Primary and Secondary Survey Flashcards
TCCC primary survey
Massive hemorrhage
Airway
Respirations
Circulation
Head injury and hypothermia
Used as a primary adjunct for massive or arterial bleeding until controlled by dressing or hemostatic agents
Tourniquet
In general, loss of up to ________ of circulating blood volume, is tolerated well in healthy patients.
15 percent (about 750 mL)
Class I hemorrhage
There is minimal or no tachycardic response, and changes in blood pressure usually do not occur. Without further bleeding, fluid replacement therapy is usually not needed.
Class I hemorrhage (15%)
Blood loss of ________ of total blood volume, generally results in tachycardia and narrowed pulse pressure.
15 to 30 percent (about 750 to 1500 mL)
Class II hemorrhage
There may be mild mental status changes. Provided the casualty had a normal RBC volume before hemorrhage, this degree of blood loss is tolerated without RBC replacement provided circulating volume is restored.
Class II hemorrhage (15-30%)
As blood loss increases beyond ____________ there is worsening hypotension, tachycardia, peripheral hypo perfusion, and
decline in mental status
30 percent (1500 mL)
Class III hemorrhage
At greater than ____________ the ability of the body to compensate has reached its limits and hemodynamic decompensation is imminent without effective resuscitation.
40 percent (2 Liters) blood loss
Class IV hemorrhage
Look, listen, and palpate from nose/mouth to trachea/bronchial tree
Airway
Should be part of the first response for a patient making inadequate respiratory effort.
Chin Lift/Jaw thrust maneuver simultaneously with in-line head and neck stabilization followed by insertion of an oral or nasal airway
Inspect to identify any abnormalities
Auscultate for presence or absences of breath sounds
Respirations
Intervention for tension penumothorax
Needle thoracostomy
Intervention for hemopneumothorax
Chest tube
Intervention for sucking chest wound
Occlusive dressing
Circulation is divided into two parts:
Hemodynamic Status
Hemorrhage Control
Evaluation of level of consciousness, skin color and presence and magnitude of peripheral pulses
Hemodynamic Status (Circulation)
Should not be used for measurement during the primary survey of circulation.
Rapidly obtain information by consciousness, pulse, skin color, and capillary refill time
Blood pressure measurement
Systolic pressure if radial pulse is felt
> 80 mmHg
Systolic pressure if femoral pulse is felt
> 70 mmHg
Systolic pressure if coratid pulse is felt
> 60 mmHg
Provides a rapid initial assessment of peripheral perfusion.
Skin Color and Cap Refill
Should be performed once the massive hemorrhage is controlled, airway is patent, breathing evaluated and the patient is stable hemodynamically
An abbreviated neurologic exam
Abbreviated neuro exam should include:
Assessing the Level of Consciousness
Pupillary size and reactivity
Motor function
Should be used to quantify the patient’s level of consciousness, ranging from a score of 3 (no response) to 15 (normal response on all measures)
Glasgow Coma Scale (GCS)
A GSC score of ≤ __ indicates severe head injury/coma.
8
HISTORY: A patient’s pertinent past medical history must be obtained. A useful mnemonic is the word:
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal
- Events associated with injury
A head-to-toe physical examination, to include a reassessment of vital signs.
Secondary Survey
Hemotympanum and/or disruption of the auditory canal on otoscopic exam are additional findings suggestive for:
Basilar Skull fracture
CSF leaking from the ear is confirmatory for:
Basilar Skull fracture
Presence of bruising around the eyes (raccoon’s eyes) or behind the ears (Battle’s sign)
Basilar Skull fracture
A gloved finger placed into the mouth can move the central incisors and palate.
Mid-face fracture
Malocclusion of the teeth is seen with either:
Mandibular or maxillary fractures
Indicates a C-spine injury until proven otherwise
Any patient who is unconscious
Neurologic deficit
Injury above the clavicles
In the absence of hypovolemia, neck vein distension can be suggestive of a:
Tension pneumothorax
Cardiac Tamponade
Shortness of breath, pain, and tenderness to direct palpation or anterior posterior compression suggest:
Rib fractures
Auscultation of distant heart sounds may be indicative of:
Cardiac tamponade
Percussion of hypertympanic sounds may indicate:
Tension pneumothorax
Any trauma patient in shock must have ________ injuries excluded
because these injuries are potentially dangerous.
Abdominal
Most commonly injured organ in blunt trauma
Often associated with other injuries
Left lower rib pain may be indicative
Often can be managed non-operatively
Splenic injuries
Second most common solid organ injury
Can be difficult to manage surgically
Often associated with other abdominal injuries
Liver injuries
Small bowel and colon injuries result most often from:
Penetrating trauma
Free fluid without solid organ injury is a ______ injury until proven
otherwise
hollow viscous
The three basic regions of the abdomen are the peritoneal cavity with its:
Intrathoracic component
Retroperitoneum
Pelvic portion
Diaphragm rises as high as the __ intercostal space
4th
Extremities
Decreased or absent pulses suggest a:
Vascular injury
Extremities
First sign of ischemia and should be aggressively evaluated.
Pain
If there is any suspicion that a compartment syndrome is developing or exists, what should be performed?
Fasciotomy
Extremities
For crush injuries, what must be considered?
Rhabdomyolysis
For a patient with cardiac arrest, definitive care is:
Defibrillation with resultant normal rhythm
Diabetic coma, definitive care is:
IV glucose until normal blood glucose levels returns.
Casualties with obstructed airway, part of the definitive care are the:
Jaw thrust and assisted ventilation.
Is comprised of evaluating circulation, airway and c-spine, breathing, disability (mental status), and environmental exposures.
Primary survey
Includes a total evaluation of the patient injuries from head to toe
Secondary survey
First thing you want to touch during the secondary survey
Skull and hair looking for blood
