In First aid and emergency Medicine, the vital functions is the functions of the organization which ensure the life, and whose failure involves the short-term death (a few minutes).

These functions are:

  • the Conscience: the whole of the Reflex S of safeguarding of the life (cough, swallowing, avoidance…) ; the conscience results from the good activity of the Nervous system, in particular of the Cerveau (seat of the Vie) and of the Spinal-cord;
  • the pulmonary Ventilation: contribution of Air by the movement of the Lungs
  • the Blood circulation: the transport of the Dioxygène extracts from the air by the lungs.
They are the fundamental physiological needs in the Pyramide for the needs.

The safeguarding of the vital functions is the main concern of the actors of the urgency, well before the treatment of the cause (“one treats the victim, not the wound”); it is the ABC of Peter Safar:

  • has irway , freedom of routes air (to ensure the passage of the air towards the lungs),
  • B reath , Breathing (to practice the artificial Ventilation if the victim does not breathe spontaneously),
  • C irculation , Blood circulation (to stop the Hémorragie S, to practice thoracic compressions if the heart does not beat).

Evaluation of the vital functions

One distinguishes two types of evaluation:

  • the vital evaluation: it is a question of determining if the vital function functions or not, this conditions the gestures of first aid to be carried out, and the alarm to be transmitted to the helps;
  • the functional evaluation: if the vital functions function, their degree of operation is evaluated.

Vital evaluation

The vital evaluation must be done in less than 30 seconds.

The first function to be evaluated is the conscience. If a person moves or speaks, it is conscious. If it does not move and does not speak, it is then necessary to seize the hand to him and

  • to raise a simple question to him, for example “You hear me? ”;
  • to give him a simple order, for example “open the eyes”.
If she answers or reacts (moves), she is conscious, the vital assessment stops there (a conscious person breathes and its heart beats). If she does not answer and does not react, she is unconscious.

If it is unconscious, its breathing should then be evaluated:

  • to release the air routes
    • by detaching clothing obstructing breathing (cravatte, collar, girdle, first button of the pants);
    • by opening the mouth, one checks that there is no object inside; if an object is seen, it delicately is removed;
    • by raising the chin to the top (for a victim dish-back), in order to make raise the épiglotte (for a victim sitting, one rectifies it against the file and one puts his head in light back rocker);
  • to approach its ear of the nose of the victim and to look at the belly, during 10 seconds.
If one feels a flow of air on the cheek, that one sees the belly or the chest to rise or bend down, or that one hears breathing with the ear, the person breathes, the assessment stops there (a person which breathes has a heart which beats). It should be turned on the side (in PLS) and to prevent the helps).

If a person does not breathe, the helps are prevented, and one carries out two blowings (kiss of life), and one recontrôle breathing (cf above);

  • if the person reacts (moves, coughs), its heart beats; one continues the kiss of life during one minute, and one recontrôle breathing (except if it began again spontaneously);
  • if the person does not have any reaction, its heart does not beat, it is then necessary to practice the cardiopulmonary Réanimation.

See the article: Assessment (first aid).

Functional evaluation

If the person is conscious, or that it is unconscious but breathes spontaneously, one will evaluate the operation of the vital functions. this will allow the regulating doctor to judge state of the person, and to decide continuation of the operations.

Neurological evaluation

Level first-aid worker

If the person speaks, one asks him questions in order to determine

  • if she speaks in a coherent way or not;
  • if it is directed (it knows where it is, which date one is, which it did);
  • if she remembers what arrived to him.

One asks the witnesses if it had a loss of initial conscience (NCV); if one sees a wet spot on the pants, one asks the person if she remembers to have urinated (a loss of urine can indicate a loss of conscience).

One asks him to move the ends (fingers, toes), and one touches the ends to him, in order to see whether the sensitivity and motricity are normal.

One observes the Pupille S and one notes if it have the same size; by hiding the eye then in the illuminant with a lamp, one determines if the pupils are reactive (in normal weather, it increase in the darkness and they narrow with the light; it is necessary to be wary of the glass eyes and the recent ophthalmologic examinations).

If the victim is unconscious (it is thus in PLS), one stimulates it by gripping the back of the hand to him (one can also press on a nail with a hard object) and by raising the eyelids to him, in order to see whether it reacts to the pain and the light.

One can classify the results of this evaluation according to the four degrees of the scale AVPU:

  1. conscious victim ( Alert );
  2. the victim does not move or speaks only in response to the Stimulus and to the orders ( Verbal );
  3. the victim does not speak and moves only in answer to the pain ( Pain );
  4. no answer, neither word nor movement ( Unresponsive ).

medical Level

The doctors and male nurses use, in urgency, the scale of Glasgow: it is about a scale going of 3 (Coma S deep) to 15 (perfectly conscious and directed victim), which is based on three criteria:

  • opening of the eyes;
  • word;
  • reaction to the pain.
Except vital urgency, they can supplement the evaluation by testing reflexes. In hospital medium, this evaluation can be supplemented with a electroencephalogram (EEG) and a IRM or a scanner.

See also

Evaluation of breathing

This evaluation is made if the person breathes.

Level first-aid worker

One makes a quantified and qualitative evaluation of the ventilation:

  • one determines the ventilatory frequency (many breakdowns by minute): one poses the hand on the top of the belly (after having explained the gesture) in order to perceive the ventilatory movements, and one counts them on 30 second, then one multiplies the result by two (except urgency, one can also simply count over one minute); one can also simply base oneself on the noise (if breathing is noisy) or on the movement visible (if it is full);
  • one determines the amplitude (ventilation full or weak) and the regularity (regular or irregular ventilation);
  • one listens if one hears noises (gargouillis, whistles, raucous breathing) with the inspiration or the expiry.
The frequency, the amplitude, the regularity, the possible presence of noises constitute the ventilatory assessment.

medical Level

The doctors auscultate the back and the chest in order to listen to the ventilatory noises. They can have the probes in the device of inhalation or blowing in order to determine the fraction of dioxygene inspired (FiO2) and the carbon dioxide concentration expired. A luminous device, called oxymeter, gives the saturation of dioxygene blood (SpO2).

Evaluation of circulation

Level first-aid worker

One takes the pulse carotidien (after having explained the gesture), and one determines the frequency (many beats per minute: one counts the number of beats over 30 seconds and one multiplies the result by two) as well as the regularity (regular or irregular). Then, one takes the pulse with the two wrists, to see whether it is felt or not.

If the pulse carotidien is not felt whereas it is known that the heart beats (the person breathes), one tries to take the femoral pulse.

One observes the coloring of the skin, in particular mucous membranes (interior of the eyelids, interior of the lip, nails) at the people with the dark skin, and one notes an abnormal color: pale, blue victim (cyanosée), or presenting marblings. It is looked at if the person presents Sueur S in absence of heat or physical effort.

These elements (absence or presence of the principal and distal pulses, frequency and regularity, coloring, sweats) constitute the circulatory assessment.

If a person is in cardiac arrest, one poses a semi-automatic Défibrillateur to him (so available) which will make an automatic diagnosis.

medical Level

The doctors auscultate the heart in order to listen to the noises which it makes. It can raise a electrocardiogram (ECG).

Interaction enters the vital functions

Maintenance of the vital functions

Long run: to ensure the Homeostasis.

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