2. WHAT IS PRIMARY SURVEY ?
•The primary survey is a quick way to find out
how to treat any life threating conditions one
may experience in an ER in the order of
priority. We can use cABCDE to do this.
3. PRIMARY SURVEY
• Control of Catastrophic Hemorrhage
• Airway with c-spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
• Disability: Neuro status
• Exposure / Environmental control
4. FASTEST WAY TO ASSESS A PATIENT IN 10 SEC
• ASK THE PATIENT HIS/HER NAME
• ASK THE PATIENT WHAT HAPPENED
• PALPATE DORSALIS PEDIS ARTERY WHILE THE
PATIENT IS BEING TRANSFERRED TO THE BED
5. WHAT WILL WE KNOW FROM THIS ?
• A Patent airway
• B Sufficient air reserve to permit speech
• C Sufficient perfusion ,(A MINIMUM OF 90/60 MMHG IF
D.PEDIS IS PALPABLE)
• D Clear sensorium
6. BUT DOES THIS MEAN THE PATIENT IS GOING TO
STAY IN THE SAME CONDITION ?
• MAY BE ……
THE PRESENT GCS MIGHT BE
CONSISTENT WITH THE PATIENT’S
CONDITION IF THE INJURIES ARENT
SEVERE ENOUGH ie MILD INJURIES.
• NO ….
IN MAJOR TRAUMAS LIKE BEING
THROWN FROM A VEHICLE ie WHEN
THERE IS EPIDURAL HEMATOMA ,
THERE IS LUCID INTERVAL PHASE
WHERE THE PATIENT IS NORMAL FOR
FEW HOURS BEFORE COMPLETE
DETERIORATION
7. THEN HOW DO WE KNOW IF THE PATIENT IS
GOING TO DETERIORATE OR NOT ?
• HERE’S THE PLACE WHERE THE ROLE OF PRIMARY
SURVEY KICKS IN…
• LETS DISCUSS ABCDE
8. AIRWAY WITH C-SPINE PROTECTION/PRECAUTION
• Begin by asking the victim a question…What is your name ? Are u
alright ?what happened ? Meanwhile look for fractures , foreign bodies .
• Cervical spinal precautions should be instituted immediately on
suspicion of injury to immobilize the cervical spine above and below the
suspected level of injury, preventing flexion, extension, lateral rotation
and lateral flexion. A well-fitting semirigid cervical collar is adequate
until imaging can be conducted. If a cervical collar is not available, the
patient can be placed in a neutral supine position on a rigid surface
(spine board if available) and the head immobilized with sandbags or
rolled towels and tape
9. WHAT IS NEXUS CRITERIA ?
• Focal Neurologic deficit
• Midline Spine tenderness
• Altered mental status
• Evidence of Intoxication
• Painful Distracting injury
If even one criteria is
present c-spine
imaging is necessary
!
11. AIRWAY
• Now that you have secured c-spine, proceed to airway management by looking for
blood secretions , vomitus , stridor , foreign body
• If we find anything we can eventually clear the airway, suction if required and opening
a secure airway .
• If airway obstruction is untreated it will lead to cardiac arrest. Perform either a chin lift
or jaw thrust if airway obstruction is recognized; even though, jaw thrust is favored if
cervical spine injury is suspected. Chin lift by placing hand on forehead of the victim
and gently tilt his head back. At the same time, place fingertips under the point of the
chin, lift the chin (do not push on the soft tissues under the chin as this may block the
airway). Jaw thrust by placing the long fingers behind the angle of the mandible and
pushing anteriorly and superiorly
13. BREATHING AND VENTILATION
•Only Airway route patency doesn't
ensure adequate ventilation. Sufficient
gas exchange is required to boost
oxygenation and carbon dioxide
disposal.
14. BREATHING AND VENTILATION
• Assess adequate oxygenation and ventilation.
• Inspect , palpate and auscultate .
• Respiratory Rate
• Deviated trachea
• Chest movement
• Sucking chest wound
• Absence of sounds
• O2 sats
Required to assess the
need for bag mask vent ,
needle/tube
thoracostomy
15. BREATHING AND VENTILATION
• Suspect pneumothorax or hemothorax if reduced lung sounds., This, combined
with either tracheal deviation or hemodynamic compromise, can be a sign of a
tension pneumothorax that should be treated with needle decompression
followed by a thoracotomy tube placement.
17. CIRCULATION WITH HAEMORRHAGE CONTROL
• Blood volume, cardiac output, and bleeding are major circulatory issues to be
addressed in C. Recognizing, rapidly controlling hemorrhage, and initiating
resuscitation are therefore crucial steps in assessing and managing such victims.
Once tension pneumothorax has been excluded as a cause of shock, consider that
hypotension following injury is due to blood loss until proven otherwise.
• Any observable hemorrhage should be controlled during the primary survey, by
applying a direct pressure on hemorrhagic site. Tourniquet is an effective in
massive bleeding but has a risk of ischemic injury to the affected site. Utilize a
tourniquet just when direct weight isn't viable and the person's life is
compromised
18. CIRCULATION AND HAEMORRHAGE CONTROL
• The significant territories of inner drain are the chest, retroperitoneum, pelvis, and long bones.
Normally recognized by physical assessment and imaging (e.g., chest x-ray, pelvic x-ray, FAST)
• Check pulse (a rapid, thread like pulse is typically a sign of hypovolemia) , bp , capillary refill(A
capillary refill time of more than 2 seconds may indicate poor perfusion unless an extremity is
cold) , skin(warm or cold), pallor(normal , present , sev)
• Ordinarily, two large bore intra venous catheters are put to direct crystalloids, blood, or plasma.
Blood tests for pattern hematologic examinations are acquired, including a pregnancy test for all
females of childbearing age and blood classification and cross coordinating. To survey level of
shock, blood gases and additionally lactate level are acquired.
• placement of Foley’s catheter which will give more elaborated information about the patient’s
circulatory functions.
19.
20. CIRCULATION AND HAEMORRHAGE CONTROL
• Fast scan can be done to look at hepatic , cardiac , splenic and pelvic view .
• Depending upon the amount of blood present due to bleeding and other
conditions, stage of shock can be assessed and treated accordingly .
21. CIRCULATION AND HAEMORRHAGE CONTROL
• It is important to remember that up to 30% loss of blood volume can occur
before a reduction in blood pressure. But, the pressure may remain within
normal limits after significant blood loss, especially in children.
• With no obvious signs of hemorrhage, and when there is a hemodynamic
compromise, a pericardial tamponade must be considered, and if
suspected, corrected through the creation of a pericardial window.
22. DISABILITY
• This is evaluated by Glasgow coma scale (GCS), pupil size
and response.
• A diminishing degree of cognizance may demonstrate
decreased cerebral oxygenation and perfusion .
• Hypoglycemia, liquor, opiates, and different medications
can likewise modify degree of cognizance.
23.
24. EXPOSURE
• Patient has to be totally stripped and uncovered (by removing their pieces of
clothing to encourage a careful assessment and appraisal), to guarantee that no
wounds are missed or indications of injury, dying, skin responses (rashes), needle
marks, and so on., must be watched.
• After finishing the evaluation, spread the casualty with warm covers or an outside
warming gadget to prevent that person from hypothermia .The effect
of hypothermia can cause or contribute to serious conditions such as: Poor
cardiovascular function, such as ischemia, decreased pumping function,
myocardial infarction and cardiac dysrhythmias. .
