By American College of Emergency Physicians, Margaret Austin, Rudy Crawford, Vivien J. Armstrong, Gina M. Piazza

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Ask the casualty if she is aware of grating sensations when breathing, and listen for unusual sounds. Note whether breathing causes any pain. Look for any external injuries, such as bleeding or stab wounds. 13 any evidence of bleeding, and to identify any Gently feel the casualty’s abdomen to detect rigidity or tenderness of the abdomen’s muscular wall, which could be a sign of internal bleeding. Compare one side of the abdomen with the other. Note any bruising on the abdomen or pelvis. Feel both sides of the hips, and examine the pelvis for signs of fracture.

Specialized treatment by paramedics and in the hospital stabilizes the casualty’s condition. Chain of survival Four elements increase the chances of a collapsed casualty surviving. If any one of the elements in this chain is missing, the chances of survival are reduced. » 57 THE UNCONSCIOUS CASUALTY « LIFE-SAVING PRIORITIES IMPORTANCE OF MAINTAINING CIRCULATION If the heart stops beating, blood does not circulate through the body. As a result, vital organs—most importantly the brain—become starved of oxygen.

Depending on your findings, you may not move on to the next stage of the assessment. If the lifethreatening injuries are successfully managed, or there are none, you can continue the assessment and perform a secondary survey. happens, you are unlikely to move on to the next stage. If the casualty is breathing, check for and treat any breathing difficulty such as asthma, then move on to the next stage: circulation. ■ Circulation Is the casualty bleeding severely? 112–13). Call 911 for emergency help.

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