Editing in Progress

Monitoring a Casualty

based on First Aid Manual 8th Edition (fully revised & updated) 2002.  page 42-3.  ISBN: 0-7513-3704-8.   www.dk/com/firstaidmanual

 

Introduction to monitoring a casualty                                                      

Any injury to a casualty can have unexpected effects on them; some very serious indeed.

Whilst awaiting professional help, a First Aider is advised to monitor various aspects of their casualty's status, often called "vital signs". This will assist the professional healthcare staff to watch out for improvement or deterioration in the casualty.

Accuracy is vital if monitoring of a casualty is undertaken. If you can't accurately assess something, don't guess! 

 

Levels of Response

Introduction

As you will already know, there are various states of consciousness, between fully conscious and unconscious. There are two ways that a casualty's level of response can be assessed:

  • AVPU scale                                                  (the quick and easy guide)

  • Scale based on the Glasgow Coma Scale   (the more complicated but detailed one)

 

A V P U

A Alert the highest level of response on this scale
V responds to Voice although not fully awake, they will react to a voice
P responds to Pain although they appear unconscious, pinching the back of their hand or ear-lobe gets some form of reaction.
U Unresponsive the casualty doesn't respond to voice or pain.

 

Scale based on the Glasgow Coma Scale

EYES:   do they:

  • open without being spoken to

  • open on being spoken to

  • open during a painful stimulus (eg pinch)

  • remain closed even when spoken to or pinched.

MOVEMENT:   does the casualty:

  • obey a simple command?

  • move if they receive a painful stimulus (eg pinch)

  • make no response even when spoken to or pinched.

SPEECH:   does the casualty:

  • respond sensibly to questions

  • appear confused

  • make sounds rather than words

  • make no sounds even when spoken to or pinched.

 

Breathing

Introduction

Breathing is something we don't usually think about. It just happens. It is controlled by an automatic system, called the autonomic nervous system.

The number of times an adult breathes (on average) is about 16 times per minute, when they are resting. A child breathes (on average 20 - 30 times per minute) when they are resting.

The sound of an individual's breathing is usually almost silent.

The breathing cycle has three distinct phases: breathing in, breathing out and then a short pause.

Monitoring breathing

SPEED:   

  • how many times per minute does your casualty breathe in one minute? NB adult breathing rate is about 16/minute. Children's breathing rate is between 20-30/minute.

 

NOISE:

  • is the breathing very quiet or does it have a noise (eg wheeze, snore, gurgle, etc)? NB Noisy breathing often means an airway obstruction.

DIFFICULTY:

  • does the casualty find it easy or difficult to breathe? NB Breathing should be relatively easy for the casualty to do. If they are aware of their breathing, this is often a sign of breathing difficulty.

 

RHYTHM:

  • does the breathing have a regularity about it? NB Breathing is usually regular. When a casualty has breathing problems, the pause in between their breaths can vary in length. This also applies to the breathing in times as well as the breathing out times.

 

DEPTH:

  • does the casualty appear to be taking short, sharp breaths or deep, full breaths? 

 

Pulse   -   this is never used to decide if resuscitation is required. Only for monitoring an alive casualty

Introduction

The pulse beat is caused by the heart beating. When the heart squeezes the blood out of it's chambers, it bangs against the main artery wall (aorta), which then causes the artery to wobble, causing a pulse.

The pulse is felt when an artery comes near to the surface of the body. First Aiders generally use the pulse in the wrist (radial) in a conscious casualty. In an unconscious adult casualty, First Aiders will use the casualty's neck pulse (carotid), if at all possible.  The pulse of a baby is felt on the inner side of the baby's upper arm.

Monitoring pulse

SPEED:   

  • how many times per minute does your casualty's pulse beat in one minute? NB adult heart rate is about 60/minute. A child's heart rate is faster than an adults. 

 

STRENGTH:

  • is the pulse itself weak (difficult to find and when found, hard to feel) or strong (easy to find and when found, bounding)? NB Strength of a casualty's pulse may be neither weak not strong. It may be just "normal".

 

RHYTHM:

  • does the pulse have a regularity about it? NB A pulse is usually regular. When a casualty has heart problems, the pause in between their beats can vary in length. 

 

External Internet Link/s

Please note that First Aid Training has no control over the content or accuracy of the site/s listed. Please evaluate the information for yourself.  How?

Sample observation chart, for you to copy, adapt if you wish & use

Sample Patient Report Form

 

Date this page was lasted edited: 08/04/2004

 

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