1. Primary Survey

2. When do you use it?

3. What is it? Rapid assessment Identify anything that can kill Pt  Look for anything that’s not right Not just for trauma Not just for unconscious people  It’s on every PRF Easy to remember – work down the body Should be less than 1 min

4. DR ABCDE Danger Response (Summon help) Airway (with C-spine considerations) Breathing Circulation Disability / dysfunction Expose Deal with each as you come to it!

5. Danger Have a proper look! How many patients? Size up the scene (what could have caused injury?)

6. Response Have a look at Pt – big sick or little sick? Approach from feet AVPU  Question, command, pain  PAIN – how do we check this? Note how response changes

7. Response - If Alert? If talking, airway OK  NOTE – obstructed airway? If talking, breathing OK  NOTE – breathing difficulty? Assess circulation  Pulse, skin colour / moisture / temperature

8. Response - If NOT Alert? If alone, shout help If in a first aid team, shouldn’t be alone Do you call for backup (ETA, HCP) ???

9. Airway (with C-spine considerations) Check C-spine  Feel down back of neck (tenderness, irregularities) Check jaw  Feel across mandible (fracture obstructing airway?) Check mouth  Any obvious obstructions? Take em out Action - Head tilt & Chin lift OR Jaw thrust??  When would you do this? Check neck  Trachea OK? Swelling? Discoloration?

10. Breathing Check breathing for 10 secs  NB agonal breaths don’t count Someone to take over head tilt / chin lift? Check chest  If appropriate, LOOK at the chest  Anything odd? Bruising, swelling,.. knife? Palpate (Feel) chest  Check for equal expansion  Breathing fast or slow (don’t need resp rate)

11. Circulation “Blood on the floor and 4 more” Can bleed to death internally – looking for this

12. Circulation Check abdomen  Bruising? Discoloration? Swelling? Wounds? Feel abdomen  Palpate the four quarters (feel for hardness, watch for tenderness)

13. Circulation Feel pelvis  Check for position of iliac crests  Do not ‘spring’ the pelvis!! Feel femurs  Start at the TOP (yes, by the crotch)  Firm grip, go down to the knee Check back for blood Check PULSE in both wrists  Don’t need a pulse rate – just is it fast or slow? Check skin colour

14. Disability / Dysfunction Feel around head  Deformity (fractured skull)? Blood? Check voice response Check pain response  Squeeze trapezius muscle (neck/shoulder)  Eyes open?  Hands move? Check motor ability  Ask em to squeeze your fingers

15. Expose If you suspect injuries, have a look!

16. Summon Help? If alone, shout help If in a first aid team, shouldn’t be alone What’s needed?  Equipment? (carry chair, carry sheet, scoop)  Oxygen?  ETA? Paramedic?

17. What comes next? Observations (response, pulse, resps) Secondary survey SAMPLE Detailed assessment (OPQRST etc)