Primary Assessment (Life Threats First)
The primary assessment is done in under 60 seconds. Its only job is to find and fix immediate life threats. Follow A-B-C-D-E in order — don't skip ahead.
If you find a life threat in the primary assessment, fix it before moving to the next step. Airway obstruction → clear it now. Major arterial bleed → pack and pressure now. Don't document it and move on — address it.
SAMPLE History
SAMPLE is your structured history-taking tool. Ask these questions on every patient — they reveal the cause of the emergency and guide your treatment.
OPQRST — For Pain & Symptom Assessment
Use OPQRST whenever a patient has pain or a specific complaint. It drills down into the complaint so you understand it fully.
Vital Signs
Vital signs are objective measurements of how the body is functioning. Know the normal ranges — abnormals tell you where the patient is headed.
| Vital Sign | Normal Adult | Abnormal — Low | Abnormal — High |
|---|---|---|---|
| Heart Rate (HR) | 60–100 bpm | <60 = bradycardia | >100 = tachycardia |
| Blood Pressure (BP) | 120/80 mmHg | SBP <90 = hypotension | SBP >180 = hypertensive |
| Respiratory Rate (RR) | 12–20 breaths/min | <12 = bradypnea | >20 = tachypnea |
| SpO₂ | 95–100% | <94% = give O₂ | 100% = possible hyperoxia post-arrest |
| Temperature | 98.6°F / 37°C | <96°F = hypothermia | >100.4°F = fever |
| Blood Glucose | 70–110 mg/dL | <70 = hypoglycemia | >200 = hyperglycemia |
Skin Assessment
Skin tells you a tremendous amount about perfusion, oxygenation, and cardiac output in seconds — no equipment needed.
- Color: Pink = normal | Pale = poor perfusion or blood loss | Cyanotic (blue) = hypoxia | Flushed (red) = fever, heat, vasodilation
- Temperature: Warm = normal | Cool = shock, hypothermia, poor perfusion | Hot = fever, heat emergency
- Moisture: Dry = normal | Diaphoretic (sweaty) = shock, MI, hypoglycemia, heat exhaustion
This combination — pale, cool, and sweaty — is the classic triad of shock. The sympathetic nervous system is in overdrive trying to compensate for poor perfusion. Take it seriously even if their BP looks okay.
Secondary Assessment
Done after life threats are addressed. A head-to-toe physical exam to find additional injuries or findings. In trauma: always do a full head-to-toe. In medical: focus on the system involved plus a baseline exam.
- Head: Deformities, lacerations, DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling)
- Neck: Tracheal deviation (tension pneumo), JVD (right heart failure, tension pneumo), spine tenderness
- Chest: Paradoxical motion, crepitus, breath sounds bilaterally, equal chest rise
- Abdomen: Distension, rigidity, guarding, tenderness by quadrant
- Pelvis: Stability (compress gently — don't rock repeatedly)
- Extremities: PMS — Pulse, Motor, Sensation — in all four limbs
- Back: Spine tenderness, posterior wounds (roll carefully)