Primary Survey

Introduction

  • Primary Survey is crucial in emergency care, focusing on identifying life-threatening issues.

General Impression

  • Gain a general impression of the patient upon approach:

    • Assess if the patient is hurt.

    • Determine the severity of injuries, particularly any catastrophic hemorrhage.

Patient Assessment Triangle

  • Aim:

    • Identify and manage life-threatening problems.

    • Be conscious, objective, and systematic about observations.

Steps in Primary Survey

  1. Response - Assess alertness (AVPU).

  2. Management of Catastrophic Hemorrhage

  3. Airway Management & Cervical Spine Stabilisation (in trauma cases)

  4. Breathing Support

  5. Circulation and Circulatory Support

  6. Disability Assessment

  7. Exposure and Environmental Control

AVPU Response Categories

  • A - Alert

  • V - Responding to voice stimulus

  • P - Responding to pain stimulus

  • U - Unresponsive (unconscious)

    • Assessments include speaking to the patient and physical stimulation methods.

Pain Stimulus Techniques

  • Trapezius Muscle Squeeze

  • Supra-orbital Pressure

    • Apply light pressure, may elicit responses.

CABCDE Framework

  • C - Catastrophic Hemorrhage:

    • Direct pressure, compression bandage, tourniquet application.

    • Hemostatic dressings (e.g., CELOX, Trauma Gauze)

  • A - Airway: Open and maintain; techniques include:

    • Manual methods: Jaw thrust, chin lift

    • Airway adjuncts: OPA (Oropharyngeal Airway), NPA (Nasopharyngeal Airway), Suction, etc.

  • B - Breathing:

    • Assess adequacy of breath and rate.

    • Consider assistive ventilation if rates deviate.

  • C - Circulation:

    • Check pulse (radial/carotid), capillary refill time, temperature, etc.

  • D - Disability:

    • Continuous evaluation of consciousness.

    • Check for indications of neurological status.

  • E - Exposure:

    • Remove clothing to evaluate injuries, be cautious of hypothermia.

Breathing Evaluation

  • Check for air rise, breathing sounds, pulse simultaneously (10 seconds).

  • If no pulse, immediately start CPR.

Continuous Patient Evaluation

  • Re-evaluate the patient's level of consciousness.

  • Look for a downward trend in responsiveness, especially in trauma cases.

  • Treat uncooperative patients as potentially hypoxic until proven otherwise.

Documenting Findings

  • Document response levels on ePCR.

  • Identify possible causes for altered consciousness (medical history, presenting complaints).

Lateral Position Technique (H.A.L.O)

  • Safely move the patient into a lateral position to maintain airway patency:

    • Position: HAND, ARM, LEG OVER

Time Critical Conditions

  • Recognize and respond to time-critical conditions:

    • Unmanageable airway, significant internal hemorrhage, etc.

  • Focus on rapid transport if necessary, performing additional treatment en route.

Examples of Time-Critical Situations

  • Respiratory failure,

  • Severe trauma with serious medical conditions,

  • Rising Intracranial Pressure (ICP),

  • Major external hemorrhage.