9. aspirating  of  vomitus.  Never  give  an  un- conscious person any substance by mouth. Always  carry  a  litter  patient  feet  first  so that  the  rear  bearer  can  constantly  observe the  victim  for  respiratory  or  circulatory distress. ASSESSING  THE  PATIENT’S CONDITION The following procedures for assessing a pa- tient’s condition under various circumstances are based  upon  Department  of  Transportation  recom- mendations.  These  are  general  guidelines  that  can be  modified  to  suit  the  situation. DETERMINING  THE  PROBLEM A. If the patient can communicate, determine if  the  problem  is  medical  or  trauma related. 1. If medical, follow the sequence below. a.    Evaluate  diagnostic  and  vital  signs. b.  Develop  the  patient’s  history. c.  Examine for the medical problems. d.   Examine   for   a   trauma-related problem. 2. If trauma-related, follow the sequence below. a.  Evaluate diagnostic and vital signs. b.    Examine  the  injury. c.    Develop  the  patient’s  history. d.  Examine  for  a  medical  related problem. B. If the patient cannot communicate, follow the  sequence  below. 1. 2. 3. 4. Evaluate diagnostic and vital signs. Develop   the   patient’s   history,   then determine if the problem is medical or trauma related. If  medical,  examine  first  for  the medical  problem  then  for  a  trauma related  problem. If trauma related, examine first for the trauma  related  problem  then  for  a medical  problem. EVALUATING  THE  DIAGNOSTIC AND  VITAL  SIGNS A.  Sequence  of  taking  vital  signs 1. If the patient with a traumatic injury is communicative, assess the injury site after taking vital signs. 2. If the patient with a medical problem is  communicative,  take  vital  signs  after the  preliminary  assessment  and  in  con- junction  with  the  medical  history,  if possible. 3.  If  the  patient  is  noncommunicative, take vital signs immediately after the primary assessment. B.  Essential  diagnostic  and  vital  signs 1. Mental status a.    Consciousness—avoid    descriptive words  like    “stupor”   or   “semi- conscious”;  be  specific. b.  Reaction  to  stimulus—describe c.   Orientation d.  Responsiveness 2.  Respirations a. b. c. d. e. f. g. h. Tracheal  deviation Rate—tachypnea Depth (1)  Hyperpnea (2)   Hypopnea Dyspnea Breathing sounds Flaring   of   anterior   nares   on inspiration Retraction  of  suprasternal  notch  on inspiration Retraction  of  intercostal  spaces 3.  Pulse a.  Rate b.   Rhythm c.  Strength 4.  Blood  pressure EXAMINING   FOR   TRAUMA-RELATED PROBLEMS A.  Assess  each  of  the  following 1.  Head a.  Inspect  for (1)  Obvious  hemorrhage (2)   Ecchymosis,   erythema,   or contusions (3)  Scalp  lesions 4-2