DO A PRIMARY SURVEY OF THE VICTIM

A.    EMERGENCY ACTION PRINCIPLES; DO THE PRIMARY SURVEY OF VICTIM

The primary survey (initial or rapid assessment) is a methodical process used to quickly identify immediate life threatening injuries and conditions that require intervention without delay. The primary survey should be completed promptly upon  initial patient contact if no immediate life threatening injuries and conditions requiring intervention are found during the survey. The primary survey should only be interrupted when:

1.      life threatening condition is identified and immediate life saving interventions are initiated

2.      the scene conditions require that the patient be moved immediately due to danger to EMS personnel or the patient

The purpose of a primary survey is to check the life threatening conditions and to give urgent first aid care.

The primary survey of the victim can be done with:

1.      Check for Consciousness

You may or may not know the cause of unconsciousness if you discover an unconscious victim. Unconsciousness can have many causes including:

·         Injuries, especially head injuries

·         Illness or severe infection

·         Blood loss and shock

·         Poisoning

·         Severe allergic reaction

·         Diabetic reaction

·         Heat exhaustion

·         Fatigue

·         Stress

Checking Level of Consciousness

·         There is a difference between fainting and unconsciousness. Both conditions can have the same causes, however fainting is usually much LESS serious than a state of unconsciousness. Most people who faint recover quickly when laying down.

·         If a victim appears unconscious, tap him/her gently but firmly on the shoulder and ask “Are you okay?”  If you do not get a response, then your next step will be to check the victim’s Airway, Breathing and Circulation (pulse).  We call this step the ABC’s.

·         It is important to check airway and breathing whenever you find an unconscious victim.  This is because a blocked airway or no breathing will cause a victim to become unconscious due to the victim not getting needed oxygen into the body.

·         To check the ABC’s, the victim should be lying on his/her back, on a firm, flat surface.  If the victim is lying crumpled or face down, you will need to re-position the victim onto his/her back.  We will cover this procedure later.  Since “not breathing” is life threatening, moving the victim may be necessary in order to save a life.

2.      Explain and Demonstrate ABCs:

A is Airway

Your first step is A - the airway.  The airway is the passage through which air (oxygen) travels to the lungs when we breathe. If a victim’s airway is blocked, oxygen cannot reach the lungs and death will soon follow.  If a victim is talking, crying and/or coughing, then he/she is getting SOME air through the airway.

An airway can be blocked by the tongue when a victim is lying on his/her back.  In fact, the tongue is the most common cause of a blocked airway in an unconscious person.  When you encounter an unconscious victim, it is critical that you open the airway.  There are 2 methods which you can use.  Either method will lift the tongue away from the back of the throat and make breathing possible again.

a)      The Head Tilt / Chin Lift (demonstrate technique on a volunteer or mannequin if available)

·      Place one hand on the victim’s forehead and apply firm (but gentle), backward pressure with the palm to tilt the head back.

·      Place one or two fingers of the other hand (use one finger for an infant) under the bony part of the lower jaw near the chin and lift to bring the chin forward.

·      Do NOT press the fingers into the soft tissue under the chin. This may block the airway.

·         Do NOT use the thumb for lifting the chin.

·         Do NOT close the victim’s/infant’s mouth completely.

b)      Jaw Thrust Technique (demonstrate technique on a volunteer or mannequin if available)

·         Use this technique if head or neck injury is suspected.

·         Sit at the victim’s head facing the length of the body.

·         Rest your elbows on the same surface on which the victim is lying.

·         Grasp the bony part of the victim’s lower jaw and lift with both hands, one on each side.

After you open the airway using one of the methods, look in the mouth. In an injured or suddenly ill victim, the airway can be blocked by mucous, blood, vomit or a foreign object like a small toy or a piece of food.

·         If you see blood or vomit in the mouth, wear gloves, and try to wipe the mouth clear with a tissue or piece of cloth.

·         If a foreign object is clearly seen in the mouth, remove it.

B is Breathing

After you open the airway, check for breathing. Sometimes opening the airway will help the victim to start breathing again. Look, listen & feel for breath.

·         Look for the chest to rise and fall.

·         Listen for breath with your face close to victim’s nose and mouth.

·      Feel for air coming out of the victim’s mouth and nose with your face close to victim’s nose and mouth.

Chest movement alone does not mean that the victim is breathing.  Do not rely on any one sign.  Remember to keep the airway open.

If victim is breathing, check the quality of the breathing.  Does breathing seem normal for this victim or is it rapid, shallow or labored? Is the victim gasping for air or wheezing etc.?  Abnormal breathing tells you that something is wrong.

C is Circulation

a)      Pulse

You only need to check the pulse if the victim is not breathing.  If the victim is breathing, then the heart must be beating.  If the victim is not breathing, check the pulse.  There are two methods that you can use to check.  Which method you use depends on the age of the victim.

·      If the victim is less than one year old, check the pulse by placing 2 fingers (NOT the thumb) on the inside of the infant’s arm between the elbow and the shoulder (brachial pulse).

·      If the victim is one year old or older, check the pulse by placing two fingers on either side of the neck, below the jaw (carotid pulse).

Feel for a pulse for about 10 seconds.  While checking the pulse, remember to keep the airway open by keeping gentle pressure on the victim’s forehead.

b)      Bleeding

Is the victim bleeding severely? Without moving the victim, check the victim’s body quickly for blood.  Look for blood soaked clothing or pools of blood near the victim. Bleeding is severe if blood is spurting or flowing freely from a wound or if you can’t stop it. We will cover how to control bleeding later.

Importance of the ABC’s

1.   Whenever you have an unconscious victim or a victim with altered consciousness, check the ABC’s first. DO NOT start any other first aid until you have checked them. By checking them, you will be able to identify the conditions most in need of immediate care.

