1. To rapidly assess and intervene for life-threatening conditions in critically ill or injured patients.

1. The presence of an environmental hazard, such as fire, noxious fumes, or explosion risk, that mandates immediate evacuation of the area takes priority over the primary assessment.

2. Do not proceed to the next assessment step until interventions for life-threatening conditions have been implemented.

Towel rolls, foam blocks, or other head-support devices

Stethoscope

Flashlight

Other equipment as indicated for resuscitative procedures

1. Assess airway patency while simultaneously maintaining cervical spine alignment with manual stabilization. Airway patency is assessed by looking for chest rise and fall and by listening and feeling for air movement from the nose and mouth. If the airway is partially or completely obstructed, implement the appropriate intervention. Potential interventions include the following and are described elsewhere in this text:

2. If the patient is at risk for cervical spine injury, have an assistant manually stabilize the head until the primary and secondary assessments are complete and more definitive immobilization can be instituted (see Procedure 111). In the absence of an assistant, towel rolls or foam blocks set alongside the head will help maintain alignment and remind a conscious patient not to move. Do not tape down the head and blocks until the patient is fully strapped to a backboard. Cervical spine immobilization should be maintained until the neck is cleared by x-ray or clinical examination.

3. Assess breathing adequacy by observing the respiratory rate, depth, and difficulty. Briefly auscultate breath sounds bilaterally. Implement pulse oximetry monitoring for all seriously injured or ill patients (see Procedure 21). If respirations are absent or abnormal, implement appropriate interventions. Potential interventions include the following and are described elsewhere in this text:

4. Assess circulation by evaluating the radial or carotid pulse for rate and strength. Observe and palpate the skin for warmth, color, and moisture. Check for exsanguinating external hemorrhage and, if present, apply direct pressure to the site. If the circulation is absent or altered, implement appropriate interventions, including chest compressions, as indicated. If an assistant is available, institute electrocardiographic monitoring (see Procedure 55). Other potential interventions include the following and are described elsewhere in this text:

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