Scenario You are a newly qualified doctor and have just seen someone get hit by a car. What would you do?
Primary Survey D Danger R Response A Airway B Breathing C Circulation D Disability E Exposure
Danger: You must assess the situation: Are you in direct danger? Is the patient in danger? ** Make the situation as safe as possible** Danger and Response Response: Assess the patients level of consciousness
Airway Protect Cervical Spine Assessment: any signs of obstruction? Management: Establish a patent airway Look into their mouth, if any liquid is found place the patient on their side and drain the liquid (postural drainage). Place patient back onto their back and open the airway using a head tilt/chin lift techniques.
Breathing Assessment: Respiratory rate Check bilateral chest movement Percuss and auscultate Management: If no respiratory effort, treat as arrest If breathing compromised - high concentration O 2
Circulation Assessment: HR BP Capillary refill (Normal <2 secs) Look for evidence of haemorrhage Management: If shocked, treat with Bolus IV fluids If no Cardiac output treat as arrest
Cardiac Arrest Lower sternum Heels of the hand on top of each other Direct weight of your body through your straight arms Rate 100-120 BPM Depth 5-6cm Davidson, E. H. et al, UK Adult Basic Life-support Algorithm 2010, OHCM, Eighth Edition
Disability and Exposure Disability/Dysfunction of Nervous System: Assess level of consciousness with AVPU A – Alert V – Voice P – Pain U – Unresponsive Check Pupils – Size and equality, reactions Glasgow Coma Score Exposure: Expose patient to assess for full extent of injuries Avoid Hypothermia
Glasgow Coma Score Motor 4 spontaneous eye opening 3 Open in response to speech 2 Open in response to pain 1 No eye opening Verbal 6 obeying commands 5 localises to pain 4 withdraws to pain 3 flexor response to pain 2 Extensor posturing to pain 1 No response to pain 5 oreinted 4 confused 3 Inappropriate speech 2 Incomprehensible speech 1 None Eyes
What Next? It is essential to get a thorough History from witnesses, family, friends. Are they on any medications we need to worry about i.e. Warfarin Progress to Secondary Survey
References ABCDE Preliminary Assessment (Primary Survery), The Oxford Handbook of Clinical Medicine Davidson, E. H. et al, UK Adult Basic Life-support Alogorithm 2010, OHCM, Eighth Edition Nolan J P, Parr M J A. Aspects of resuscitation in trauma. Br J Anaesth 1997; 79: 226-240. Primary and Secondary Survey, First Response, Accessed 12/11/13, available at [http://www.firstresponse.org.uk/first-aid-az/108-primary- secondary-survey]http://www.firstresponse.org.uk/first-aid-az/108-primary- secondary-survey The Primary Survey, St Johns ambulance, Accessed 12/11/10, Available at [http://www.sja.org.uk/sja/first-aid-advice/life-saving- procedures/primary-survey.aspx]http://www.sja.org.uk/sja/first-aid-advice/life-saving- procedures/primary-survey.aspx