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Primary Survey TNCC
| Question | Answer |
|---|---|
| Airway assessment | maintain C-spine protection / check for verbal response (and normal sound of voice) / tongue obstruction / loose teeth or foreign objects / vomit, blood, or other secretions / oedema |
| Breathing assessment | spontaneous breathing / rise and fall of the chest / rate and pattern of breathing / use of accessory muscles or diaphragmatic breathing / skin colour / soft tissue and bony structures of chest wall / bilateral breath sounds / tracheal deviation + JVP |
| Circulation assessment | palpate central pulse for strength and rate / inspect and palpate the skin for colour, moisture and temperature / check for cap refill: esp in paediatric patients / assess for uncontrolled bleeding / ?auscultate blood pressure |
| Disability assessment | AVPU / assess pupils for size, shape, equality, and reactivity to light / look for lateralising signs (eg: unequal pupils, unilatral deterioration of motor movements, any unilateral neurological deficit) |
| Exposure assessment | remove all pts clothing so that can be examined for any life threatening injuries that may have missed. |
| airway interventions | maintain C-spine protection / open and clear an obstructed airway: jaw thrust, chin left, remove loose teeth/objects / suction / insert guedel or NPA / prep for intubation / use alternate airway if tubing fails / reassess after interventions |
| Breathing interventions | |
| Circulation interventions: effective circulation | insert large bore cannula, run warmed isotonic crystaloids at an appropriate rate |
| hypothermia and trauma: why is it important to warm the pt? | hypothermia in trauma pts is associated with increased mortality. It may contribute to dysrthmias, coma, coagulopathy, and decreased CO |
| exposure interventions | remove pts clothing carefully in case of broken glass, chemicals or other agents that may harm team members / ensure correct preservation of evidence as necessary / keep the pt warm by using warmed blankets, turning up room heating or heat lamps |
| airway assessment if the pt has been tubed / alternate airway insitu: | equal rise and fall of the chest with ventilation / auscultate over the epigastrium and then over then over the lung fields / specific tests to check tube placement: Co2 detector, Esophogeal detetection device, CXR |
| steps in preparing for and assisting with endotracheal inutbation | |
| method for auscultating bilateral breath sounds in primary assessment | bilaterally in 2nd intercostal space midclavicular line and 5th intercostal space at the mid axilary line |
| Breathing assessment, asessed to be present, but innefective: can indicate severe life threatening conditions: list signs that may support this finding: | altered mental status (restless, agitated <LOC) / cyanosis: central / accessory muscle use or diaphragmatic breathing / paradoxical chest movement / sucking chest wounds / absent or diminished breath sounds |
| During the primary assessment you encounter ineffective breathing with absent or diminished breath sounds, what will your response be? | -admin high flow 02 via non-rebreather OR: assist ventilations with bag mask / AND anticipate and assist with intubation/definitive airway mx |
| During the primary assessment you encounter absent breathing, what is your response? | ventilate with bag mask AND asssit with definitive airway eg: intubation AND address any life threatening injuries that are interfering with breathing eg: tension pnuemo, open pnuemo, hemothorax, flail chest,pulmonary contusion |
| Circulation interventions: ineffective circulation: | control uncontrolled ext bleeding / canulate 2 large veins w large needles / blood sample 4 G + H, infuse warmed isotonic crystaloids: rapid rate, use blood tubing anticipating blood products / use rapid infuser / admin blood products as ordered |
| methods for controlling uncontrolled bleeding: | apply direct pressure eg: pressure bandage / elevate bleeding extremity / apply pressure over proximal arterial points / use a tourniquet (rare intervention as last resort). |
| circulation interventions: absent circulation: | no pulse? = CPR. / if traumatic arrest, find and fix the underlying cause eg: tension pneumo/ exanguination. admin IVT/bloods as ordered / prep for OT as required |
| life threatening trauma conditions that might compromise effective circulation: | uncontrolled bleeding / shock (either internal/external haemorrhage or massive burns)/ pericardial tamponade / direct cardiac injury / tension pneumo |
| disability interventions | person not alert or verbal? continue to monitor and support airway and breathing / disability discovered, investigate further in 2nd assessment / if signs of herniation or neurological deterioration consider hyperventilation (after manitol?) |
Created by:
jessharries