primary+survey+&+resuscitation

 clinical home toc =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. <span style="font-family: Georgia,serif; font-size: 110%;">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.

<span style="font-family: Verdana,Geneva,sans-serif;">Video of simulation of primary survey of uninjured volunteer
media type="youtube" key="LcdLqfdIkFc?fs=1" height="385" width="640"

<span style="font-family: Georgia,serif;">If no problems are found that require resuscitation the primary survey should take no more than a minute or two to complete. <span style="font-family: Georgia,serif;">If the condition of a patient/casualty deteriorates at any time, after ensuring safety, work through the primary survey again. <span style="color: #ff0600; font-family: Georgia,serif;">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.

<span style="font-family: Georgia,serif;">Each part of the primary survey & resuscitation phase is linked to a separate page: <span style="font-family: Georgia,serif;">airway <span style="font-family: Georgia,serif;">breathing <span style="font-family: Georgia,serif;">circulation <span style="font-family: Georgia,serif;">disability <span style="font-family: Georgia,serif;">environment & exposure

<span style="font-family: Verdana,Geneva,sans-serif;">Adjuncts to the primary survey
<span style="font-family: Georgia,serif; font-size: 110%;">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 ||

<span style="font-family: Verdana,Geneva,sans-serif;">Links
<span style="font-family: Georgia,serif;">[|St John Ambulance advice on performing primary survey in first aid]

<span style="font-family: Georgia,serif;">Patient assessment <span style="font-family: Georgia,serif;">Guidelines on trauma care <span style="font-family: Georgia,serif;">Guidelines for essential trauma care (WHO) <span style="font-family: Georgia,serif;">Assessment of the ill or injured patient (from RGS book "Expedition Medicine") <span style="font-family: Georgia,serif;">First aid (from "Expedition Medicine") <span style="font-family: Georgia,serif;">Management of the seriously injured casualty (from "Expedition Medicine") <span style="font-family: Georgia,serif;">Tactical primary survey