Primary Survey

When do you use it?

What is it?

Rapid assessment Identify anything that can kill Pt

Look for anything that’s not rightNot just for traumaNot just for unconscious people

It’s on every PRFEasy to remember – work down the bodyShould be less than 1 min

DR ABCDE

DangerResponse(Summon help)Airway (with C-spine considerations)BreathingCirculationDisability / dysfunctionExpose

Deal with each as you come to it!

Danger

Have a proper look!How many patients?Size up the scene (what could have caused

injury?)

Response

Have a look at Pt – big sick or little sick?Approach from feetAVPU

Question, command, pain PAIN – how do we check this?

Note how response changes

Response - If Alert?

If talking, airway OK NOTE – obstructed airway?

If talking, breathing OK NOTE – breathing difficulty?

Assess circulation Pulse, skin colour / moisture / temperature

Response - If NOT Alert?

If alone, shout helpIf in a first aid team, shouldn’t be aloneDo you call for backup (ETA, HCP) ???

Airway (with C-spine considerations)

Check C-spine Feel down back of neck (tenderness, irregularities)

Check jaw Feel across mandible (fracture obstructing airway?)

Check mouth Any obvious obstructions? Take em out

Action - Head tilt & Chin liftOR Jaw thrust??

When would you do this?Check neck

Trachea OK? Swelling? Discoloration?

Breathing

Check breathing for 10 secs NB agonal breaths don’t count

Someone to take over head tilt / chin lift?Check chest

If appropriate, LOOK at the chest Anything odd? Bruising, swelling,.. knife?

Palpate (Feel) chest Check for equal expansion Breathing fast or slow (don’t need resp rate)

Circulation

“Blood on the floor and 4 more”Can bleed to death internally – looking for

this

Circulation

Check abdomen Bruising? Discoloration? Swelling? Wounds?

Feel abdomen Palpate the four quarters (feel for hardness, watch for

tenderness)

Circulation

Feel pelvis Check for position of iliac crests Do not ‘spring’ the pelvis!!

Feel femurs Start at the TOP (yes, by the crotch) Firm grip, go down to the knee

Check back for bloodCheck PULSE in both wrists

Don’t need a pulse rate – just is it fast or slow?Check skin colour

Disability / Dysfunction

Feel around head Deformity (fractured skull)? Blood?

Check voice responseCheck pain response

Squeeze trapezius muscle (neck/shoulder) Eyes open? Hands move?

Check motor ability Ask em to squeeze your fingers

Expose

If you suspect injuries, have a look!

Summon Help?

If alone, shout helpIf in a first aid team, shouldn’t be aloneWhat’s needed?

Equipment? (carry chair, carry sheet, scoop) Oxygen? ETA? Paramedic?

What comes next?

Observations (response, pulse, resps)Secondary surveySAMPLEDetailed assessment (OPQRST etc)