Primery & Secondery Survey Flashcards
Primery & Secondry Survey and Ongoing Observations / Life signs
What Acronym Is Used For The Primary Survey
DR C A (W/ C-Spine) B C D E
What Does The First ‘D’ stand for in DRCABCDE
DANGER
In the D (Danger) Part of the primary survey what do you need to think/do
- Is the area safe
- Am I safe
- Do I have the correct PPE
- Put Gloves On
- look around for potential clues to mechanism of injury (including people)
What does R (response) of the primary survey mean you do
- Does the mechanism of injury indicate C-Spine
- approach from feet
- Place hand on head to protect spine from movement
What does R in DR C ABCDE stand for
Response
What does the first C in DR C ABCDE stand for
Catastrophic Haemorrhage
What does A in DR C ABCDE stand for
Airway and C-Spine Consideration
What do you have to do during A in DR C ABCDE
- Check/Clear Airway
- Open Airway
- Maintain Airway
- Protect C-Spine
Treat before moving on
How can C-Spine be protected and opened during and after primary Survey
Manual inline stabilization
Jaw thrust
If there is no likelihood of C-Spine how can airway be opened
Head tilt chin lift or jaw thrust
What could be used to maintain an airway in an unconscious or semi-conscious casualty
- Oropharyngeal Airway (OPA) for unconscious and not needing respiratory support
- Nasopharyngeal (NPA) for unconscious and semi-unconscious casualties and not needing respiratory support
- i-gel for deeply unconscious with need of respiratory support
How and when is an OPA (Oropharyngeal Airway) used
- Unconscious casualties without needing respiratory support
- Apply; Invert, Insert & Rotate
- measured from jaw bone to center of incisors
-if casualty rejects remove and try NPA
How and when is an NPA (Nasopharyngeal Airway) used
- unconscious and semi-unconscious casualties without needing respiratory support
- size 6mm for the average female
- size 7mm for the average male
- lube well
- insert by pushing and twisting in a vertical direction toward the ground NOT forehead
- do not force nose bleed can cause airway obstruction
- can be used alongside OPA
When is an i-gel used
Deeply unconscious casualty with need for respiratory support
Cardiac arrest, drug OD, Head injury, severe hypothermia and respiratory insufficiency
What Does ‘B’ stand for in DRCABCDE
Breathing
What do you have to do in ‘B of the primary survey
- Watch (for chest rise and fall)
- Listen (for breathing/respetory distres)
- Feel (for breath and tummy moving)
- check for breathing for no longer than 10 seconds
- Check for 20/30 seconds to count breaths
- Through assessment of the chest (Twelve Flaps)
- Oxygen if appropriate (15L per minute, non-rebreath mask)
What do you do if there are no signs of breathing
- Start CPR
- Attach AED
- if pulse use BVM or i-gel
What is an adults normal breathing rate
12-18 breaths per minute
At what breathing rate would you start assisted breathing
<8 breaths per minute unless severe hypothermia
Use BVM
30> serious but not treatable outside hospital
What is respiratory distress
Noisy breathing, use of accessory muscles (neck and shoulders)
What is the acronym “TWELVE FLAPS” used for
Thorough assessment of the chest for life threatening injury
What does the acronym TWELVE FLAPS mean
TWELVE
- T: Tracheal Deviation
- W: Wounds; Front, Sides, Back
- E: Emphysema (air in tissue, feels crackly
- L: Laryngeal Trauma (bruising or injury around Adams Apple)
- V: Vein distention in neck
- E: Evaluate chest injuries
FLAPS (incorporated in W)
- F: Feel chest wall
- L: Look for injury; bruising, abrasion, uneven shape, hole in chest wall, asymmetric movement
- A: Armpits
- P: Palpte; back, front, Sides for tenderness and unevenness
- S: Sides (as above)
What Does the second ‘C’ stand for in DRCABCDE
Circulation
What do you do in the circulation part of the primary survey
- Pulse; rate, rhythm, strength
- Central Capillary Refill Time (CRT); forehead or center of chest. 5 seconds pressure.
- External and Internal haemorrhage (one on the floor and four more)
- Haemorrhagic Shock
How/where do you take capillary refill, and what are the expected numbers?
