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Primary Survey

Primary Survey. Conditions. The candidate should perform this skill on a simulated patient under existing indoor, ambulance, or outdoor lighting, temperature, and weather conditions. Indications. Every patient every time. Red Flags.

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Primary Survey

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  1. Primary Survey

  2. Conditions The candidate should perform this skill on a simulated patient under existing indoor, ambulance, or outdoor lighting, temperature, and weather conditions.

  3. Indications Every patient every time

  4. Red Flags Life-threatening conditions must be identified and managed during the primary survey.

  5. PPE!

  6. Ensure that scene is safe

  7. Determine number of patients

  8. Call for more help, if needed

  9. On approach, observe scene for clues to injury

  10. Clue: starred windshield

  11. Clue: damaged steering wheel

  12. Clue: no seatbelt

  13. Manually stabilize head and neck, if indicated

  14. Assess AVPU

  15. Assess airway

  16. Possible Airway Interventions Manual airway (head-tilt chin-lift or modified jaw thrust) Oropharyngeal or nasopharyngeal airway Abdominal thrusts to relieve obstruction Direct visualization Note: ALS interventions should not be performed at this point if BLS interventions establish a patent airway

  17. Secret: Any patient below A on AVPU needs a BLS airway

  18. Assess breathing

  19. Possible Breathing Interventions Oxygen via non-rebreather, nasal cannula, or blow-by Assisted ventilations with a bag mask attached to high flow oxygen Open wound to neck or chest Apply immediate pressure with gloved hand to seal wound Needle chest decompression If a tension pneumothorax is indicated, perform this ALS procedure on scene as soon as possible

  20. Assess circulation

  21. Circulation Interventions Evaluate pulse and skin color, temperature, and condition Position for shock Control major bleeding Minor bleeding should not be controlled at this point

  22. Assess disability

  23. Disability Interventions Reconsider level of consciousness Evaluate for neck or spine injury Apply cervical collar if injury is suspected

  24. Expose patient as needed to conduct physical exam

  25. Inspect torso for major bleeding and life- threatening injury

  26. Inspect pelvis and lower extremities for major bleeding or hip fracture

  27. Only treat life-threatening injuries

  28. Decide now: Is this patient critical? Is rapid transport indicated?

  29. Use PPE!!!

  30. Consider scene safety issues

  31. Establish need for cervical spine stabilization

  32. Manage airway threats immediately

  33. Manage breathing threats immediately

  34. Manage circulation threats immediately

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