# Primary assessment order



## dang88 (Jul 8, 2014)

Hello all, I am getting ready to take my nremt-b test and have a question about  the order of the primary assessment. As you all know the skills sheets go A-B-C, in  my brady book it says that you will not always follow this in that order because if you come up to a patient who is significantly bleeding you will start with C. I also was wondering for the test if there are any visible threats to A-B-C would  you perform those before C-spine. I basically want to know if I should use the skill sheets as gospel for the test? Thank you


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## dang88 (Jul 8, 2014)

*Patient assessment*

Hello all, I am getting ready to take my nremt-b test and have a question about the order of the primary assessment. As you all know the skills sheets go A-B-C, in my brady book it says that you will not always follow this in that order because if you come up to a patient who is significantly bleeding you will start with C. I also was wondering for the test if there are any visible threats to A-B-C would you perform those before C-spine. I basically want to know if I should use the skill sheets as gospel for the test? Thank you


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## tred1956 (Jul 8, 2014)

If a person has no blood, airway and breathing become very unimportant. For the skills if it is a life threatening bleed it must be stopped first. I just took the NREMT test about three or four weeks ago (passed it) and on my particular test, I don't recall any questions concerning this.


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## dang88 (Jul 8, 2014)

Thanks! I am more concerned about being tricked by the test because I think I am very knowledgeable


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## tred1956 (Jul 8, 2014)

I am from SC and the first time I took the NREMT test was about 7 years ago. During changing jobs a couple of times I acted a Fool and let my registry expire. A change of policy required me to take it again in order to keep my State card. Just stay calm and read close. You can usually eliminate two answers and with a little closer look you can pick the best of the two left. There is always something that makes the right answer better.

Good luck
Doug


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## avdrummerboy (Jul 8, 2014)

Immediate life threats MUST be dealt with IMMEDIATELY. In other words, yes take care of a spurting arterial bleed BEFORE c-spine or airway/ breathing assessments. The other case that ABC wouldn't be true is an unresponsive person who appears not to be breathing, where under 2010 AHA guidelines, you do a CAB assessment on the person.

Other than that, read questions closely, take your time, and you'll be fine.


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## Uclabruin103 (Jul 8, 2014)

Just to clarify: your assessment for unconscious is still a b c. If you find there is no pulse the action to correct this is now c a b. 

For order of primary think of the term GILT right after scene before level of consciousness. GILT = general impression life threats. Treat those first. Then continue primary.


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## dang88 (Jul 8, 2014)

Thank you for all your input guys greatly appreciated!


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## avdrummerboy (Jul 8, 2014)

CAB is for a person who is unconscious (U on the AVPU scale of the initial assessment) who appears to not be breathing. That's why it was changed in the newest guidelines, people were wasting critical time checking for breathing and airway patency BEFORE checking to see if there was even a pulse. I can promise you that the person will not be breathing if they don't have a pulse.

You don't wait until you don't find a pulse to start a CAB assessment, you do it immediately on a person who appears to be lifeless!


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## BASICallyEMT (Jul 9, 2014)

For testing purposes ABC is always the correct format. For example, you run on a pt with multiple gunshot wounds and you immediately start treating the hemorrhage. You patch the pt up and notice his airway is filled with blood and he's in respiratory arrest. What good is your patch work if your pt can't breathe? Always start with your ABCs. During your primary assessment you can determine if the pt could have compromised his spinal column due to mechanism of injury.


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## vcuemt (Jul 9, 2014)

http://www.emtlife.com/showthread.php?t=40441

Ahem.


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## rabidrider (Jul 9, 2014)

You always start with ABC. Even in the field as you approach your patient you are going to ask what happened. If he answers you then unless you hear can be pretty sure he has an open airway and is breathing (he had to take a breath to answer you). From there you can go after the hemorrhage. Then from there you will always play close attention to the airway (in case blood or vomit comes up). Be ready to suction. As already stated it dont matter how well you can apply a bandaid if your patient cant breath. 

Take my advise with a grain of salt as I have not taken the NREMT yet. I am still waiting for state approval on the NREMT site. I do have one hell of a precepter in paramedic school trying to get me ready for the test. From what he said on almost all questions regarding assessment if there is an airway answer as a choice it will be the correct answer 99% of the time.


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## rabidrider (Jul 9, 2014)

I must disagree with you avdrummerboy. How do you find out if he is unresponsive and not responsive to pain? By a sternum rub? Would you not be able to check the airway at that time? Or when you are checking for a pulse you can check to see if he is breathing. 

I just got certified by AHA for BLS resuscitation and step on is check airway with head tilt chin lift or jaw thrust. then pulse then begin CPR. By following those that is ABC in that order. Sure once you begin treatment you follow CAB by jumping up and down on his chest 30 times and then attempting 2 breaths but the initial assessment is ABC

Just my opinion


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## ffemt8978 (Jul 9, 2014)

Duplicate threads merged.


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## JPINFV (Jul 9, 2014)

rabidrider said:


> I must disagree with you avdrummerboy. How do you find out if he is unresponsive and not responsive to pain? By a sternum rub? Would you not be able to check the airway at that time? Or when you are checking for a pulse you can check to see if he is breathing.
> 
> I just got certified by AHA for BLS resuscitation and step on is check airway with head tilt chin lift or jaw thrust. then pulse then begin CPR. By following those that is ABC in that order. Sure once you begin treatment you follow CAB by jumping up and down on his chest 30 times and then attempting 2 breaths but the initial assessment is ABC
> 
> Just my opinion



In my experience, the fact that you can do multiple things at once is generally too complex for a lot of instructors to understand. For example, next scenario, ask what you see when you walk into the room and chances are you'll just get a blank stare. This is despite the fact that in the real world, evaluating the patient starts from the moment you can see the patient.


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