Primary Survey

Report
Primary Survey
When do you use it?
What is it?
 Rapid assessment
 Identify anything that can kill Pt
 Look for anything that’s not right
 Not just for trauma
 Not just for unconscious people
 It’s on every PRF
 Easy to remember – work down the body
 Should be less than 1 min
DR ABCDE
 Danger
 Response
 (Summon help)
 Airway (with C-spine considerations)
 Breathing
 Circulation
 Disability / dysfunction
 Expose
Deal with
each as you
come to it!
Danger
 Have a proper look!
 How many patients?
 Size up the scene (what could have caused injury?)
Response
 Have a look at Pt – big sick or little sick?
 Approach from feet
 AVPU
 Question, command, pain
 PAIN – how do we check this?
 Note how response changes
Response - If Alert?
 If talking, airway OK
 NOTE – obstructed airway?
 If talking, breathing OK
 NOTE – breathing difficulty?
 Assess circulation
 Pulse, skin colour / moisture / temperature
Response - If NOT Alert?
 If alone, shout help
 If in a first aid team, shouldn’t be alone
 Do you call for backup (ETA, HCP) ???
Airway (with C-spine considerations)
 Check C-spine
 Feel down back of neck (tenderness, irregularities)
 Check jaw
 Feel across mandible (fracture obstructing airway?)
 Check mouth
 Any obvious obstructions? Take em out
 Action - Head tilt & Chin lift
 OR Jaw thrust??
 When would you do this?
 Check neck
 Trachea OK? Swelling? Discoloration?
Breathing
 Check breathing for 10 secs
 NB agonal breaths don’t count
 Someone to take over head tilt / chin lift?
 Check chest
 If appropriate, LOOK at the chest
 Anything odd? Bruising, swelling,.. knife?
 Palpate (Feel) chest
 Check for equal expansion
 Breathing fast or slow (don’t need resp rate)
Circulation
 “Blood on the floor and 4 more”
 Can bleed to death internally – looking for this
Circulation
 Check abdomen
 Bruising? Discoloration? Swelling? Wounds?
 Feel abdomen
 Palpate the four quarters (feel for hardness, watch for
tenderness)
Circulation
 Feel pelvis
 Check for position of iliac crests
 Do not ‘spring’ the pelvis!!
 Feel femurs
 Start at the TOP (yes, by the crotch)
 Firm grip, go down to the knee
 Check back for blood
 Check PULSE in both wrists
 Don’t need a pulse rate – just is it fast or slow?
 Check skin colour
Disability / Dysfunction
 Feel around head
 Deformity (fractured skull)? Blood?
 Check voice response
 Check pain response
 Squeeze trapezius muscle (neck/shoulder)
 Eyes open?
 Hands move?
 Check motor ability
 Ask em to squeeze your fingers
Expose
 If you suspect injuries, have a look!
Summon Help?
 If alone, shout help
 If in a first aid team, shouldn’t be alone
 What’s needed?
 Equipment? (carry chair, carry sheet, scoop)
 Oxygen?
 ETA? Paramedic?
What comes next?
 Observations (response, pulse, resps)
 Secondary survey
 SAMPLE
 Detailed assessment (OPQRST etc)

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