The Primary Survey
When first confronted with an emergency it is important to initiate your primary survey. This is a process designed to detect life-threatening problems. Many problems can become life-threatening if left unattendedhowever, certain problems require immediate attention. Examples of such life-threatening situations include the patient who is not breathing, whose heart is not beating, or who is experiencing severe bleeding.
Remember the ABC's of the primary survey:
A = Airway. You must assess responsiveness and open the airway.
B = Breathing. You must check to make sure the person is exchanging air.
C = Circulation. This includes checking pulses and heart function as well as stopping any profuse bleeding.
Airway. Check immediately for responsiveness. If the victim is conscious, it means he also is breathing and circulation is intact (although possibly not adequate). To check for responsiveness touch the patient's arm or shoulder and ask, "Are you OK?"
If the patient is in a prone position (face down) it is very difficult to assess his airway. He must be placed in a supine position by using a single log roll maneuver (first aid courses teach this procedure). By using this technique you will minimize the chance of aggravating a possible spinal cord injury. If there appears to be an airway problem, try the head-tilt, chin-lift procedure as taught in CPR courses. If spinal cord in" jury is suspected use the "modified jaw-thrust," following these steps:
1. Patient is on his back.
2. Kneel at top of head, resting elbows.
3. Place one hand on each side of patient's chin along the lateral side of lower jaw.
4. Use forearms to stabilize head, then push his jaw forward using fingers.
5. Do not tilt head. Breathing. Simply by taking a few moments to look, listen, and feel you can rapidly assess breathing.
Look. See if there are chest movements associated with breathing. Listen. Place your ear next to patient's nose and see if you hear air movement.
Feel. do you feel the air movement on your cheek?
If you conclude that there is no breathing, you must immediately initiate rescue breathing.
1. Maintain the patient's airway in an open position.
2. Open your mouth wide and take a deep breath.
3. Place your mouth over the victim's and make a tight seal with your lips. Pinch the patient's nose.
4. Exhale into the patient's mouth. Watch for signs ofthe patient's chest rIsmg.
5. Reposition the patient's head or clear his or her mouth if resistance is met.
6. Break contact with the patient's mouth and allow him or her to exhale passively.
7. Take another breath and repeat the cycle about every 1.5 to 2 seconds.
Circulation. The best way to determine if a patient has had a cardiac arrest (heart has stopped or is just twitching) is to feel for the carotid pulse (see figure 25-1). To do this, locate the "Adam's apple," place your fingertips (index and middle) on it, then slide your fingers to the side ofthe neck closest to you. Do not feel both sides of neck simultaneously for this may cause a slowing or stoppage of blood flow to the brain. Very little pressure is needed to feel the pulse. Take no more than 5 to 10 seconds to find the pulse. If there is no pulse, you must initiate cardiopulmonary resuscitation. Finally look for sites of severe bleeding. Only bleeding that is spurting or flowing freely is considered in the primary survey.
By the time you finish the primary survey you will have made sure the patient has an open airway, adequate breathing, a carotid pulse, and that any profuse bleeding is controlled.
