Primary Survey

Component Assessment Intervention

Airway 1. Talk to patient

1. Establish a patent airway

2. If no response, look for :

2. Apply jaw thrust or chin lift

• External deformity - face wound

• most of cases of airway obstruction
• Internal -open the mouth and look for is because of tongue fallen back.

any blood or foreign body

3. Clear the airway from any vomitus or
3. Listen to :
blood, remove foreign body.

• Stridor
4. Insert oropharyngeal or
• Wheezing
nasopharyngeal airway

• Hoarseness of voice
5. Establish definite airway

• Gargling sound • intubation

• cricothyroidotomy

Cervical FOR TRAUMA CASE Steps to apply cervical collar

immobilisation 1. In-line immobilisation

2. Calculate the distance between the

chin and clavicle

3. Adjust the size of cervical collar

4. Apply the cervical collar

5. Palpate the carotid pulse

Breathing 1. Adequate exposure of the chest

1. Administer high concetration oxygen

2. Inspection :
2. Ventilate with a bag-mask device

• Chest rise

• Flail chest
• Tension pneumothorax - Needle
• Open wound
thoracocentesis followed by chest
• Distended neck vein
tube

• Calculate respiratory rate

• Hemothorax - Chest tube, give blood

3. Palpation :
• Flail chest

• Tracheal deviation
• Open chest wound - Three sided
• Chest expansion
chest dressing

• Apex beat
• Cardiac tamponade -
• Tenderness
Pericardiocentesis

4. Percussion :

• Resonance - Normal
3. Attach CO2 monitoring device to
• Hyper resonance - Pneumothorax
ETT

• Dull - Consolidation
4. Attach pulse oximeter to the patient
• Stony dull - Effusion

5. Auscultation :

• Equal air entry

• Vesicular breath sound

• Bronchial breath sound

• Added sounds : crepitation, wheezing

Circulation 1. Look for any sign of shock :
1. Apply direct pressure

• Skin colour changes

2. If internal hemorrhage present,
• CRT<2s
consider operative intervention.

• Peripheries (warm/cold)
3. Fluid (2 large bore)

• Pulses (rate and volume)

4. Obtain blood for blood typing and
• Blood pressure
crossmatch

• Eyes (conjunctival)
5. Transfusion of blood O-

• Mouth (central cyanosis, coated 3. Definite management

tongue)

• JVP ( flatten)

• Abdomen ( tenderness)

2. Identify source of external

hemorrhage

• Patient

• Back/bed

• Floor/drain

3. Identify potential source of internal

hemorrhage

C-chest

R-retroperitoneum

A-abdomen

P-pelvic and long bones

Disability 1. Assess GCS/AVP

2. Pupillary reflexes

3. Assess lateralising sign and spinal

cord injury

Exposure 1. Expose the patient to look for any Prevent hypothermia

wound, bleeding

2. Do log-roll :

• Immobilise the patient

• Check the back of patient : cervical

tenderness, back tenderness

• Check anal tone

6 Life Threathening :

A Airway obstruction -evidence of foreign bodies

T Tension pneumothorax -asymmetrical chest movement and

-dilated neck vein

O Open chest wound

-big wound
-wound >2/3 of trachea diameter

M Massive hemothorax
-asymmetrical chest rise
->200ml of blood coming of per hour
for 3 consecutive hours.

F Flail chest -paradoxical movement

C Cardiac tamponade -dilated neck vein

-muffled heart sound

Adjunct to Primary Survey :

A - ABG

B - BP cuff

C - Cardiac monitoring, CBD

F - Fast scan

X - X-ray of pelvic, thigh

6 Potential Life Threathening :

A Aortic injury

T Thorax injury

O Oesophageal perforation

M Muscular diaphragmatic injury

F Fistula and tracheobronchial injury

C Contusion to heart and lung

Criteria for unstable patient :

• Tachycardia or bradycardia

• Low blood pressure

• Sign of shock

• Altered mental status

• Acute ongoing chest pain

• Acute heart failure