Primary Survey
What does ABCDE stand for?
Airway
Breathing
Circulation
Disability
Exposure
Name 2 airway maneuvers you can perform if a patient is an obstructed airway
Jaw thrust
Head tilt, chin lift
Shoulder roll
Use adjunctive airway
You are bagging a patient who is not breathing on their own. What do you look for to ensure bagging is effective?
chest rise
Name 2 signs and symptoms of shock
Tachycardia
Hypotension
Weak pulse
Altered mental status
Poor perfusion
What does AVPU stand for?
Alert
Responds to Voice
Responds to Pain
Unconscious
Name 2 times when you perform a primary survey
Upon arrival
Every 5 minutes during resuscitation
After intervention has been performed
When an acute change has occurred
A patient has concern for cervical spine injury and has an obstructed airway. What airway maneuver should you NOT perform for this patient and why?
Head tilt-chin lift
Does not maintain c-spine
A 3 month old is breathing at a rate of 40 breaths/minute. Is this normal for their age?
Yes
Name 3 things to do when assessing circulation.
Pulses
Capillary refill time
Heart sounds
Heart rate
Blood pressure
Skin perfusion (temperature/color of extremities)
A patient comes in with altered mental status. Name 3 differential diagnoses
Toxic ingestion
Increased ICP (bleed, mass, hydrocephalus)
Drug/alcohol use
Meningitis/infection
In trauma, the primary survey is <c>ABCDE. What does <C> stand for?
catastrophic hemorrhage
What else should you consider putting on the patient during the airway portion of the primary survey, especially if it is a trauma patient?
c-collar
Name 3 signs of respiratory distress
Tachypnea
Head bobbing
Retractions
Tracheal tug
Nasal flaring
Stridor
Tripoding
Abnormal breath sounds
Name 4 categories of shock
Hypovolemic
Distributive (septic, anaphylactic, neurogenic)
Obstructive
Cardiogenic
What are the 3 categories used to calculate a GCS?
Eye-opening
Verbal response
Motor
A patient has large active bleeding from their leg, a tension pneumothorax, and a broken arm. What injury do you attend to first?
large active bleeding (<C> in ABCDE for trauma)
Name 2 indications for intubation
Obstruction or trauma to airway
Respiratory failure
Severe neurological dysfunction (GCS <8)
Concern for inhalation injury
Airway protection from aspiration of gastric contents or blood
Absent breath sounds, tracheal deviation, tachycardia, hypotension, dyspnea, and hypoxemia are concerning for what?
Tension Pneumothorax
A patient comes in for a trauma (motorcycle accident) with a large, distended abdomen and is in shock. What type of shock is she most likely to have?
hypovolemic (hemorrhagic)
A 3 year old fell off a chair and hit their head. They have had 3 episodes of vomiting, and have a GCS of 9. What are 2 supportive care measures to do while you await transfer?
elevate HOB 30 degrees
give TXA
give mannitol/hypertonic saline
decrease stress on the body (pain management, oxygen management, temperature management, etc)
Consider intubation
What does each letter of the AMPLE history stand for?
Allergies
Medications
Past Medical History
Last meal
Events before injury
What does RSI stand for and why do we do it?
rapid sequence intubation
reduce risk for emesis/aspiration especially if patient is not NPO (or last meal is unknown)
Mom heard her 2yo acutely start coughing this morning. Since then, has developed respiratory distress and on exam has a unilateral wheeze. What is your top differential diagnosis?
Foreign body aspiration
A patient faints while exercising. Her vital signs/exam are consistent with shock. You give her 20ml/kg of fluid and she gets worse. Why?
She is in cariogenic shock and you caused fluid overload
What is one point of care lab value you should consider checking when assessing disability?
dextrose