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Primary Survey

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.

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Primary Survey

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  1. Primary Survey

  2. When do you use it?

  3. 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

  4. DR ABCDE Danger Response (Summon help) Airway (with C-spine considerations) Breathing Circulation Disability / dysfunction Expose Deal with each as you come to it!

  5. Danger Have a proper look! How many patients? Size up the scene (what could have caused injury?)

  6. 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

  7. Response - If Alert? • If talking, airway OK • NOTE – obstructed airway? • If talking, breathing OK • NOTE – breathing difficulty? • Assess circulation • Pulse, skin colour / moisture / temperature

  8. 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) ???

  9. 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?

  10. 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)

  11. Circulation • “Blood on the floor and 4 more” • Can bleed to death internally – looking for this

  12. Circulation • Check abdomen • Bruising? Discoloration? Swelling? Wounds? • Feel abdomen • Palpate the four quarters (feel for hardness, watch for tenderness)

  13. 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

  14. 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

  15. Expose If you suspect injuries, have a look!

  16. 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?

  17. What comes next? Observations (response, pulse, resps) Secondary survey SAMPLE Detailed assessment (OPQRST etc)

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