Primary Survey By Chris Krause

Front 1

What are the first things every patient needs upon entering a room?

Back 1

1) IV, O2, monitors

2) Full set of vitals which includes ALL SIX vital signs: heart rate, blood pressure, O2 sats, respirations, temperature, and blood sugar.

3) Assess general appearance including color, tone, level of consciousness.

4) Consider personal protective equipment (PPE) for yourself and your team - gloves, gown, mask, face shield.

Front 2

In a primary survey, how do you assess "A" (the airway)?

Back 2

**Firstly, if there is trauma remember to maintain C-spine precautions.**

1) First, note the Sp02.

2) Are there spontaneous respirations?

3) Observing the patient, consider the 6 S's:
Is there evidence of Snoring, Stridor, Swelling [of the face/mouth/neck], Soot [or singed nasal hairs], Secretions [or blood], or [facial] Smash?

Front 3

In a primary survey, how do you assess "B" (breathing)?

Back 3

1) First, note the respiratory rate and the patient's color.

2) What is the work of breathing? Is the trachea midline?

3) Are there bilateral breath sounds?

4) Is there any chest wall deformity or assymetry of movement?

Front 4

In a primary survey, how do you assess "C" (circulation)?

Back 4

1) First, note the pulse and blood pressure.

2) Listen to the heart sounds.

3) Fell the peripheral pulses in all 4 limbs.

4) Look for evidence of hemodynamically significant hemorrhage in the 5 key areas:
"Four plus the floor" - chest, abdomen, pelvis, long bones, and external hemorrhage.

Front 5

In a primary survey, how do you assess "D" (disability)?

Back 5

1) Note the blood glucose.

2) Check pupillary reflexes - pupil size, symmetry, and reactivity.

3) Calculate GCS - (Eyes out of 4, Motor out of 6, Verbal out of 5.)
Sample test:
E - Ask to open eyes.
M - Ask them to squeeze hands, wiggle toes. Note whether all 4 limbs move equally.
V - Ask the patient their name, do they know where they are, do they have pain.

If no good response - painful stimuli, peripheral and central.

Front 6

In a primary survey, how do you assess "E" (exposure)?

Back 6

1) Note the temperature.

2) Undress the patient fully, then cover in warm blankets.

3) Look for external signs of trauma including armpits, back, buttcheeks, and sack. Also consider the neck under the C-collar.

4) Log roll - examine scalp, back, and perineum. Digital rectal exam to assess anal tone and feel for high riding prostate.

Front 7

If there was an "F", what would "F" be?

Back 7

1) FAST scan (i.e. Point of Care Ultrasound).

2) Insert Foley.

Front 8

If there was a "G", what would "G" be?

Back 8

1) Girl --> pregnancy test.

2) Glucose - if not already checked.