooperative). 

•  Type of conditions:

- Dangerous (cross fire, fires, confined spaces, terrain). 

- Harsh weather conditions. 

- Uncomfortable environment (eg. small tunnel). 

- Uncooperative public.

Alert

Hello       

Identify yourself to the patient, bystanders or person in charge of the scene (e.g. I am John and a qualified first aider, may I help?).

Responsiveness

Try and determine if the patient is responsive (level of consciousness) (e.g. HELLO! Are you OK? Shoulder tap / sternal rub).

Help

Call for help and try to get a bystander (s) to help you.

Airway

Check the Airway

Check the airway for any visible obstructions. (Refer to the section on choking for the methods of clearing the airway).

If indicated, do a finger sweep or vomit roll.

Open the Airway

In the unconscious casualty the tongue often obstructs the airway. The following technique can be used to lift the tongue away from the back of the throat:

Head tilt - Chin lift (Pistol grip method).

Place one hand on the casualty's forehead gently tipping the head backwards, at the same time placing the other hand on the chin in the pistol grip position (The forefinger along the jaw line, the thumb pointing in the same direction on top of the chin. The 3 fingers that are not used are curled up and placed under the chin.). The chin is then lifted slightly opening the airway.

Opening The Airway – Head Tilt Chin Lift

Maintaining the Airway

Keep the airway open by keeping the hand on the forehead in place.

Breathing

Breathing is checked in the following way, for a minimum of 10 seconds:

LOOK ‑ at the casualty's chest and abdomen for breathing movements.

LISTEN‑ for sounds of breathing.

FEEL ‑ for airflow by placing your ear above the casualty's mouth and nose.

During checking for breathing you are trying to determine the following:

• Normal Breathing. The patient’s chest and abdomen is moving, breath sounds can be heard and the exhalation of air can be felt on the check.
• Respiratory Distress. If a person is suffering from respiratory distress (dyspnoea - difficult breathing), they are not providing their body’s tissues with enough oxygen. Some causes for respiratory distress include asthma, airway obstruction due to an object or allergic reaction, disease, and hyperventilation. (See page 8 for respiratory distress signs.)
•  Respiratory Arrest. If a person stops breathing, it is called respiratory arrest. When a person stops breathing, the vital organs, such as the brain, heart and lungs can only continue to be oxygenated for a very short period of time. If the breathing stops, the respiratory system must be supported through rescue breathing (see below) before the heart stops (cardiac arrest).

If Respiratory Distress or Arrest is confirmed the First Aider must initiate Rescue Breathing (see below).

ASPHYXIA

Asphyxia is a potentially fatal condition due to the lack of oxygen (O₂) available in the blood. The body's tissues are dependant on the respiratory and circulatory systems to supply them with O₂. If one of the two systems fails, the body experiences a shortage of O₂ which can lead to permanent tissue damage.

Conditions That Can Lead To ASPHYXIA

• Smothering and insufficient oxygen in the air.
• Obstruction of the trachea.
• Compression of the airway.
• Compression of the chest.
• Fluid in the lungs (Drowning & Oedema).
• Lung contusion.
• Injuries that affect the respiratory and nervous system.

Signs and Symptoms

• Dyspnoea (difficult breathing)
• Inability to make verbal sounds
• Universal distress signal
• Cyanosis (bluish discolouration of the lips, tongue, mucosa, skin and nail beds
• Exaggerated breathing
• No sounds of breathing
• Loss of consciousness

Treatment

• Remove cause
• Ensure airway is open
• Ensure patient gets enough oxygen

Foreign Body Airway Obstruction (Choking)

Respiratory emergencies, whether caused by a foreign body airway obstruction or as a result of illness or injury to any part of the respiratory system, are extremely distressful for the patient.

SIGNS AND SYMPTOMS

Partial Blockage

• Not a full expansion of the chest wall
• Sounds during exhaling (whistling)
• Cyanosis

Total Blockage

• No chest movement
• No audible sounds
• Unconsciousness
• Cyanosis