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What is a Primary Survey?
- A= Airway with cervical spine (always together)
- B= Breathing
- C= Circulation
- D= Disability
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Mandated Reporting of:
- Any death in ER
- Child abuse
- HIV, hepatitis, TB,
- Abuse of disabled adults, elder abuse
- Elopement of psych patient
- Extensive burns, gunshot wounds, stab wounds, Homicide
- Infectious outbreaks, Internal disaster, Sexual aassault, STD, suicide
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Triage:
- Sorts patients accodring to severity of health problem and immediacy of treatment required.
- Patients with threat to life, vision, or Limb are treated before other patients
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Life threatening Conditions identified during primary survey
- Airway- inhalation, obstruction, penetrating wounds.
- Breathing- Anaphylazis, flail chest, hemothorax, pnuomothorax (open or tension)
- Circulation- Direct cardiac injury (MI or trauma), tamponade, shock (hypovolemic or burns), hemorrhage
- Disability - AVPU head injury or stroke
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S/s of airway compromised:
Dyspnea, inability to vocalize, presence of foreign body, face or neck trauma
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Maintain Airway by:
Jaw thrust maneuver, suction &/or remove foreign body, nasopharyngeal or oral airway, endotracheal intubation
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S/s of breathing compromised:
Dyspnea, paradoxic/asymmetric chest wall movement, decreased/abscent breath sounds, Chest wall trauma, tachycardia, hypotension
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Support for breathing problems
High flow O2, bag-valve-mask ventilation with 100% o2. intubation for life-threatening conditions, cricothyrotomy or tracheostomy
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S/s of circulation compromised:
Check central pulse, assess skin color, temp, moisture, assess mental status and capillary refill
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Support for Circulation:
2-large bore IVs, aggressive fluid resuscitaion, normal saline or lactated ringers, blood or blood products
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If disability is present:
- Pts LOC,
- A=Alert
- V=response to voice
- P=Response to pain
- U= unresponsive
- Glascow coma scale, pupils (size, shape, response to light, equality)
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AVPU
- A=alert
- V=verbal stimuli
- P=Painful Stimuli
- U= unresponsive
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Secondary Survey
- Brief systematic process to identify all injuries
- undertaken after completion of primary survey
- undertaken when life-threatening injuries have been stabilized
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E
F
G
H
I
- E- exposure/environmental control
- F- Full VS/5 interventions/Facilitate family presence
- G- Give comfort measures
- H-History/Head to toe assessment (AMPLE)
- I-inspect posterior surfaces
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Five interventions:
EKG, Pulse OX, Indewelling Cath (core temp) NGT or OGT (blood in Stomach), Blood studies ( sugar, alcohol, electroylytes, liver and cardiac enzymes, pregnancy test)
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