PAM Flashcards
RSE
Environment
Hazards
MOI
Witnesses
Approach casualty, and introduce (do not move head). Buddy, perform head grip.
May I know what is bothering you?
Primary survey order
LOC Delicate spine Airway Breathing Circulation Rapid body survey Skin Oxygen Airway Position Decision Load and go Reassess Ambulance Notify
Secondary survey order
Chief complaint History of chief complaint Medical history Medication Allergies Vital signs
LOC
AVPU
Delicate spine
Sir did you fall down and hit your head
Sir I’m going to check your neck for spinal injuries
I am checking and palpating for deformities and bruises
Buddy, remove spinal grip
Airway (DABC)
If casualty is talking and conscious, airway is clear.
If unconscious, cross finger technique, then sweep or suck. Then insert OPA
Breathing
Check rate and quality of breathing.
If unconscious, look listen feel and look for problems such as cyanosis, use of accessory muscles. Do rescue breathing if needed
Circulation
Check one radial pulse.
If none, check the other. If none, check carotid. If none, CPR
RBS
Sir, I am going to do a rbs to check for any injuries you may have. Please sound off if you feel pain.
Maintain eye contact.
Check back for blood
If pain, expose wound
Skin
Check for skin colour and condition using back of hand.
Oxygen
Give 100% oxygen at 10L, using nrm or BVM
Airway 2
Reassess airway, check for vomitus
Check misting on mask
Check chest rise
Position
Sir are you comfortable?
Decision
Since casualty has injuries x,y, he is unstable. This I will load and go
Load and go
I will strap him onto stretcher and lift with proper lifting technique
Ask witness to being ID and medication
Reassess ABC
A: check if OPA still in place, misting, chest rise
B: look listen feel or butterfly. Rate and quality
C: radial, carotid pulse
On ambulance
Close door
Switch oxygen to main tank
Drive to medical centre and switch on beacon and siren
Notify medical centre:
Gender, age, suspected injury, loc dabc, vital sign, treatment administered, ETA. Standby!
Chief complaint
What is bothering you the most?
How did it happen?
History of chief complaint
Location: where is the pain located?
Onset: when did it start? How long does it last? Does it change over time?
Type: what does it feel like, can you describe
Aggravating: what makes it worse
Associated: are there other symptoms such as nausea
Relieving
Radiating
Recurring
Precipitating: what were you doing before it started, were there any specific triggers?
Medical history
Have you been admitted to the hospital in the last 5 years? Clinic last 3 months?
Have you seen a doctor for any medical problems recently?
How long ago did you have this problem?
Medication
Are you taking any medication? Can I have a look at it? (Check expiry and dosage) How often do you take it? Is there any change in dosage? When was the last time you took it
Allergies
Food environment drug
WhAt would happen?
Vital signs
LOC with GCS BP PR RR Skin colour and condition Severity of pain (Temperature)
Take every 5 mins for unstable
Report to doctor
Gender, age
Baseline vital signs and change
Findings
Head to toe order
Inspect general appearance Inspect head and face Palmate skull and face Inspect neck Palpate neck Inspect chest Palpate chest Listen to chest Inspect abdomen Palpate abdomen Inspect pelvis Compress pelvis Inspect lower extremity Palpate lower extremity Assess distal pulse Assess sensation and movement in lower extremities Compare lower extremities [same for upper extrmities] Inspect back Palpate back
Inspect general appearance for
Laceration signs of Trauma Cyanosis Dehydration Rashes Jaundice
Inspect head and face for
Laceration Contusion, Battle signs, Blood or fluid from ears/nose, Burns on face nose mouth, unusual breath Odour, Racoon eyes, distortion of the face
Size of Pupils equal and reactive to light, Echymosis or Cyanosis of conjunctiva, Periorbital Edema
Trauma Bleeding from mouth, cyanosed lips, Saliva Drool Foam
Palpating the skull and face for
Depression
Abnormal mobility
Deviation
Inspect neck for
Laceration Contusion, Distended Neck Vein, Signs of Trauma, Neck Rigidity
Palpating the neck
Tracheal deviation
Inspecting the chest for
Signs of Trauma, Operation Scar, Accesory Muscles
Penetrating injuries, barrel chess, intercostal retraction
Paradoxical Motion, Contusion, Sucking chest wound, deformity
Palpating chest for
Crepitus, Instsbility, Tenderness, Pacemaker, Asymmetry
Listen to chest for
Presence and equal air entry on both sides
Abnormal breathing sounds
Inspect abdomen
Penetrating Injuries
Contusion
Distension
Palpate abdomen
Tenderness Guarding Distension Rigidity Masses
Inspect pelvis
Signs of bowel or urine incontinence
Compress pelvis laterally
Tenderness or instability
Inspect lower extremity for
Deformities, Operation Scars, Skin Ulcers, Ankle Edema, Vein distension
Palpate extremities
Tenderness, pain, crepitus, unusual movement
Assess distal/radial pulse
Presence of pulse
Capillary refill
Assess for sensation and movement of extremities
Can you feel me gripping and touching your toes/fingers
Can you move them?
Compare the lower extremities
Are there any differences?
Inspect upper extremities for
Finger clubbing, track marks/cigarette stains, deformities or bruises
Inspecting back
Sacral edema or scoliosis
Laceration, contusion, penetrating injuries
Palpate back for
Deformity, instability, tenderness, bleeding
