THE SAFE APPROACH

 PRIMARY SURVEY
o THE MOTTO- ASSES AND MANAGE
o IT IS A TEAM WORK!
o REPEAT AS NEEDED
o SHOULD NOT TAKE NO LONGER THAN 5 MIN.
1. A- airway and oxygenation
a. C collar? trauma case
b. Asses responsiveness [GCS]
c. Put all patient on maximum oxygen then deescalate as needed
d. If conscious ask the patient their name [ the 10second ABCD assessment]
e. Asses airway [ history and physical exam]
f. Do chin lift jaw thrust and head tilt- jaw thrust only if trauma
g. Remove possible foreign body
h. Suction
i. Check gag reflex [ GCS/during jaw thrust]-> to help decide between oral and nasal
airway
i. Airway maintenance via airway devices in the following order
1. Pay attention to functionality of the equipment, size, indication, and
contraindication -REFERENCE-AIRWAY MANAGEMENT PDF
a. nasal airway
b. +/- oropharyngeal airway->face mask + BVM [ patient may or
may not be conscious]
c. Endotracheal intubation + laryngoscope + BVM [ patient
shouldn’t be conscious/ needs anesthesia]
d. LMA + BVM [ patient shouldn’t be conscious/ needs
anesthesia]
e. Tracheostomy/ cricotracheotomy
2. B-breathing and ventilation
a. Look/inspection-
i. Pulse oximetry – oxygen saturation on ? Liters of oxygen via nasal spec-Account
for factors that give false rise in oxygen saturation
ii. color
iii. RR- count and characterize, effort of breathing
iv. chest symmetry, asymmetrical chest movement
v. traumatic site
b. Feel/palpation and percussion-
i. tracheal position,
ii. chest wall deformity and crepitus
c. Listen /Auscultation –
i. talking [sentences, phrases, words],
 ii. auscultate [bilateral air entry, wheeze, silent chest other added sounds]
3. C- circulation and shock management
a. ASSES SHOCK [ HR, BP, cool extremities, urine output]
i. Shock position lift leg up and left lateral tilt in pregnancy
ii. IV access and fluid challenge with +/- specific treatment
b. Do cardiovascular examination
i. Look at the color
ii. Examine peripheries
iii. Heart sounds
iv. Pedal edema
4. D-disability due to neurologic deterioration
a. AVPU/ GCS/BM
b. Pupil size/response
c. Posture
d. Pain relief
5. E-exposure and examination
a. Complete disrobing of patient – maintain dignity
b. Log roll
c. PR
d. Warm blankets/ prevent hypothermia

SECONDARY SURVEY

1. Detailed history
2. Order investigations
a. ABG, CXR, 12 lead ECG, Specific bloods
3. Management plan including monitoring plan
4. Referral
5. Handover
a. SITUATION
b. BACKGROUND
c. ASSESMENT
d. RECCOMENDATION