Primary Survey

What is the Primary Survey and what is its purpose?

Swift patient assessment which should take 60-90 seconds. Stepwise approach, meaning any abnormalities identified in one step should be addressed before moving onto next.

D - Danger (including your global overview) R - Response (AVPU) C - Catastrophic haemorrhage A - Airway B - Breathing D - Danger E - Expose/evaluate

Describe the Danger part of the primary survey (Global overview)

Assessing risks and hazards to self, patient and others. Also gives you a first impression of what may have happened, any PPE required or any additional resources required.

Describe the Response part of the primary survey

How responsive the patient is. Assessed using AVPU A - alert (eyes open, tracking) V - voice (responds to voice) P - pain (responds to pain) U - unresponsive

If anything other than alert, escalate to senior clinician 🚩

Describe the Catastrophic Haemorrhage part of the primary survey

Identify if there are any catastrophic haemorrhages (i.e pat will die of this haemorrhage within minutes) and address immediately (tourniquet)

Describe the Airway part of the primary survey

Look Listen Feel

• Look for signs of airway obstruction
• Listen for noisy or absent breathing
• Feel for air movement as the patient breathes

Manage as required to achieve a patent airway before moving on (open, maintained, protected)

Describe the Breathing part of the primary survey

Look to see if patient is breathing.

• If not, need to provide ventilations (BVM).
• If breathing, see if sufficient by taking RR and observing chest wall movement. Attach pulse ox to measure saturations. May include a quick auscultation.

Describe the Circulation part of the primary survey

Look at colour of patient's skin and their limbs and peripheries to assess perfusion. Feel for a pulse and take a pulse rate (distal if conscious, carotid if unconscious). Check and address any non catastrophic bleeding. Can also undertake ECG and BP as a crew

Describe the Disability part of the primary survey

Measure of neuro function and level of consciousness.

• AVPU again
• Check pupils equal and reactive (pen torch - PEARL)
• BM to see if altered blood sugar causing disability
• FAST

Describe the Evaluate/Expose part of the primary survey

• Evaluate to see if you've missed anything, quick head to toe to check for any obvious trauma or illnesses such as rashes that may indicate underlying cause (e.g. meningitis)

What are the three elements of consent? How should we act if a patient cannot give consent (e.g unconscious)?

Consent is gaining permission to do something for the patient and ensuring the patient understands.

• Voluntary

• Informed decision

• Capacity

If cannot gain consent, act in best interest of the patient