Primary Survey

Question 1

As I approach I…

Answer 1

put on gloves and check the time, what BSI precautions do i need?

Question 2

Scene Survey

Answer 2

I am surveying the scene
Do I hear, smell, or sense anything dangerous?
Are there other patients? Ask patient and bystanders
Look for evidence of others
I am surveying for MOI. Is MOI generalized or focused, is it potentially life-threatening? Look and ask bystanders
Do we need more help? Decision based on number of patients and circumstances

Question 3

Patient Overview

Answer 3

As I approach the patient, what is my general impression? What is the skin colour? Do I see any grossly angulated fractures or significant bleeding?

Question 4

Level of consciousness - C-Spine

Answer 4

“Please do not move until we have checked you for injuries.” “I’m here to help you, can you tell me what happened?”
What is your Name?
Can you take a deep breath?
Do you hurt anywhere?

If patient does not respond to verbal, is the patent responsive to pain or unresponsive? AVPU ?
UNCONSCIOUS and INADEQUATE BREATHING - Immediately check pulse and commence chest compressions if absent. Request backup and ready the AED

Question 5

Responsive Patient - Airway

Answer 5

As I evaluate the airway is the patient breathing?
If patient is speaking, the airway is open. Is it clear, are there any abnormal sounds? If not, look and position to ensure the airway is open and clear. Is the airway open and patent?

Question 6

Breathing

Answer 6

As I evaluate breathing, is the patient breathing? What is the rate and quality of respirations?

Question 7

Ventilation Instructions

Answer 7

Order oxygen for any patient with abnormal respirations, head injury, or shock.
Assist ventilation if patient is hypoventilating.
Hyperoxygenate and ventilate the patient with an altered LOC.
Any unconscious patient should be ventilated.

Question 8

Circulation

Answer 8

Is the radial pulse present; is the rate too fast, too slow?
What is the rhythm and quality? (wrist only for conscious patient acceptable)
If no radial pulse, is the pulse palpable at the neck?
What is the skin colour, condition and temperature?
Do I see or feel any significant bleeding?

Question 9

Decision

Answer 9

Is this a critical Situation?
Are there any interventions that must be made now?
Delegate to team to prepare for rapid transport following completion of primary survey

Question 10

Head and Neck

Answer 10

Are there any obvious wounds to the head or neck?
I am looking at and feeling the neck. do I see for feel any DCAP-BLS or tenderness of the neck?
Do the neck veins look and feel flat or distended? Does the trachea look and feel midline or deviated?

Question 11

Chest

Answer 11

I am looking at and feeling the chest. Do I see for feel any DCAPP-BLS or TIC?
Is the chest symmetrical?
I am listening to the chest high in the midaxilliary line bilaterally. Are the breath sounds present and equal? Are they clear?

Question 12

Abdomen

Answer 12

I am looking at the abdomen. Is there any DCAP-BLS?
I am feeling the four quadrants of the abdomen.
Is the abdomen soft or hard (rigid?)
Is there any tenderness? Is there any distention?

Question 13

Pelvis

Answer 13

I am looking at and feeling the pelvis. Pushing in on iliac crests. Is there any DCAP-BLS or TIC? Is there any bleeding or incontinence?

Question 14

Lower Extremities

Answer 14

I am looking at and feeling the legs. Is there any DCAP-BLS or TIC? Is CMS normal?

Question 15

Upper Extremities

Answer 15

I am looking at and feeling the arms. Is there any DCAP-BLS or TIC? Is CMS normal?

Question 16

Transport Decision

Answer 16

Is this a critical situation?
Are there any other interventions to be made now?
Critical patients should not have transport delayed.

Question 17

Exam of the Posterior

Answer 17

Done during transfer to the backboard. Is there any DCAP-BLS or TIC?

Question 18

CMS (for patients with altered mental status - may be done earlier in survey)

Answer 18

Are the pupils equal and reactive?
Does the patient have a medical identification device?