Primary Survey & History Taking Flashcards
What does the “SMART” Approach stand for?
S- Scene Safety
M- Mechanism of Injury
A- Additional resources
R- Roles and responsibilities
T- Triage
Things to consider for “S” in “SMART”
The safety of you and your crewmate
Is PPE required
Is the scene safe for the patient
Things to consider for “M” In “SMART”
Is the presenting complaint trauma or medical?
Was is witnessed?
Did it happen from a height?
Things to consider for “A” in SMART
Is a second crew needed, fire, police or HART?
Things to consider for “R” in SMART
Local guidelines, HCPC, JRCALC
ROLE Criteria
Things to consider for “T” in SMART
Stepwise approach - if there is 2 or less unconscious patients approach with caution, if there is 3 or more do not approach and contact control
What is the criteria for ROLE
decapitation
massive cranial and cerebral destruction
hemicorporectomy
decomposition
incineration
rigor mortis
exsanguination
DNACPR
living wills and respect forms
During the primary survey what does a “stepwise approach” mean?
any abnormalities found during any stage should be resolved before moving onto the next stage.
List the order of immediate actions that you should take when you approach a patient during the primary survey
General observations
Catastrophic haemorrhage
Response
Airway
Breathing
Circulation
If a patient only responds to you during a trapeze squeeze where do they fall on the AVPU scale?
Pain
What Level of intervention is a head tilt chin lift & a jaw thrust in airway management?
Basic
What two pieces of equipment can be used in basic airway management?
Oropharyngeal airways
Nasopharyngeal airways
What may be used for intermediate level airway management?
Laryngeal mask airway (LMA)
I-Gel
What procedures fall under advanced airway management?
endotracheal intubation
needle cricothyroidotomy
Name some ways in which an airway can be cleared
postural drainage, suction. finger sweep & Magill’s forceps
When assessing the breathing of a conscious patient you should assess the…
rate, rhythm and depth
When assessing the breathing of an unconscious patient you should open the airway and then…
look, listen and feel for breathing
Where can each of the following pulses be found:
Femoral
Brachial
Radial
Pedal
Popliteal
Femoral - groin
Brachial - upper arm
Radial - wrist
Pedal - top of foot
Popliteal - back of knee
What does AVPU stand for?
Alert, Verbal, Pain, Unresponsive
How do you assess the circulation on a conscious patient?
Gain consent
Assess peripheral pulse (radial)
Peripheral capillary refill test: squeeze nailbed for 3 seconds and release - time how long it takes blood to return)
How do you assess the circulation on an unconscious patient?
Central pulse test (carotid/femoral) for 10 seconds
Central capillary refill test: press on sternum for 3 seconds
What are the 3 parameters for the GCS and what can each one be scored to?
Best eye response: 1-4
Best verbal response: 1-5
Best motor response: 1-6
GCS: Eye response 1-4
- no eye opening
- eye opening to pain
- eyes opening to sound
- eyes open spontaneously
GCS: Verbal response 1-5
- no verbal response
- incomprehensible sound
- inappropriate words
- confused
- orientated
GCS: Motor response 1-6
- no motor response
- abnormal extension to pain
- abnormal flexion to pain
- withdrawal from pain
- localising pain
- obeys commands
Adult vital signs: RR & HR & Temperature
RR: 12-20bpm
HR: 60-100bpm
Temp: 36-37.5 degrees celcius
Adult vital signs: Blood Pressure
90/60mmHg - 120/80mmHg
Adult Vital signs: capillary refill time
less than 2 seconds
Adult vital signs: blood glucose (BM)
4.4-7.2mmol/L
Adult vital signs: oxygen saturation
94-99%
Medical Model: Presenting Complaint
PC
Brief explanation
Things to ask: what’s being going on today? what’s made you call us?
Medical Model: History of Presenting Complaint
HPC
detailed explanation
Use SOCRATES OR SOCATE
Medical Model: Past Medical History
PMH
Existing Health Problems
Medical Model: Medication History
DH
What medication does the patient normally take, have they taken it today? when was medication last reviewed? any side effects?
What does SOCRATES stand for?
S- site
O- onset
C- character
R- radiation
A- associating symptoms
T- time
E- Exacerbating
S- severity
