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Primary Survey
When do you use it?
What is it?
Rapid assessment Identify anything that can kill Pt
Look for anything that’s not rightNot just for traumaNot just for unconscious people
It’s on every PRFEasy to remember – work down the bodyShould be less than 1 min
DR ABCDE
DangerResponse(Summon help)Airway (with C-spine considerations)BreathingCirculationDisability / dysfunctionExpose
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 feetAVPU
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 helpIf in a first aid team, shouldn’t be aloneDo 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 liftOR 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 bloodCheck 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 responseCheck 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 helpIf in a first aid team, shouldn’t be aloneWhat’s needed?
Equipment? (carry chair, carry sheet, scoop) Oxygen? ETA? Paramedic?
What comes next?
Observations (response, pulse, resps)Secondary surveySAMPLEDetailed assessment (OPQRST etc)
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