Patient Survey

Advanced First Aid

Introduction and Motivation

[0:00] Aims:

• Understand the key discovery points of a patient survey
• Be able to perform prompt and effective Primary Survey
• Be able to perform a thorough Secondary Survey
• Know when a Secondary Survey is appropriate
• Be able to perform a good and quick handover

Motivation

• Memorised survey schedule is an anti-panic device
• Priority order addresses your patient's needs

Primary Survey

[02:00] Before

Need to take 15 seconds to approach scene and make visual assessment.
This gives you your mech injury clues (link forwards)
Demo in class how long 15 seconds is

Danger

Get hazards list from class

[04:00] Response

Appropriate rousing methods:

• Match to environment (and bystanders)
• Match to mechanism
• Match to patient

Shout for Help

Why? Reasons from class.
Key: 2 heads better than 1, 4 hands better than 2.

[06:00] Airway

• Check, clear and open
• Use whatever adjuncts are quick and appropriate
• Listen to sounds (link back)

[08:00] Breathing

• Look, listen and feel
• Quickly assess rate, rhythm and depth
• Tidal/minute volume issue
• If inadequate (< 10, > 30) then bag 'em
• OXYGEN! trauma patients are dying for it
• Breath sounds; tells you about chest trauma

[10:00] Circulation

• Control obvious serious bleeding
• Carotid pulse: quick rate and strength
• Skin colour and temperature: "skin signs tell all"
• Cap refill: more than 2 seconds is a problem
• If shock suspected, check radial pulse; if gone, patient is serious
• Treat shock: OXYGEN and leg elevation (if safe)

[12:00] Disability

• You're talking to your patient, aren't you?
• AVPU
• Obvious motor / sensory problems
• Immobilise dangerous fractures (affecting ABC)

[14:00] Expose, Examine, Evacuate

• "You can't treat what you don't find"
• If you uncover an area, be able to re-cover it
• Ill people are vulnerable to cold, wind and wet

[15:00] Primary Survey general points:

• Don't go past a section until you've done as much as reasonable to fix / prevent problems
• You may never get past A!
• Whenever something changes (e.g. patient moved), re-assess
• Get ambulance as soon as you know or reasonably suspect serious injury. Don't wait for E!

Practical demo:

Quick examination of u/c student found in the bushes.

[19:00] Discussion

Check understanding so far

Secondary Survey

[22:00] Purpose

"Focused Examination"

• Find out what you missed on the first pass
• Get vital signs, and WRITE THEM DOWN
• Time to consider what you've found
• For a first aider, think forward to ambulance arrival

When to use it:

• Primary survey must be complete
• Patient must be as "stable" as possible, requiring no current intervention
• Ambulance must be on its way

[25:00] Vital signs

• Carotid pulse
• Respiration rate
• AVPU (GCS if adventurous)
• Blood pressure if competent
• Reassess every 5-10 minutes

[27:00] Head-to-toe

Technique:

• Find out what you missed first time around
• Work systematically down the body
• Keep talking to patient, even if u/c!
• Use all senses (apart from taste)
• Compare both sides of body to detect abnormality
• Check what you can; don't disturb body unnecessarily

Demonstrate going down and assessing all bits of casualty

[33:00] Handover

Preparation:

• If possible, have someone meet ambulance crew at arrival point and bring them to you
• Have your notes written and ready to hand over

Execution:

• Situation: "This is George Deakins, he fell headfirst 20 feet onto concrete"
• History: "It was 15 minutes ago. He was u/c when reached."
• Injuries: "Depressed area of his right skull, breathing was noisy, breathing and pulse is slow."
• Treatment: "We put in an OP airway, put on a collar and gave 100% O2"
• Transfer: "Here are his vital signs. His name is George."

Conclusions

[37:00]

Summary of survey technique

• 15 seconds to save your life
• A B C D E - in that order
• If in doubt - reassess
• Secondary survey a nice-to-have; but if you do it, do it well
• Handover: just the facts, ma'am

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