Initial Assessment and Management Flashcards
What elements are included in the ‘initial assessment’?
Preparation
Triage
Primary survey (ABCDE’s) with immediate resuscitation of patients with life-threatening injuries
Adjuncts to the primary survey and resuscitation
Consideration of the need for patient transfer
Secondary survey (head-to-toe evaluation and patient history)
Adjuncts to the secondary survey
Continued post resuscitation monitoring and revaluation
Definitive care
How can you assess A-E using the 10-second method?
Identifying yourself, asking the patient for his or her name, and asking what happened.
What are the ABCDEs of the primary survey?
Airway maintenance with restriction of cervical spine motion
Breathing and ventilation
Circulation with haemorrhage control
Disability (assessment of neurological status)
Exposure/Environmental control
What is included in the assessment of the airway?
Inspecting for foreign bodies
Identifying facial, mandibular and/or tracheal/laryngeal fractures and injuries resulting in obstruction
Suctioning accumulated blood or secretions
What elements of B are you aiming to assess in exposing the patients neck and chest?
Jugular venous distension
Position of the trachea
Chest wall excursion
What injuries can significantly impair ventilation in the short term?
Tension pneumothorax
Massive haemothorax
Open pneumothorax
Tracheal or bronchial injuries
What can convert a simple pneumothorax to a tension pneumothorax?
When a patient is intubated and positive ventilation pressure is provided before decompressing the pneumothorax with a chest tube.
What key features provide information about haemodynamic status?
Level of consciousness
Skin perfusion
Pulse (tachy, thready)
How must you assess the pulse?
Centrally and bilaterally
What are the major areas of internal haemorrhage?
Chest
Abdomen
Retroperitoneum
Pelvis
Long bones
What imaging can be used to identify bleeding sources?
X-ray (chest/pelvic)
FAST scan
Diagnostic peritoneal lavage
What are immediate management options for haemorrhage?
Chest decompression
Pelvic stabilising device
Extremity splints
Pressure
What fluids are used for haemorrhage resuscitation?
Crystalloid warmed but not too much, need blood if more than 1.5L required.
What are you identifying in the neurological examination?
Level of consciousness
Pupillary size and reaction
Presence of lateralizing signs
Spinal cord injury level
What adjuncts are used to the primary survey?
Continuous ECG
Pulse oxymetry
CO2 monitoring
ABG
Respiratory rate
Urinary catheter
Gastric catheter (NG tube)
Blood lactate
X-ray
eFAST
DPL
What can dysarrithmia indicate?
Tachycardia, AF, PVC, ST changes - blunt cardiac injury
Extreme hypothermia
What can PEA indicate?
Cardiac tamponade, tension pneumothorax, profound hypovolaemia
What can bradycardia, aberrant conduction and premature beats indicate?
Hypoxia and hypoperfusion
What should you consider in terms of transfer when ordering diagnostic tests?
Do not delay transfer to perform in depth diagnostic evaluation. Only undertake testing that enhances the ability to resuscitate, stabilise and provide safe transfer.