Forehead or center of chest. Hold 5 seconds of pressure.
Refill of 2 seconds or less is normal
How do you check for external and internal hemorrhage?
“one on the floor and four more”
- run hands under casualty and inside waterproofs. (Soft ground can hide blood loss and hard surfaces make it look worse)
- Chest (Haemothorax)
- Abdominal Cavity 4 quadrants (Feel for tenderness and firmness)
- Pelvic Fracture (History, gentle feel for deformity) splint if in doubt
-Long bones (look and feel for shortening, abnormal position, bone visible, thigh deformity)
What are the signs of Haemorrhagic Shock
- Pulse >120 (or steadily increasing)
- raised respiratory rate (> normal)
- skin colour (pale, sweaty, cold, clammy)
- feels faint on sitting up (altered conscious or confusion)
How to deal with hemorrhagic shock
- Lie casualty down, raise legs (if no spinal or Pelvic injury suspected)
- high flow oxygen
What are normal and abnormal pulse rates?
- Serious Low: <45
- Concerning Low: 45-54
- Acceptable: 55-100
- Concerning High: 101-120
- Serious High: >120
What are normal and concerning capillary refill times
- Acceptable: <2
- conserning: 3
- serious: >4
What does the second ‘D’ in DR C ABCDE stand for
Disability
What do you do/check under ‘Disability’ of the primary survey
- Conscious Level (AVPU/GCS)
- Head / Brain Injury (Trauma/Stroke)
- Pupils (PEARL)
- BM (Blood Glucose )
- Temperature
What does AVPU stand for
Conscious levels
- A: Alert
- C: Confused
- V: responds to Voice
- P: responds to Pain
- U: Unresponsive
What does PEARL stand for and what are you looking for
Pupils Equal And Reactive to Light
- Shape of Pupils
- Size of pupils (mm)
- similar size pupils
- both pupils react to light (when shone into each eye)
What is normal pupil size
- concerning low: 1
- Acceptable: 2-5 mm
- concerning high: >6
What is a normal and concerning BM (blood glocouse)
- serious low: <3
- concerning low: 3-3.9
- acceptable: 4-8 mmol
- concerning high : 8.1 - 16
- serious high: >16
What is normal and concerning temperature
- Serious Low: <32
- Concerning Low: 32.1-34.9
- Acceptable: 35 - 37.5
- Concerning High: 37.6-39
- Serious High: <39.1
What does E in DR C ABCDE stand for
Environment / exposure
What do you do in E in the primary survey
- Consider shelter
- keep casualty warm
What is normal and concerning blood oxygen levels (SpO2)
- Serious: <91%
- Concerning: 92% - 95%
- Acceptable: >96%
What is the secondary survey
A thorough head to toe assessment as extension of the primary survey once casualty is stable
What Primary things are checked In the secondary survey
- C-Spine (asses and immobilise)
- breathing (depth and sounds)
- circulation (minor wounds, pulse Strength and regular)
- Limbs ( distal pulse and CRT, movement and sensation, reduction, splinting)
- Sample history
-clues (medical alerts, suerch bags and pockets) - monitor / retake stats
- Pain assessment
-GCS
What are normal and concerning GCS
- Serious: < 12
- Concerning: 13-14
- acceptable: 15
What does SAMPLE stand for
SAMPLE history
- S: Symptoms
- A: Allergies
- M: Medication
- P: Past Illnesses
- L: Last Meal/Drink
- E: Event leading to
What Acronym is used for pain assessment
O P Q R S T U
What does OPQRSTU stand for
- O: Onset (sudden/gragual)
- P: Provocation (what makes it worse)
- Q: Quality (e.g. stabbing)(getting worse/no change)
- R: Radiation
- S: Severity (pain score)
- T: Time (when it started)
- U: You (what does the casualty think it is)
What are the scores for eye opening on GCS
Eyes open to:
- 4 Alert
- 3 Verbal
- 2 Pain
- 1 No response
What are the scores for Verbal on GCS
- No Respose
- Groans
- Single Words
- Confused
- Orientated
What are the scores for Motor on GCS
- None
- Extention
- Abnormal Flexion
- Withdraw From Pain
- Localises Pain Site
- Obeys Commands
