RESUSCITATION- PRIMARY SURVEY

AWARENESS RECOGNITION MANAGEMENT

AIRWAY 1. Head injury Look -cervical collar: protect cervical cord
-↓ consciousnessmuscle tone & Agitation, Hypoxia -chin lift: pull jaw and pharyngeal structure forward off
pharynx collapse around the anxiety, cyanosis the post pharyngeal wall and glottis and open up the
glottisobstruct the airway ↓ consciousness Hypercarbia airway
-tongue drop backward in supine Sweating ↑ autonomic -jaw thrust: with thenar eminence rested on the casualty
position activity maxilla and 4 fingers positioned under the angles of the
Use of accessory mandible, lift the mandible up and forward to open the
2. Maxillofacial injury muscle on airway
-disruption of facial boneface fall breathing, flared -OP airway: inserted above the tongue with concave
backwardcompress and obstruct the nostril aspect upwards until ot touches the end of hard palate,
pharynx Tracheal tug Exaggerated rotate so the concave aspect slides over the tongue
intrathoracic -NP airway: soft plastic tube with smooth
3. Neck trauma pressure swing distal bevel
-lead to haemorrhage and Listen : choose size according to the
swellingcompress and distort the Noisy breathing, Obstructed upper casualty little finger
upper airway stridor airway
Hoarse voice Laryngeal
4. Laryngeal trauma damage
-horse voice, coughing of bright red Absent of noise Complete airway
blood, surgical emphysema obstruction or
apnoea
5. Inhalational burn Feel
-facial burn, smoke staining, singed -movement of air by placing palm over
nasal hair nose or mouth
-tracheal deviation
BREATHING Look -oxygen administration
-RR: tachypnoeahypoxia -ventilation
-shallowed, laboured breathingrespiratory failure -check and manage life threatening chest injuries
-cyanosis: hypoxia
-plethora: asphyxia and chest crushing 1. Tension pneumothorax
-paradoxical respiration: respiratory failure -D: one- way valve build up air under pressur eint he
-unequal chest inflation: pneumothorax, flail chest pleural cavity, leading to compression and collapse of
-distended neck veins: tension pneumothorax, cardiac temponade the underlying lung
Listen -S: absent breath sound, tracheal deviation,
-absent breath sound: indicate apnoea and tension pneumothorax hyperesonance
-noisy breathing, stridor: obstructed airway -M: 14G IV cannula, 2nd intercostals space, mid
Feel clavicular line
-tracheal deviation: tension penumothorax
-tenderness 2. Cardiac temponade
-crepitus: fractured ribs -D: accumulation of blood within pericardium
-surgical emphysema: tension pneumothorax, rupture bronchi and trachea, which restrict the ability of the heart to fill resulting in
 fractured larynx progressive loss of CO
-S: distended neck vein (d/t ↑ venous pressure), muffled
heart sound, fall in arterial blood pressure
-M: needle pericardiocentesis (14G IV Cannula inserted
through left xiphisternum towards the pericardium)

3. Flail chest
-D: d/t multiple rib fracture paradoxical respiration &
lung contusionhypoxia & ventilator compromise
-S: CXR (fracture), ABG (hypoxia)
-M: oxygen administration
: mechanical ventilation
: epidural analgesia

CIRCULATION Awareness
1. Vasoconstrictive: hypovolaemic, cardiogenic
Hypovolaemic -loss of volume within circulation (haemorrhage, burns)
-compensatory mechanism: tachycardia, peripheral
vasoconstriction with narrowed pulse pressure, tachypnoea,
shift of fluid from tissue into circulation and ↓ UO
Cardiogenic -d/t ↓ myocardial contractility↓ stroke volume↓cardiac
output
4. Simple pneumothorax
-D: air entering pleural cavity causing collapse of the
lung (unlike TP, the air is at Patm, hence there is no one
way valve effect)
-S: absent/ reduced breath sound, hyperesonance
-M: chest tube insertion at safety triangle
-control of haemorrhage: direct pressure on bleeding
wound, tourniquet
-insert 2 14G IV cannula: take blood sample for
baseline investigation and GXM besides administration
of crystalloid before blood grouping is done

2. Vasodilative: septic, neurogenic, anaphylactic

Septic -entry of toxin into circulation poison the vasoconstrictive
mechanismvasodilation↓ afterloadwiden pulse
pressure
Neurogenic -SCI disrupt the sympathetic nerve controlling
vasoconstriction the peripheral vasculature relaxes and
dilated ↓ preload and afterload
Anaphylactic -Histamineprofound vasodilationmassive capillaries
leakageoedema

Recognition
-Look
(a) peripheral/ central cyanosis and pallor
(b) tacypnoea/ respiratory distress
(c) Change in mental status
(d) ↓ consciousness
-Feel
(a) Poor peripheral perfusion: cold and clammy
(b) Capillaries refill
(d) Pulse rate: tachycardia and thread pulse
(e) Loss of pulse: indicate severity of pulse
(f) Blood pressure: initially narrowed pulse pressure later both systolic and
diastolic drop lead to unrecordable BP