Primary survey Flashcards
Stages in primary survey
-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.
Testing level of consciousness
AVPU
Alert
Voice- responding to voice stimulus
Pain- responding to pain stimulus eg. shake shoulder, squeeze trapezius muscle (shoulder)
Unresponsive/ unconscious
Dealing with catastrophic haemorrhage
Head and torso
-direct pressure
-compression bandage
-wound packing
Limbs
-tourniquet
Haemostatic dressings
Airway management
Manual methods
-jaw thrust
-trauma chin lift
-OPA- tube down throat
-NPA- nasal
-Suction
Breathing and pulse check
-10 seconds on carotid pulse (neck) and check breathing at the same time
-look for rise and fall of chest
-look, listen and feel
Circulation
Is there a pulse?
-no pulse= CPR
-pulse present- rate, rhythm, volume
-skin- colour, temperature
Disability
-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
Hypoxic-
-low levels of oxygen in the tissues
Expose/ environment
-remove as much clothing as necessary, selectively uncover
-be aware of environment
-beware of hypothermia
Steps after primary survery
-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
Recovery position
-hand up
-tuck other arm round head
-tuck further leg up and use to roll
-tilt head back
What to do if life threatening/ time critical
-stabilise spine
-arrest major haemorrhage and transport to hospital
-IV access
Measuring breathing
-average rate, COPD average, limitations
-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
Measuring circulation
What we’re feeling for, normal range, abnormal ranges, where to feel pulse
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
Capillary bed refill/ capillary refill time
-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
Blood pressure
-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
Manual non-invasive blood pressure process
- Gain informed Consent
- Attach Blood Pressure cuff
- Palpate the radial Pulse
- Pump up cuff and note when the radial disappears
- Release pressure
- Pump up to 20mmHg above the pressure noted above
- Place stethoscope over brachial artery
- Deflate slowly and note the first Korotkoff sound (systolic)
- Continue deflating and note the last Korotkoff sound
Disability
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
Decorticate posturing-
-when limbs move to the core of the body after pain stimulus
Decerebrate posturing-
-worse than decorticate
-rigid extended legs
-wrists flexed outwards
Exposure
Temperature
-use tympanic thermometer= ear
-normal range= 36-38
-hyperthermia= above 38
-hypothermia= below 36
