Tuesday, 6 March 2012

Primary & Secondary Survey

Primary & Secondary Survey:

PRIMARY SURVEY

The Primary Survey, or initial assessment, is designed to help the emergency responder detect immediate threats to life. Immediate life threats typically involve the patient's ABCs, and each is correct as it is found.

 

Life threatening problems MUST be identified first. This is to be completed in an order of priority to ensure the most important steps are undertaken in a logical order ensuring nothing is missed. This systematic approach uses the acronym DRABC.

 

D: Danger:

  • Ensure safety for yourself and any others. Do not put yourself at risk.
  • Remove danger or move the patient.
  • Information: Find out what has happened from witnesses if possible.

 

R: Response:

  • Assess the patient’s level of consciousness using the AVPU score (see levels of response AVPU).

Note: The presence of dementia in the elderly patient can make it hard to accurately assess the mental status and the responder should utilise family/carers to obtain baseline information.

 

A: Airway:

  • Look into their mouth, if any liquid is found place the patient on their side and drain the liquid (postural drainage).
  • Place patient back onto their back and open the airway using a head tilt/chin lift techniques.

 

B: Breathing:

  • Place your ear over the patient mouth and look, listen and feel for 10 seconds.
  • Ask yourself is the patient breathing normally, and not taking occasional gasps of air.
  • If patient is breathing normally carry out a secondary survey.
  • If in any doubt patient is breathing normally dial 999.
  • Asses the patients circulation (pulse and bleeding) if needed start chest compressions or defibrilation (see below).

 

C: Compressions

  • Start chest compressions depth 5-6cm, rate of 100-120 per minute with combined 2 inflations (mouth-to-mouth).
  • Continue at a 30 compression then 2 inflations (mouth-to-mouth is till gold standard treatment)
  • If unwilling to or unable to perform mouth-to-mouth continue with chest compressions only, until paramedics arrive.
  • Remember that the elderly often have an irregular pulse which is rarely life threatening, however the speed of the pulse i.e. too fast or too slow, can be life threatening.

 

Defibrillator:

  • Attach an AED (Automatic External Defibrillator) as soon as it arrives, if available at your workplace. Follow voice prompts.

 

IMPORTANT:

  • Patient should be on a hard surface to allow you to perform quality chest compressions, beds are not ideal. Be careful not to injure yourself removing then from a bed.

 

REMEMBER:

Any resuscitation is better than no resuscitation at all.

 

SECONDARY SURVEY

A focused history and physical exam should be performed after the initial assessment. It is assumed that the life threatening problems have been found and corrected. If that process involved CPR you may not get to this stage.

 

The focused history and physical exam includes examination that focuses on specific injury or medical complaints, or it may be a rapid examination of the entire body as follows, which should take no more than 3 minutes.

 

The secondary survey is a systematic approach to identify any bleeding or fractures. This system starts at the head and works down to legs.

 

  • Bleeding : Carryout out a head to toe check for bleeding.
  • Head & Neck: Clues to look out for are: bruising, swelling, deformity or bleeding (See Spinal Injuries).
  • Shoulders & Chest – Place both hands on opposite shoulders, run them down comparing both sides of the body. (See Fractures & Dislocation).
  • Abdomen & Pelvis: Place palm of hand onto abdomen and push gently checking for painful responses from patient.
  • Legs & Arms: Using both your hands compare both arms & legs for fractures, dislocations, look also for medic alerts.
  • Pockets: Look for clues, which might indicate any existing medical condition.
  • Recovery Position: If patient is unconscious place them in the recovery position (see Recovery Position).

 

It also includes obtaining a patient history and vital signs and the acronym used for this is SAMPLE:

 

S = Signs & symptoms

A = Allergies

M = Medications

P = Pertinent past medical history

L = Last oral intake

E = Events leading to the illness or injury

 
We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.
 
You might also be interested in our blog. One of our more popular articles is about quality or quantity when it comes to first aid training.
 

You can also sign-up to our newsletter on our homepage.

 

 

First Response. Training for life. Training to save a life.

Published in First Aid
Tuesday, 6 March 2012

Poisoning

 

Poisoning:

Description:

A poison also called a toxin is a substance which, if taken into the body insufficient quantity, may cause temporary or permanent damage.

 

Thee 4 main entry routes into the body are:

  • Inhaled:  When it is taken in to the lungs when we breath.
  • Ingested: Swallowed either accidently or on purpose.
  • Absorbed: Absorbed through the skin.
  • Injected: Injected into the tissues or a blood vessel.

 

Poisons are common in the home and the workplace .There are 2 major types:

 

1. Corrosive:                 

This group contains products that were never intended to be ingested or inhaled.

 

Examples are: Household products cleaning products such as bleach, dishwasher powered, acids, carbon monoxide, plane leaves, paint thinners and shampoo.

 

2. Non-Corrosive:

This group contains products that are to be ingested in small quantities, but which are harmful taken in large amounts.

 

Examples are: Pharmaceuticals, alcohol, drugs, medicinal herbs etc.

 

Possible Signs & Symptoms:

The effects of poisons are numerous as the poisons themselves .The mechanism of many poisons is still not understood but some poisons interfere with metabolism, whilst others destroy the liver and kidneys. Some depress the CNS (Central Nervous System) leading to coma and eventual respiratory and circulatory collapse. Severity of symptoms can range from headache to convulsions and death.

 

Look for:

  • Evidence of bottles , containers , plastic wrapping.
  • Tablets or drugs.
  • Syringes.

 

Other indicators of possible poisoning are:

  • Low level of consciousness (AVPU).
  • Headache.
  • Possible fitting.
  • Confusion or hallucination.
  • Nausea and/or Vomiting (if vomiting keep a sample for testing in the hospital to determine exact composition of poison.
  • Abdominal pains.
  • Burns around the lips and mouth.

 

Treatment:

Corrosive substance:

  • Personal safety – make sure it is safe.
  • Dilute the substance or wash it away.
  • Ingested substances-encourage patient to rinse out their mouth, then give frequent sips of milk or water.

 

Substances on the skin:

It’s important the first raiders are familiar with the corrosive substances used within the workplace and the correct treatment needed.

  • Make sure of your personal safety first.
  • Dry powder chemical can be carefully brushed of the skin, but make sure it is contained.
  • Irrigate the burn with lots of running water away, at least 20 minutes – remove contaminated clothing carefully whilst irrigating the burn.
  • If the patient’s eyes are affected, irrigate as above ensuring the water runs away from the unaffected eye.
  • Some workplace chemicals cannot be safely diluted with water but may require an ‘Antidote’. ALL first aiders should be familiar with the correct procedure and use of this antidote should an emergency occur.
  • If the patient becomes unconscious and is breathing normally, place in the recovery position and dial 999. Continually monitor patients airway and breathing until paramedics arrive.

 

Non-Corrosive substances:

  • Dial 999 and answer the questions from the ambulance operator.
  • If the patient becomes unconscious and is breathing normally, place in the recovery position.
  • Continually monitor patients airway and breathing until paramedics arrive.

 

Useful information for paramedics:

  • Evidence found in and around patient, containers or product information.
  • How much may have been take.
  • When it may have been take.

 

CAUTION:

  • NEVER make the patient vomit.
 
We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.
 
You might also be interested in our blog. One of our more popular articles is about quality or quantity when it comes to first aid training.
 

You can also sign-up to our newsletter on our homepage.

 

 

First Response. Training for life. Training to save a life.

 

Published in First Aid

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