Skills

Question 1

How long should it take to complete a primary survey?

Answer 1

90 seconds

Question 2

Do you treat as you go in the primary survey?

Answer 2

yes

Question 3

What are the components of the primary survey?

Answer 3

Initial impression
* Reaction to & appropriateness of verbal response to greeting
* perfusion and posture
* distress or discomfort
Airway + spinal management if required
* consciousness
* ability to take a deep breath
* ability to speak a full sentence (word/phrase/sentance’)
Breathing
* Look, listen & feel
* RR (15 seconds x 4)
* work of breathing (effort & efficacy)
* Auscultate breath sounds
Circulation + arrest life threatening haemorrhage
* Examine for life-threatening haemorrhage
* Count pulse rate (15 seconds x 4)
* Assess pulse volume & rhythm
* Assess peripheral & central perfusion
- Skin temperature
- Skin colour
- Central & peripheral cap refill
Disability/Dysfunction (neurological)
* Measure LOC (AVPU or GCS)
* Check pupil size & function
* Assess ability to walk, if appropriate to do so
* Assess ability to move limbs
Exposure/environment
* Expose and inspect torso and limbs
Focused Hx & adjuncts
* Blood Pressure
* BGL
* Pulse oximetry
* Measure tympanic temperature
* ECG
* Calculate Worthing Physiological Score
Ask questions
* What is the main problem you have called the ambulance for today?
* Do you currently have chest pain or breathing difficulty?
* With respect to the problem that you called the ambulance for today:
- When did it start?
- What were you doing when it started?
- How severe is it at the moment?
- Is it getting better or worse?

Question 4

What are the components of the secondary assessment?

Answer 4

Head
- Posteriorly / laterally - check nose and ears for blood, foreign bodies & CSF & check for facial #
- Assess pupils using pupil torch - PEARL
- Ask Pt to bite and to run tongue around inside of teeth
Neck
- Assess spinal cord function - squeeze both hands wiggle toes numbness/tingling
- Assess jugular vein for distension
Chest/breast
- Assess chest movement - Pneumo/Haemo/Tension Pneumothorax, sucking chest wound, subcutaneous emphysema, tracheal deviation, unequal chest movement, trauma, Oedema/erythema/purpura
- Gently spring the ribs
Abdomen
- Palpate the abdomen across all regions - assess for distension, rigidity, guarding & palpate the presence of femoral pulses as indicated
Pelvis/Genitalia
- Protect modesty and privacy
- Localised trauma
- Oedema / erythema / purpura
**Upper and Lower limbs **
- Assess distal perfusion and pulses - If no # or dislocation is suspected confirm this by asking the Pt to move each limb
- Ensure palpation of all bones is performed, e.g. upper limb from clavicle and scapula to fingers
Back and Spine
- Maintain spinal alignment - log roll
- Check in natural hollows for trauma
- Palpate carefully along the spine for tenderness and deformity
Take the History
- Record chief complaint
- Assess pain - OPQRST
- Ascertain treatment given prior to your arrival
- If the Pt unconscious prior to your arrival, was it continuous and how long
- Obtain an AMPLE history

Question 5

Non-Invasive Ventilation - CPAP Procedure

Answer 5

• Place pt in seated position
• Explain procedure to the pt (their understanding and cooperation is essential for successful CPAP)
• Prepare equipment
• Select the appropriate size face mask ensuring the inner circumference of the air cushion encompasses the bridge of the nose, side of the mouth and inferior border of the bottom lip (with mouth slightly open)
• Size 4 - small adult (red)
• Size 5 - large adult (blue)
• Attach the vectored flow valve to the mask and the oxygen tubing, ensuring harness connector remains in place
• Connect the oxygen tubing to a standard 15 L/min oxygen flow metre
• Adjust oxygen flow rate to L/min to generate 5cm H2O continuous positive airway pressure
• Monitor patient’s response to treatment (resp rate, SpO2, BP, chest sound & WOB) and increase airway pressure every 3-5 mins to a maxiumum of 15 cm H2O
• If the pt shows evidence of deterioration, discontinue CPAP immediately and treat in accordance with appropriate CPG