Primary survey

Question 1

Stages in primary survey

Answer 1

-SCENE assessment
-Patient assessment triangle- colour, work of breathing, appearance
-catastrophic haemorrhage/ blood loss
-airway management
-breathing
-circulation
-disability
-exposure, environment- trying to find injuries etc.

Question 2

Testing level of consciousness

Answer 2

AVPU
Alert
Voice- responding to voice stimulus
Pain- responding to pain stimulus eg. shake shoulder, squeeze trapezius muscle (shoulder)
Unresponsive/ unconscious

Question 3

Dealing with catastrophic haemorrhage

Answer 3

Head and torso
-direct pressure
-compression bandage
-wound packing
Limbs
-tourniquet
Haemostatic dressings

Question 4

Airway management

Answer 4

Manual methods
-jaw thrust
-trauma chin lift
-OPA- tube down throat
-NPA- nasal
-Suction

Question 5

Breathing and pulse check

Answer 5

-10 seconds on carotid pulse (neck) and check breathing at the same time
-look for rise and fall of chest
-look, listen and feel

Question 6

Circulation

Answer 6

Is there a pulse?
-no pulse= CPR
-pulse present- rate, rhythm, volume
-skin- colour, temperature

Question 7

Disability

Answer 7

-continuous re-evaluation of patient- LOC
-alert of downward trend in terms of awareness
-consider patient involved in serious trauma to be hypoxic until proven otherwise
-haemoglucose test (HGT)
-AVPU
-check for head injury
-test alert and orientated in 4 areas- person, place, day, event
-assess STM and LTM

Question 8

Hypoxic-

Answer 8

-low levels of oxygen in the tissues

Question 9

Expose/ environment

Answer 9

-remove as much clothing as necessary, selectively uncover
-be aware of environment
-beware of hypothermia

Question 10

Steps after primary survery

Answer 10

-document LOC on electronic patient care record (ePCR)
-identify cause of reduced consciousness- history, medication
-may need to give oxygen or put in the recovery position

Question 11

Recovery position

Answer 11

-hand up
-tuck other arm round head
-tuck further leg up and use to roll
-tilt head back

Question 12

What to do if life threatening/ time critical

Answer 12

-stabilise spine
-arrest major haemorrhage and transport to hospital
-IV access

Question 13

Measuring breathing
-average rate, COPD average, limitations

Answer 13

-average is 12-20 per min (above 20= tachypnoea, below 12= bradypnoea)
-O2 saturation= average 94-98%
-88-92%= COPD average
-below average= hypoxemia
Limitations
-poor circulation
-skin pigmentation
-skin thickness
-skin temperature
-nail polish
-movement

Question 14

Measuring circulation
What we’re feeling for, normal range, abnormal ranges, where to feel pulse

Answer 14

Feeling for
-rate (BPM)
-rhythm- regular, irregular
-volume- strength
-normal range= 60-100 BPM
-tachycardia= >100
-bradycardia= <60
-absolute bradycardia= <40
-feel carotid or radial pulse
-capillary bed refill
-blood pressure

Question 15

Capillary bed refill/ capillary refill time

Answer 15

-choose site- peripheral eg. finger vs central eg. sternum
-gain consent
-apply pressure for 5 secs
-release pressure
-time how long it takes for colour to return
-normal = less than 2 seconds

Question 16

Blood pressure

Answer 16

-measure with sphygmomanometer
-124/ 82 mmHg- 124= systolic pressure- when ventricles contract, 82= diastolic blood pressure- ventricles relaxed
-Hypertension= systolic over 140 mmHg
-Hypotension= systolic less than 90 mmHg
-Crisis hypertension= systolic above 180 mmHg

Question 17

Manual non-invasive blood pressure process

Answer 17

1. Gain informed Consent
2. Attach Blood Pressure cuff
3. Palpate the radial Pulse
4. Pump up cuff and note when the radial disappears
5. Release pressure
6. Pump up to 20mmHg above the pressure noted above
7. Place stethoscope over brachial artery
8. Deflate slowly and note the first Korotkoff sound (systolic)
9. Continue deflating and note the last Korotkoff sound

Question 18

Disability

Answer 18

Glasgow coma scale (GCS) (NEED TO KNOW FOR EXAM IN MORE DETAIL, USE DIAGRAM)
-indicates level of injury and illness based on LOC
-3 sections- eyes (max score 4), verbal (max= 5), motor (max= 6)
-Range of 3-15

Blood sugar
-normal= 4-7.8 mmol/L
-above 7.8= Hyperglycaemia
-below 4= Hypoglycaemia

Question 19

Decorticate posturing-

Answer 19

-when limbs move to the core of the body after pain stimulus

Question 20

Decerebrate posturing-

Answer 20

-worse than decorticate
-rigid extended legs
-wrists flexed outwards

Question 21

Exposure

Answer 21

Temperature
-use tympanic thermometer= ear
-normal range= 36-38
-hyperthermia= above 38
-hypothermia= below 36