ABCDE (Primary Survey) Flashcards
Airway - Assessment:
What would suggest the airway is patent?
Under what GCS means that a swallowed tongue could be swallowed causing an obstruction?
What else could become aspirated?
Why does a lower GCS cause this?
Abnormal sounds - what do the following sounds indicate:
- Snoring
- Gurgling
- Stridor
Due to airway reflexes being reduced
The patient is talking
GCS under or equal to 8
Vomit
Pharyngeal obstruction by the tongue
Fluids in the upper airway
Obstruction of upper airway
Airway - Management of compromised airway:
What airway manoeuvres can be done?
What can be done if you see vomit?
What can be done if you see an obstruction?
What position should they sit in to reduce the risk of swallowing their tongue or aspirating vomit? - 2
Head tilt and chin lift
Jaw thrust
Use suction under direct inspection
Remove directly
Sitting up or in the recovery position
Airway - Airway adjuncts:
Oropharyngeal adjuncts:
- What is this called?
- Why is it only appropriate in an unconscious patient?
- Why do you rotate it as you push it in?
Nasopharyngeal adjuncts:
- It can be considered in semi-conscious patients!!
- Why is this contraindicated in basal skull fractures?
- You should be cautious to use this on patients with coagulopathy. What drug could cause this?
It avoids pushing the tongue back into the throat
Guedel
It can trigger the gag reflex and vomiting if awake.
It risks insertion into the cranial vault
Warfarin - anything that will prevent the blood from clotting
Airway - Intubation and ventilation:
Definitive airway management is a cuffed endotracheal tube in the trachea.
What is the cuff and what does it prevent?
Who puts this in?
An inflated balloon
Prevents entry of materials down the sides (e.g. aspiration)
Anaesthetist
Breathing - Assessment:
What needs to be checked? - 5
What are some signs of difficulty? - 6
Under what SATS does central cyanosis occur?
Why is it more reliable to check under the tongue for central cyanosis?
Why is peripheral cyanosis not as reliable?
Resp rate - note the respiratory effort O2 SATS Chest expansion Percuss Auscultate
Other parts of the examination if it is indicated!
RR > 20 Low SATS Tired, shallow breathing Asymmetric chest expansion Accessory muscle expansion Abnormalities on chest auscultation
<85%
It has a more consistent blood supply and looks the same no matter what ethnicity.
It can be due to hypoxia and/or hypoperfusion
Breathing - Specific Signs:
Cheyne-stokes breathing:
- What is it?
- What is it a sign of?
See-saw breathing:
- What is this also called?
- What does it mean?
- Why does this happen and what is it, therefore, a sign of?
- What is it a sign of?
Apnoea alternating with deep breaths/tachypnoea
Brainstem hypoxia (could be from compression) ---- Paradoxical breathing
Abdomen moves outward as chest moves inwards during inspiration
Due to the downward movement of the diaphragm without air entry.
Sign of complete airway obstruction
Breathing - Specific Signs:
Flail chest:
- What is it?
- What is a common cause?
- Why is this so dangerous?
Single rib fractures in 2 places, leaving a fragment unconnected to the skeleton
Trauma
Leads to pain and further local trauma (e.g. pneumothorax)
It pulls in to the low-pressure thorax during inspiration, while the rest of the rib cage expands, and protrudes during expiration while the rest of the rib cage contracts.
Breathing - O2 Saturation:
What factors change Hb’s affinity for O2?
Why is it hard to determine if someone has carbon monoxide poisoning from SATS?
What reduced the accuracy of the SATS probe?
- pH
- Levels of carbon dioxide
- Temperature
O2 might be normal as SATs monitor can’t differentiate between CO and O2 bound to Hb
Poor peripheral perfusion
Nail varnish
False nails
Bright overhead lights
Breathing - Management:
What position should the patient be in to improve the V/Q ratio?
How is oxygen given?
What SATS do you aim for?
