NB403 Year 1: DR[C]ABCDE

Why do we carry out a primary survey

Recognise deteriorating patients
Systematic in approach
Dynamic
Prioritises lift threatening conditions
Recognises need for assistance

What is the primary survey acronym and the meaning

D R [C] A B C D E

Danger
Response
[Catastrophic Haemorrhage]
Airway
Breathing
Circulation
Disability
Expose and examine (everything else!)

Give some examples of Danger in the primary survey

Glass, sharps, animals, roads, traffic, other people, fire, gas, smoke, unstable structures

In Response, What does ACVPU mean

Alert, [new] confusion, voice, pain, unresponsive

Name the ways in that an airway can become obstructed

Blocked, narrowing, oedema, infection, CNS depression

When in a primary survey do we look, listen and feel

For recongition or airway, breathing and circulation issues

In airway recognition what do we 'look' for

Distressed,
choking,
tired,
paradoxical breathing,
using accessory muscles,
cyanosed

In airway recognition what do we 'listen' for

Not talking or finding it hard to talk
Not breathing or short of breath
Stridor from partial obstruction
No sound - Silence.

In airway recognition what do we 'feel' for

Breath coming from the nose or mouth,
Chest rise and fall

What is the management of an airway

Administer high flow oxygen at 15l per minute,
Create a patent airway using head tilt / chin lift or jaw thrust,
Use simple airway adjuncts such as NPA or OPA
Use advanced airway techniques like supraglottic airwats (igels) or tracheal tubes

Name the ways in which breathing can become problematic

CNS depression leading to reduced respiratory drive,

Decreased respiratory effort due to:
Muscle weakness,
Nerve damage,
Restrictive chest defect,
Pain from fractured ribs

Lung disorders:
Pneumothorax
Haemothorax
Pulmonary oedema
Pulmonary embolism
Infection
Acute excacerbation of COPD
Asthma

In breathing recognition what do we 'look' for

Respiratory rate
Respiratory distress
Type of breathing shallow, or laboured
Use of accessory muscles
Cyanosis
Chest deformity
Conciousness level
Pulse oximetry

In breathing recognition what do we 'listen' for

Not talking or finding it hard to talk
Noisy breathing
Breath sounds

Name abnormal breath sounds

Rales: Small clicking, bubbling, or rattling sounds are heard when inhaling and can be described as fine, coarse, moist, or dry. They can indicate fluid in the lungs or that they aren't inflating properly.

Rhonchi: These sounds resemble snoring and occur when air flow is rough or blocked in the large airways.

Stridor: This high-pitched, musical sound is heard when breathing and is usually caused by a blockage in the back of the throat or windpipe.

Wheezing: These high-pitched sounds are produced when the airways narrow and are most often heard when exhaling
.
Pleural rub: This discontinuous grating sound or creak occurs when breathing and is caused by pleural inflammation.

In breathing recognition what do we 'feel' for

Expansion
Deformities
Tenderness

What steps can we take to manage breathing

Patent airway (Remember A before B)
Oxygen as directed by pulse oximetry
Posture
Treat underlying cause such as nebulise for asthma
Support breathing if inadequate i.e. manual ventilation with BVM

Name the PRIMARY ways in that circulation can become problematic

ACS (STEMI, NSTEMI, unstable angina)
Arrythmias
Hypertensive heart disease
Valve disease
Drugs such as cocaine
Inherited cardiac disease
Electrolyte imbalance
pH abnormality (normally 7.35 to 7.45)

Name the SECONDARY ways in that circulation can become problematic

Asphyxia
Hypoxaemia
Blood loss
Sceptic shock
Hypothermia

In circulation recognition what do we 'look' for

Pale skin
Blood loss
Shortness of breath
Chest pain
Syncope

In circulation recognition what do we 'listen' for

Blood pressure

In circulation recognition what do we 'feel' for

Pulse (rate, rythm and strength)
Temperature
Moisture on skin
Cap refill
Turgor

What steps can we take to manage circulation

Patent airway
Breathing
Oxygen as directed by pulse oximetry
Call for assistance
Treat the underlying cause
Gain IV or IO access
Manage fluid

How do recognise disability in the primary survey

GCS
PERRLA (Pupils Equal Rounds Reactive to Light and Accomodation)
Measure blood glucose

What steps can we take to manage disability in the primary survey

ABCs
Treat underlying cause

What steps can we take to manage exposure in the primary survey

Remove clothing to enable thorough examination
Looking for injuries, bleeding, deformities, rashes, scars, medical tags
Avoid heat loss
Maintain dignity