2.   It is also important to keep checking the ABC’s because they can change.

B.     PRACTISE SESSION: PRIMARY SURVEY

1.      Check for consciousness                    

·         Tap and gently shake person.                

·         Shout, "Are you OK?"

If person does not respond,

·         Call for advanced medical help

2.      Check for breathing

·         Look, listen, and feel for about 10 seconds. 

If not breathing or you cannot tell,

·         Position casualty onto back.

·         Roll person as a single unit, while

supporting the head and neck.

3.      Open the airway

·         If a c-spine injury is not suspected, tilt head

back and lift chin.

4.      Recheck breathing.

·         Look, listen, and feel for about 10 seconds. 

If person is not breathing,

·         Keep head tilted back.

·         Pinch nose shut.

·         Seal your lips tightly around person's mouth.

·         Give 2 slow breaths, each lasting about 1 1/2 s.

·         Watch to see that the breaths go in.

5.      Check for pulse 

·         Locate Adam's apple.

·         Slide fingers down into groove of neck on side

closer to you.

·         Feel for pulse for 10 seconds. 

6.      Check for severe bleeding 

·         Look from head to toe for severe bleeding.

If person has a pulse and is not breathing,

·         Do rescue breathing.

If person does not have a pulse,

·         Begin CPR.

7.      Perform Chest Compression

Chest compression technique consists of serial, rhythmic applications of pressure over the lower half of the sternum (breastbone). To locate the correct hand position for chest compression :

·         Maintain head tilt, run your middle finger from the lower margin of the victim’s rib cage till you reach the Xiphi Sternum.

·         Place your index finger next to the middle finger.

·         Place the heel of one hand next to the index finger.

·         Remove the index and middle fingers.

·         Place the heel of the other hand on top of the hand on the sternum.

·         Interlace the fingers of both hands and lift the fingers off the chest wall.

·         Straighten both elbows and lock then in position.

·         Position your shoulder directly over the victim’s chest

·         Use your body weight to compress the victim’s chest by at least 5cm.

·         Count your compressions:

1,2,3,4,5,6,7,8,9-1

1,2,3,4,5,6,7,8,9-2

1,2,3,4,5,6,7,8,9-3

·         Perform chest compressions at a rate of at least 100 per minute. Allow complete recoil of the chest wall after each compression.

·         The ratio of compression and ventilation is 30 compressions: 2 breaths.

·         Healthcare Providers – Check pulse after 5 cycles of 30 compressions : 2 ventilations. If no pulse or unsure presence of pulse, resume CPR.

·         Laypersons – Continue performing CPR until help arrives or victim starts moving.

8.      Mouth-To-Mouth Breathing

To perform mouth-to-mouth-breathing :

·         Maintain head tilt-chin lift.

·         Pinch the nose with your thumb and index finger to prevent air from escaping through the victim’s nose.

·         Seal your mouth over the victim’s mouth and give 2 short breaths in quick succession one after the other.

·         Release the nostrils to allow exhalation after each breath.

·         Each rescue breath should make the chest rise.

·         The duration for each breath is 1 second.

9.      Re-Assessment (For Healthcare Provides Only)

·         Assess the victim for pulse and breathing after every 5 cycles of CPR 30:2.

·         If pulse is absent (if unsure of pulse and victim has no breathing, assume cardiac arrest), continue CPR 30:2.

·         If both the pulse and breathing are present, position the victim in the recovery position.

·         Continue to monitor the victim’s pulse and breathing every few minutes as these can stop suddenly.

ABC's of Life for Children (1 to Puberty):

Airway: Same as an Adult except look in the airway for a potential choking object that potentially could be removed.

Breathing: Same as an Adult. If giving rescue breaths, give a lower volume of air when giving breaths. Give just enough breath to see the chest rise.

Circulation: Same as an Adult. Remember to Push Hard and Push Fast. Do not hesitate or restrict compressions due to the smaller size of the child. Recognize that performing poor compression equates to poor circulation and cellular injury and death. Attempt to push 1/2 to 1/3 the chest depth of the child. If the child is small in size, you may use one hand instead of two when performing compressions. You may use the second hand to maintain an open airway and stabilize the child during compressions.

ABC's of Life for Infants (Birth to Age 1):

Airway & Breathing: Same as a Child.

Circulation: Compressions have to performed differently for infants than they would be for larger children and adults due to their smaller size.

To perform compressions on an infant, place the infant on a flat hard surface, face up, and locate the middle of the chest between the breasts. Place two fingers of one hand on top of the sternum about a fingers tips length below the nipple line. Place the second hand the infants head to maintain an open airway and to stabilize the victim. Push on the chest using the two fingers at the rate of 100 compressions per minute at a depth of 1/2 to 1/3 the chest depth. If giving CPR with rescue breathing perform 30 compressions to 2 breaths (30:2 ratio).

REFERENCES

American Heart Association 2010 Adult CPR Guidelines. Diakses di http://katrenawells.suite101.com/american-heart-association-2010-adult-cpr-guidelines-a300106

Distribution : U.S. Army Training Support Centers (TSC). 2007, Artificial Respiration/ Basic Cardiac Life Support. Headquarters, Department Of The Army. Diakses di http://www.bestcpronline.com/index.php

THE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICES-Basic Life Support – CPR Visual Aids- Introduction to BLS – CPR diakses di http://www.blscprtraining.com/online-cpr-certification.php

243322118Patient_Assessment.pdf download in http://mrwhatis.net/tncc-primary-survey.html

www.documbase.com/Primary-and-Secondary-Survey.pdf

www.ems.ohio.gov/emsc%20web%20site_11_04/pdf_doc%20files/FACC%20Part%202.pdf

www.members.shaw.ca/Primary%20and%20Secondary%20Survey.pdf