2.7 Principles of emergency patient’s assessment. 

2.7.1 Primary survey (assessment) 

DEFINTION: Primary assessment- is an ABC assessment and provision of a basic life support to sick or injured patients. These activities can be provided by trained non medical or medical workers, until definitive medical treatment can be accessed 

Aims: The 4 main aims of primary assessment are called “4 Ps” 

• Preserve life 
• Prevent further injury 
• Promote recovery 
• Protect yourself. 

2.7.1.1 P- Preserve Life 

People may collapse in front of you or you may find someone lying in ground. To identify or to determine the consciousnesses of the patient try to touch or talk loudly to the patient and see for his response. If the victim is unresponsive position carefully and see if the patient has sign of life such as the airway is patent and patient is breathing using the ABC evaluation. 

A- Airway: unconscious patients may Easley die due to airway obstruction. Just by opining the airways using manual maneuvers and proper positioning you can save life. 

• Determine unconsciousness 
• Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to maintain a patent(open) airway, as the part of the brain which autonomously controls in normal situations may not be functioning. 
• If an unconscious patient is lying on his or her back, the tongue may fall backward, obstructing the oro-pharynx. 
• Assess the airway for presence of any foreign body, secretion, the tongue is obstructing the airway 

Action 

• Patient unconscious- open the mouth using head tilt chin lift or jaw thrust maneuvers and see for chest movement or breathing 
  

• If no breathing Look for secretions or any foreign body and remove/ suction and see for again for B- breathing 
  

B- Breathing: Can patient talk and breathe freely? YES- this means patient has open airway, sufficient breathing and oxygenation, therefore go to C. if the patient/victim has no breath give TWO rescue breath with mouth to mouth or using Bag Valve Mask and go to C. 

C- Circulation: check for pulse and if the patient has pulse look for the regularity, volume and rate of the pulse, measure blood pressure and saturation of oxygen using pulse oxymetere and act accordingly: 

• Has peripheral pulse continue oxygen delivery 
• Blood pressure low insert large bore canola start resuscitation to rich the lower optimal level of blood pressure that maintains the perfusion. Do not over load patients especially if you are not clear about the cause of low blood pressure. 
• In trauma patients with low blood pressure stop bleeding, insert two large bore canolas resuscitate to maintain the optimum allowable blood pressure. Do not aim to raise the blood pressure to normal value because it will induce more bleeding. 
• If the patient is unconscious but has adequate breathing effort, and pulse place in recovery position, with the patient leant over his/her side (see the picture below). 
• NB. Consider risk of trauma to cervical vertebrae before changing position of the patient in all unconscious trauma patients. 

a. This position has the effect of clearing the tongue from the pharynx 

b. Avoids a common cause of death in unconscious patients, which is choking (aspiration). 

If patient is unconscious and seems no breathing- confirm breathing by: look for chest movement, fell air flow around the nose and mouse, listen for breathing. When you confirm breathing is not there, start CPR 

• Give TWO rescue breaths each for one second and start chest compressions30 compressions(30:2ratio) 
• If patient is a trauma case and has breathing difficulties see for tension pneumothorax/haemothrax, then decompress the lung with large bore needle or insert chest tube, or if it is open chest injury close the open injury, administer oxygen. 

D- Disability, Defibrillation 

• Asses patient for neurological deficiency using GCS, 
• Defibrillate patients with cardiac arrest as early as possible. 

Exposure/Environment 

• Undress patient and look for injury, If patient is suspected to having a neck or spinal injury do in-line immobilization 
• Protect patients from hypothermia 

2.7.1.2 Prevent further injury – while doing the primary survey or assessment in unconscious patients always protect the cervical spine until the diagnosis of cervical spine injury is ruled out. 

2.7.1.3 Promote recovery- to facilitate better outcome and minimize organ or system failure during this stage consider: 

• Oxygen administration, 
• strict follow up for vital signs, 
• aspiration protection, 
• on time initiation of definitive management, 
• Pain control… 

2.1.1.4 Protect yourself- while helping other you have to make sure about your safety. 

• Outside hospitals consider the safety of the scene-in addition to self protective devices make sure you and your patient is safe and the environment has no risk or danger such as: explosive material, electrical contact, poison…). Ideally a security or police has to investigate the scene and give you permission for medical assistance. 
• In health institution- Apply protective devices to protect contaminations,