Chapter 1 Primary Survey Flashcards
Name the ABC’s of prim survey
A - Airway Maintenance (C-spine protection) B - Breathing and ventilation C- Circulation D - Disability (neurologic status) E- Exposure/Environmental control
GCS < 8 You must ______
Intubate
What are some factors that can compromise airway
Facial, mandibular, tracheal/laryngeal fx, FB in airway (think about teeth)
What are some factors that can compromise breathing and ventilation?
Tension PTX Flail chest w/ pulmonary contusion Massive hemothorax Open pneumothorax
What are some factors that can compromise Circulation?
Blood volume after considering Tension PTX as cause of shock consider hypovolemia Cardiac output Bleeding (internal and external fx)
GCS of 13-15 indicates?
Mild TBI
GCS of 9-12 indicates?
Mod TBI
GCS of 3-8 indicates?
Severe TBI
What are the three sections of GCS eval?
E - Eye opening (4) V - Verbal response (5) M - Motor Response (6)
Describe and quantify Eye opening in GCS
(1-4) 4 - Spontaneous 3 - To speech 2 - To Pain 1 - None
Describe and quantify Verbal response in GCS
(1-5) 5 - Oriented 4 - Confused conversation 3 - Inappropriate Words 2 - Incomprehensible Sounds 1 - None
Describe and Quantify Motor Response in GCS
(1-6) 6 - Obeys Command 5 - Localized pain 4 - Flexion withdrawal 3 - Abnormal flexion (decorticate) 2 - Abnormal Extension (decerebrate) 1 - Flaccid
Patient presents to trauma s/p MVC. Upon initial presentation he is looking directly at you aware of his surroundings, he is unsure how he got here or what exactly happened but tells you that he “crashed his car” when the nurse asks him to lift his arm to put on his hospital wristband he does so immediately. What is his GCS?
4 (E) + 5 (V) + 6 (M) = 15
Patient presents to trauma s/p drug OD. Upon initial assessment she opens her eyes when you rub your knuckles on top of hers but otherwise closes them again immediately. She is unable to answer your questions and continues to tell you only yell out the name “Andrew” repeatedly, if you ask her to squeeze your hand she does not react however she does continue to grasp her stomach and roll on to her side. What is her GCS?
2 (E) + 3 (V) + 5 (M) = 10
Patient presents to trauma s/p drug OD. Upon initial assessment she opens her eyes when you rub your knuckles on top of hers but otherwise closes them again immediately. She is unable to answer your questions and continues to tell you only yell out the name “Andrew” repeatedly, if you ask her to squeeze your hand she does not react however she does continue to grasp her stomach and roll on to her side. What is her GCS?
2 (E) + 3 (V) + 5 (M) = 10
Patient presents to trauma s/p gunshot wound to the head. His eyes do not open, he does not respond to anything and does not follow any commands. He makes no sounds and does not attempt to follow any directions or draw away from painful stimuli. What is his GCS?
1 (E) + 1 (V) + 1 (M) = 3
How is the E component (environment and exposure) completed in the primary survey?
Expose the pt, log roll and examine all extremities, keep the pt WARM!
Resuscitation should happen at the same time as what?
the primary survey
secondary survey history taking should include what acronym with accompanying definition
AMPLE Allergies Meds Past illnesses/pregnancy Last Meal Events, environment relative to injury
Skill Station IA Steps 1-4
- Assessment
- Ascertain patency
- Rapidly assess for obstruction
- Management
- Perform a chin-lift or jaw thrust
- clear airway
- insert OP airway
- Establih definitive airway w/ inubation or cric
- describe jet insufflation of airway, note that this is only temporary maneuver
- Maintain c spine in neutral position w/ manual immob as necesaray when establishing airway
- Reinstate immoblization c-spine w approprate devices after establishing airway
Skill station IA Breathing Ventilation and Oxygenation steps 1 and 2
1 Assessmet
- Expose neck, and chest, esnure immob of head and neck
- Determine rate and depth of respiration
- Inspect, and palpate neckand chest for tracheal deviation, unilat and bilat chest movement, use of accessory muscles and injury
- Percuss chest for dullness or hyperresonance
- Ausculatate bilaterally
- Management
- Admin High conc O2
- Ventilate w/ bag mask
- Alleviate Tension PTX
- Seal open PTX
- Attach CO2 monitor
- Attach pulse ox
Skill station IA Circulation w/ hemorrhage control Step 1 and 2
- Assessment
- ID sourse of ext, exsanguinating hemorrhage
- ID potential internal hemorrhage
- Assess pulse: quality, rate, regularity and paradox
- Eval skin color
- Measure BP if time permits
- Management:
- Applx direct pressure to ext bleeding sites
- Cosnider internal hemorrhage and obtain surgical consult
- Insert 2 large cal IV cath
- Simultaneously obtain blood for heme and chem analysis; pregnancy test, T&C, and ABC’s
- Initiate IV w/ warm crystalloiid sol and blood replacemtn
- Prevent hypothermia
Skill Station IA Disability Step 1-3
1 - Determine lOC using GCS
- -Check pupils for size and reaction
- Assess for laterlizing signs and spinal cord injury
Skill station IA Exposure/environmental control step 1
- completely undress and log roll pt, prevent hypothermia
Skill Station IA Adjuncts to Primary survery and resusciation Step 1-6
- Obtain ABG and ventilatory rate
- Mon exhaled CO2 w/ monitoring device
- Attach ECG monitor to pt
- Insert urinary gastric cath unless contraindicated and monitor pt’s hourly output of urine
- Consider need for and obtain AP Chest and Pelvic X-rays
- Consider need for and perform FAST or DPL
Skill Station IB Sec survey; Just name the body parts that are examined
- Head and maxillofacial
- C-spine and neck
- Chest
- Abdomen
- Perineum/rectum/vagina
- MSK
- Neuro
For adult pt’s maintenance of urinary output at ______ mL/kg/h is desireable?
0.5mL/Kg/h
Acronym for a hand-over by EMS personel
Mechanism (at time) of injury
Injuries found and suspected
Symptoms and Signs
Treatmentinitiated
(MIST)