What SATS do you aim for if someone has COPD?
CHECK OXYGEN THERAPY IN RESP
Sit up
Lie down
High-flow O2 15 L/min through§ a non-rebreathre mask
94-98%
88-92%
Breathing - Management:
Further options:
- Why can be used to clear mucus plugs?
- When are nebulised bronchodilators used?
What should be done if there is no respiratory effort?
Physiotherapy
If there is bronchospasm
Intubation and ventilation
Circulation - Assessment:
What 4 things need to be checked?
Signs of impairment:
- What may you observe?
- What may you notice if they have palpitations?
- Under what BP is the radial pulse impalpable?
More on BP measurement:
- What may compensate for low BP?
- What is important to remember if evaluating someone who is young?
- How should BP be measured if they have an arrhythmia or SBP <90?
They may be warm and sweaty or cold and clammy
Cap refill
HR
BP
Urine output
You can also do temperature here as it will dictate whether you want to get bloods for sepsis or not!!
Pale or red
Cap refill > 2 secs
Raised JVP
Increased peripheral resistance
Hypotension is often a late sign of CV compromise, especially in the young
Manual BP
Circulation - In Trauma:
On the floor and four more is used in acute trauma to work out if there has been haemorrhaging.
The floor is an obvious place to lose blood in haemorrhage.
What is four and more?
Chest - lungs
Abdomen - organs in the abdomen
Pelvis
Long bones
Circulation - In Trauma:
Chest - what are some signs of haemothorax?
Abdomen - what are some signs of haemorrhaging in the abdomen?
Pelvis:
- What is a sign of bleeding into the pelvis at the using the iliac crests? - 2
- What should you put on to hold the pelvis in place, even if there is no trauma there?
Long-bones:
- What signs may you see?
Visible trauma
Abnormal movement
Dull percussion
Visible trauma
Tender on palpation
Uneven iliac crest
One leg shorter than the other
Pelvic binder - Binder at the level of the greater trochanter
Skin changes and deformities in the leg
Circulation - Management:
Obtain peripheral access - what colour should be used? - 2
At this point, you would take blood. What will you take? - 5
What bedside investigation can be done?
Grey
Orange
FBC U&E Coag Glucose Lactate (or done in ABG)
Blood cultures and CRP if infection suspected
An ECG
Circulation - Fluids:
You would give them fluids if they are SBP<90. What about if they are a hypertensive patient?
Saline is usually used but it carries the risk of raising what electrolyte?
What is a more appropriate fluid?
What should be used in major trauma?
A 500 ml bolus is given quickly. How much is given to older patients or those at risk of overload?
What is the difference between a fluid challenge and a fluid loading?
What should be done once the fluid has been given?
SBP 20% below usual
Chloride
Hartmann’s
Blood products
250 ml bolus
Fluid challenge - when initially given but not clear if it is therapeutic
Fluid loading is when it is known to be effective.
Reassess ABC
Disability - Assessment:
What 4 things needs to be done?
Consciousness
Glucose
Temperature
Pupils
Disability - Assessment:
Consciousness:
- What does AVPU stand for?
- GCS can also be used if there is time.
Pupils:
- What does unilateral fixed, dilated pupils (blow pupils) suggest?
- What do bilaterally dilated pupils suggest?
- What do bilaterally constricted pupils suggest?
Alert
Voice
Pain
Unresponsive
Ipsilateral intracranial haemorrhage - URGENT CT
Drug toxicity - ecstasy, MDMA
Opioid overdose or pontine stroke
Disability Management:
At what level of AVPU would you consider the recovery position, adjuncts or intubating?
How can be pain be assessed?
Score P - if they respond to pain but not voice
Trap squeeze
Nailvbed rub with pen
Sternal rub
Supraorbital
Exposure:
What is done here?
Unclothe, put on a gown, and check for skin changes i.e. trauma or a rash
Complete the physical examination, including abdo exam
