clinical home

Primary survey & resuscitation

The aim of this phase of care is to identify immediately life-threatening conditions and to start their treatment as soon as they are identified.

The primary survey is NOT a "one off" procedure. If the casualty/patient deteriorates at any stage the primary survey is repeated.

In a remote or wilderness environment, abnormalities found during the primary survey [airway obstruction, respiratory distress, shock, reduced conscious level] will usually prompt a plan for evacuation as rapidly as possible (e.g. SAR helicopter in the UK hills).

The standard sequence of primary survey/resuscitation is ABCDE

A Airway (with cervical spine control if necessary)
B Breathing
C Circulation (including haemorrhage control)
D Disability
E Exposure (and environment)
In settings where penetrating injuries are common the first priority becomes control of massive arterial bleeding.

Remember the primary survey comes after several other actions (see link to SAFETAC approach).
If personal protective equipment is available (e.g. gloves) put it on before you begin assessment of the casualty.

In the absence of arterial bleeding start your primary survey by talking to the casualty.
If they can talk and make sense they have a patient airway, are breathing and the brain is being perfused (at present) by oxygenated blood.

Video of simulation of primary survey of uninjured volunteer



If no problems are found that require resuscitation the primary survey should take no more than a minute or two to complete.
If the condition of a patient/casualty deteriorates at any time, after ensuring safety, work through the primary survey again.
Those anticipating operating in a remote/wilderness setting need to have the skills to carry out a primary survey in a dark or noisy environment.

Each part of the primary survey & resuscitation phase is linked to a separate page:
airway
breathing
circulation
disability
environment & exposure

Adjuncts to the primary survey

Remember "LIMITS"
Lines
ET, IV x2, catheter, NG tube
Investigations
ABGs, xrays, bloods, transfusion, ECG, cap blood glucose
Monitoring
oximter, capnography, NIBP, cardiac monitor, urine output, temperature, MEWS
IV therapy
analgesia, antibiotics, fluids, blood
Team/transfer
get the right people to the patient or the patient to the right people
Stabilise
do what is needed for ABCDEs before moving onto secondary survey

Links

St John Ambulance advice on performing primary survey in first aid

Patient assessment
Guidelines on trauma care
Guidelines for essential trauma care (WHO)
Assessment of the ill or injured patient (from RGS book "Expedition Medicine")
First aid (from "Expedition Medicine")
Management of the seriously injured casualty (from "Expedition Medicine")
Tactical primary survey