Primary Survey Flashcards
what acronym must you use for making a primary survey over the phone?
SBAR
Situation: where are you, who is patient, HPC
Background: Pt backrgound, details of aadmission
Assessment: Obs / Examination /IX
Reccomendation: what do they want from you?
What must you do before starting on A>E
Ask for HELP
What are the three steps for every system you look at in A>E approach?
Assessment
Observations
Interventions
What do you SAY and DO for Airway?
I would introduce myself and wait for a response - if they vocalising, assume patency
If not vocalising:
- Look inside mouth (secretions, angioedema)
- Feel (for expired air)
- Listen (added sounds e.g. stridor)
DO:
- visible FB: one finger sweep
- secretions: direct suction
- airway maneuvres
- airway adjunct (OPA, NPA)
if compromised/GCS <=8 > anaesthetics
What do you SAY and DO for breathing
SAY: I would assess breathing using a look, listen, feel approach
Look: RR, BL expansion, WOB, deformity
Feel: BL expansion, trachea
Listen: BL AE (crackles? wheeze? diminished breath sounds?)
DO: Sit upright (pulm oedema) or legs up (anaphylaxis)
15L O2 in non rebreath bag and mask if SpO2 <94
Consider portable CXR and ABG
What do you SAY and DO for circulation
SAY: I would assess haemodynamic status working peripherally to centrally
Look: cyanotic? perspirating?
Feel: peripherally warm / well perfused, CRT, HR (radial and jugular), BP, JVP
Listen: HS I+II+0
Obs: HR, BP, Temp, catheter (UO, Fluid balance), ECG,
DO:
- 2 14/16GG canulas in each ACF, take bloods
- ABG/VBG
- Fluid bolus
- Sepsis 6
- ECG
- portable CXR if required
What do you SAY, ASSESS and DO for disability
SAY: I would assess patient’s neuro function with GCS / AVPU
ASSESS: GCS/AVPU, Pupils PERLA, check drug chart, check BLOOD GLUCOSE
DO: dextrose IV if low BM, anaesthetics if GCS <=8, antudote if overdose, adjust/stop meds
What do you SAY and DO for EXPOSURE
I would fully expose the patient to examine the entire body, paying particular attention to…
Abdo exam +- DRE
Check:
- Calves SNT
- surgical sites
- indwelling lines
- induelling catheters
- consider urine dip and pregnancy test
What are causes for Respiratory Acidosis
ALL CAUSES OF T2 RESP FAILURE (hypoxia + hypercapnia) - they retain excess CO2
- Drugs ( opiates)
- chronic retainer (COPD)
- Insufficient ventilation
- Exhaustion (asthma)
- Paralysis (GBS)
What are causes for resp alkalosis
Blowing off too much CO2, so:
- anxiety, panic atttack
- PE
- aspirin (initial stimulation of resp centre)
- excess ventilation
- pneumothorax
How do you classify causes of metabolic acidosis
Based on the Anion Gap
How do you calculate the anion Gap
Na + K - (Cl + HCO2)
What does the anion gap indicate, and what is its normal range
If high, it indicates presence of unmeasured ions (so excess of a specific ion is causing the unbalance)
What is the normal range for anion gap
4-12
What are causes of high Anion Gap
MUDPILES
Methanol Uraemia DKA Propylene glycol Isoniazid, Iron Lactate Ethylene glycol Salycates
