PRIMARY SURVEYAs stated earlier, the primary survey is a processcarried out to detect and treat life-threateningconditions. As these conditions are detected,lifesaving measures are taken immediately, and earlytransport may be initiated. The information acquiredbefore and upon your arrival on the scene provides youwith a starting point for the primary survey. Theprimary survey is a “treat-as-you-go” process. As eachmajor problem is detected, it is treated immediately,before moving on to the next.During the primary survey, you should beconcerned with what are referred to as the ABCDEs ofemergency care: airway, breathing, circulation,disability, and expose.A=Airway.An obstructed airway may quicklylead to respiratory arrest and death.Assess responsiveness and, ifnecessary, open the airway.B=Breathing.Respiratory arrest will quickly leadto cardiac arrest. Assess breathing,and, if necessary, provide rescuebreathing.Look for and treatconditions that may compromisebreathing, such as penetratingtrauma to the chest.C=Circulation.If the patient’s heart has stopped,blood and oxygen are not being sentto the brain.Irreversible changeswill begin to occur in the brain in 4 to6 minutes; cell death will usuallyoccur within 10 minutes.Assesscirculation, and, if necessary,provide cardiopulmonary resuscita-tion (CPR). Also check for profusebleeding that can be controlled.Assess and begin treatment forsevere shock or the potential forsevere shock.D=Disability.Serious central nervous systeminjuries can lead to death. Assess thepatient’s level of consciousness and,if you suspect a head or neck injury,apply a rigid neck collar. Observethe neck before you cover it up. Alsodo a quick assessment of thepatient’s ability to move allextremities.E=Expose.You cannot treat conditions you havenot discovered. Remove clothing–especially if the patient is not alert orcommunicating with you–to see ifyou missed any life-threateninginjuries.Protect the patient’sprivacy, and keep the patient warmwith a blanket if necessary.As soon as the ABCDE process is completed, youwill need to make what is referred to as a statusdecision of the patient’s condition. A status decision isa judgment about the severity of the patient’s conditionand whether the patient requires immediate transportto a medical facility without a secondary survey at thescene. Ideally, the ABCDE steps, status, and transportdecision should be completed within 10 minutes ofyour arrival on the scene.SECONDARY SURVEYThe object of a secondary survey is to detectmedical and injury-related problems that do not posean immediate threat to survival but that, if leftuntreated, may do so. Unlike the primary survey, thesecondary survey is not a “treat-as-you-go” process.Instead, you should mentally note the injuries andproblems as you systematically complete the survey.Then you must formulate priorities and a plan fortreatment.The secondary survey for a patient who presentswith medical illness is somewhat different from that ofan injured patient. Usually the trauma assessment isabout 20 percent patient interview and 80 percentphysical exam. On the other hand, the medicalassessment is 80 percent patient interview and 20percent physical exam. Both the physical exam andpatient interview should always be done for all medicaland trauma patients.NOTE: Remember, if the patient’s conditiondeteriorates, it may not be possible to completethe secondary survey before starting totransport the patient.Subjective InterviewThe subjective interview is similar to theinterview physicians make before they perform aphysical examination. The main objective of theinterview is to gather needed information from thepatient. Other objectives of the interview are to reduce4-4
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