Week 3- Primary Survery

Primary survery

A rapid, systematic approach used by paramedics to assess and manage life-threatening conditions in emergency situations. It is designed to be completed within 10 seconds, emphasising the principle: "Find it, fix it!" This method ensures that critical issues are identified and addressed immediately to stabilise the patient before further assessment.

DRABC

Danger

Response

Airway

Breathing

Circulation

Response- what to do to check?

AVPU

Alert-is patient alert and talking to us?

Voice-patient responds to voice?

Pain- Do they respond to painful stimuli

Unresponsive- no response at all? straight for pulse/circulation

OPA procedure- Oropharyngeal Airway Device

Measure insisors to angle of jaw, select appropriate size.

Insert 1/3 then flip 180 degrees so concave faces roof of mouth (no flip in paediatric patients, concave face floor)

Continue inserting until flange is on lips

Triple airway manoeuvre procedure

1. Head tilt- Two hands are used to tilt the head in order to open the airway.

2. Jaw thrust- The jaw thrust moves the tongue anteriorly with the jaw, further minimising

obstruction. Lifting from under the angle of the jaw on both sides, causes the jaw to thrust up and

forward. This position is maintained often with assistance from an oral airway adjunct.

3. Open mouth- The tips on both thumbs are used to open the mouth to visualise the oropharynx

Triple airway manoeuvre contraindications

Nil

Oropharyngeal Suctioning- Yanker Catheter

indication: patient unable to clear airway secretions

complication: potential airway trauma, stim gag reflex

Procedure:

Ensure the catheter is connected to the suction tubing and the suction tubing is connected to an appropriate suction device Test for adequate suction by occluding the catheter's side port With the side port remaining open, gently insert the catheter's tip into the patient's oral cavity Activate suctioning whilst gently withdrawing the catheter from the oropharynx Ensure the commencement of appropriate oxygenation/ventilation. If required, repeat the suctioning procedure

OPA sizes from neonate to large male

10 - Red - Large Male

9 - Yellow - Adult Male

8 - Green - Adolescent/adult female

7 - White - Child

6 - Black - Small Child

5 - Blue - Toddler

4 - Pink - Infant

3 - Lilac - Neonate

Nasopharyngeal Airway Device

Indication:

- potential or actual airway obstruction

Complication:

-Airway trauma particularly epistaxis (nose bleed)

-Incorrect size will impact effectiveness

-Exacerbate injury in base of skull fracture

-Can stimulate a gag reflex in sensitive patients

Procedure:

- Identify correct size (tip of nose to earlobe)

- Lubricate the end

- advance carefully along nasopharynx until flange on nostril

typical sizes: 6,7,8

What are the typical sizes for conducting a Nasopharyngeal Airway device procedure?

6, 7, 8

If a patient has potential or actual airway obstruction? What needs to be done?

Nasopharyngeal Airway device

If a patient cannot spontaneously clear airway secretions

Oropharyngeal Suctioning- yanker catheter

If a patient is unable to maintain airway patency?

Triple Airway Maneuver

If a patient has potential or actual obstruction of breathing?

Nasopharyngeal airway device

Manual in-line Stabilisation

Indications

Stabilisation of the head and neck in a patient with suspected cervical spine injury

Complications:

-awkward for laryngoscopy

When checking breathing, what two questions do we ask and how many breaths per minute is normal?

Are they Breathing? y/n

Is it adequate? y/n

>10 per minute is normal

Breathing:

Look for what

Listen for what

Smell what

Feel what?

Look for chest rise/fall

Listen for breathing noise (noisy? quiet? gurgling? cackles? Taking in full sentences?

Smell- alcohol on patient, vomit or fecal

Feel-

-air movement from mouth or nose

-chest expansion

-chest tenderness or crepitus (popping cracking when joint pushed through soft tissue)

-Subcutaneous emphysema (when air gets to innermost skin layer- can cause infection)

Apnoeic (apea)

not breathing

Bradyponeic

Slow breathing-could be 10 or could be less per minute

Dyspnea

difficulty breathing

Hyponea

shallow breathing (low reparatory volume)

Bag Valve Mask (BVM)

Indications:

-respiratory distress, hypoventilation (RR<10/min)

Contraindication:

Spontaneously breathing patients with adequate tidal volume and an appropriate respiratory rate >10/min.

Procedure:

Complications:

-gastric inflation (stomach bloating air going down esophagus)

-pulmonary barotrauma (of alveoli air sacks having air pushed in too hard too quick)

-hypotension (lungs constantly inflated, heart can't inflate as effectively, so blood pressure lowers)

Procedure:

- check for need

-posture patient

-create effective seal on face (E/C grip)

-gently squeeze bag

-release pressure

What to check for:

-signs of cyanosis

-adequacy of ventilation

-airway pressure

-correct functioning of all valves and tubing

-continuous supply of oxygen to the resuscitator and inflation of the reservoir bag

Bag valve mask (BLM) Body mass/ volume bag/stroke vol

Neonatal

Paediatric

Adult

Body Mass Volume Bag/Stroke

Adult >23kg 1500/1200ml

Paediatric 6.5-23kg 550/330ml

Neonatal <6.5kg 300/160ml

Why is it important not to empty entire BLM bag when conducting assisted ventilation?

Adult tidal volume is 500ml whereas bag is 1500ml. If you squeeze entire bag volume into lungs it can cause hypotension as heart is crushed.

Where to check for pulse?

Radial in conscious, carotid in unconscious

Circulation- what do we check for?

Check for pulse

Look- at skin colour, are they pale? discoloured signalling poor circulation?

Bleeding

Capillary refill time

Listen-heart sounds, absent, muffled

Feel-pulse rate/rhythm, strength, skin temp

How to measure OPA tube

Incisors to angle of jaw

OPA adult vs paediatric patient

Paediatric no 180 degree flip

How to measure nasopharyngeal airway tube

Tip of nose to earlobe

Apnea

Cessation of breathing

Bradycardic

slow heart rate, typically under 60 bpm

Haemorrhage

excessive blood loss from the body, which can be life-threatening if not controlled.

Trismus

inability to open the mouth due to muscle spasm or stiffness, often seen in jaw-related conditions.

When not to provide an OPA

Patient has intact gag reflex and or resists

Complications of NPA

Airway trauma

Wrong size or position

Trigger gag reflex

Exacerbate injury

Why is right nostril preferred for NPA?

Straighter and larger

Complications of Triple Airway Maneuover

Potential C-spine injury (Do DAM- no jaw thrust)

Indications for OPA

Maintain Airway Patency

Bite block for intubated patients

Contraindication for OPA

Conscious patient

Gag reflex

Complications of OPA

Airway trauma from OPA placement

Intolerance OPA removal

Can precipitate vomiting/aspiration for patients with gag reflex

Incorrect placement or size can exacerbate airway obstruction

Indications NPA

Potential or actual airway obstruction

Complications NPA

Airway trauma/ epistaxis

Incorrect size impacts effectiveness

Exacerbate injury'

Potential gag reflex

Epistaxis

Nose bleed

Complications for MILS

Difficult laryngoscopy

Indication of MILS

Stabilisation of head and neck with potential cervical spine injury

Contraindications BVM

Patients with natural breathing 10 breaths or below per min

Complications BVM

Gastric inflation

Pulmonary barotrauma

Undesirable cardiovascular effects such as hypotension, secondary to caval compression

Stridor sound when breathing

Continuous sound high pitched, heard predominantly on inspiration

• usually caused by partial obstruction larynx or trachea hence air sucked through and high pitch

Wheeze sound when breathing

high pitch whistle like sound, usually due to respiratory secretions

• asthma, emphysema, chronic bronchitis

Crackles sound when breathing

• sound course- low pitch moist, fine- hair rubbing against ear

• cause: air passing through fluid or mucus

• what: course- pulmonary oedema, bronchitis

• what fine- pulmonary fibrosis, congestive heart failure

Pleural Rub sound when breathing

• sounds like: ship creaking, rubbing

• cause: movement of inflamed pleural surfaces against one another

• what: tuberculosis and pneumonia