Basic Life Support (BLS) Advanced Life Support (ALS)

Primary Survey

Anthea Cayetano - 2015

Learning Objectives • Students to be introduced to principals of:

• BLS • ALS • Paramedic primary survey

• Students to be familiarised with how to undertake a

paramedic primary survey

BLS and ALS will be revisited next week with further information specific to clinical simulation examination.

PRIMARY SURVEY • D = Danger

• R = Response

• A = Airway + C spine

• B = Breathing

• C = Circulation

• D = Disability

PRIMARY SURVEY

• A primary survey is used to identify immediate, life-threatening events.

• Each component MUST be fixed before moving on to the next – start again from the top.

• It is a dynamic process - you are constantly evaluating the patient and it should be conducted multiple times on the one patient.

• Keeps you focused on what is important to maintain life.

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

DANGER

People • Includes patients and bystanders

Because of: • Infectious Diseases • Violence • Abuse- verbal, physical etc

Environmental • Traffic • Power lines • Gas - ovens etc • Weather conditions - rain, sun etc • Confined space - clandestine drug lab

What do you consider to be dangerous to a paramedic?

What do you do if you identify a danger to your or your partners safety when entering a scene?

RESPONSE

We want to know that the patient can: • Hear • See • Listen and, • Understand

What simple act can we get them to do that would indicate compliance with all of the above?

Say hello and ask them their name or ask them to perform a simple task, eg squeeze my hand.

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

RESPONSE

According to the ARC, unconsciousness: “...is a state of unrousable unresponsiveness, where the victim is unaware of their surroundings and no purposeful response can be obtained”.

So how do we accurately assess if a patient is unconscious and therefore unresponsive?

ASSESSING RESPONSIVENESS:

1. Speak to the patient - then shout

2. Touch the patient - maintain distance/escape route

3. Provide painful stimuli to the patient - ear, jaw, fingernails, but not sternum!

COMMUNICATE (Send For Help)

• Once you have identified that patient is unresponsive - tell the EOC and possibly request back up.

• Eg, “Call Sign - patient’s unresponsive, we require a second crew”.

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

AIRWAY • If patient is responsive and talking

without stridor or complication / airway compromise – airway is considered clear.

• If patient is unresponsive:

Must examine thoroughly and ensure it is clear before moving to next step

Must include C spine immobilisation consideration if spinal injuries suspected

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

Airway Manoeuvres (1/2)

Head-tilt Chin-Lift

Used when spinal injury is NOT suspected.

Airway Manoeuvres (2/2)

Jaw Thrust

Can be used if suspected spinal injury.

AIRWAY

Obstructed airway Open airway

What do we do if the airway is obstructed?

Clear airway by position Suction

C - Spine

When do we apply a c-collar?

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

BREATHING

If patient is conscious – take quick note of respiratory effort and move on or fix before moving on.

• Speaking pattern • Depth • Rate

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

BREATHING If patient is unconscious - How do we assess breathing?

1. LOOK

2. LISTEN

3. FEEL

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

BREATHING

• However, if the patient is unconscious and NOT breathing or not breathing NORMALLY- what do we do?

If patient is unconscious but breathing normally - ensure airway protection and oxygenation via OPA (and manual technique) and Hudson Mask:

Then check circulation – ie continue primary survey and move on to secondary assessment…

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

CPR • Lower half of sternum / middle of

chest!

• Depress one third of chest

diameter or ~5 cm in adults.

• Rate of 100 chest compressions

per minute

• 30 compressions to 2 ventilations

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

This is where primary survey for paramedics differentiates from resuscitation…

In resuscitation, as soon as compressions begin, the defibrillator must immediately be attached.

So in the primary survey, C and D stand for something different…

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

PRIMARY SURVEY • D = Danger

• R = Response

• A = Airway + C spine

• B = Breathing

• C = Circulation

• D = Disability

CIRCULATION

Skin – • Look – pale, flushed, cyanosed, normal • Feel – warm, cold, dry, sweaty Pulse – • Presence, strong / weak, regular / irregular

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

DISABILITY

A = Alert V = responds to Voice P = responds to Pain U = Unresponsive

Initial neurological assessment is limited to level of consciousness using the AVPU scale:

Any change in AVPU requires reassessment of: Airway, Breathing & Circulation

Assess Pupils

Then it is time for secondary assessments – ‘E’, secondary survey, history gathering and other observations

Primary Survey D = Danger

R = Response

A = Airway + C spine

B = Breathing

C = Circulation

D = Disability

PRIMARY SURVEY • D = Danger

• R = Response

• A = Airway + C spine

• B = Breathing

• C = Circulation

• D = Disability

Resuscitation

Resuscitation

Patient is Unresponsive, has a Clear Airway and is NOT Breathing Normally. We have commenced compressions immediately. Now what?

COMMUNICATE (Send For Help)

• Once you have identified that patient is in cardiac arrest - tell the EOC AND request back up.

• Eg, “Call Sign- patient’s in cardiac arrest, we require ICP back up”.

DON’T FORGET…

Defibrillate

Attach defibrillator pads and charge defibrillator. Immediately analyse rhythm and treat accordingly. Ensure you use manual defibrillation procedure appropriately.

2mins of CPR

A few things to get sorted in this time. Make sure you are doing quality 2-person CPR at this stage.

VENTILATION

• If patient is unconscious and NOT breathing normally - ensure airway protection and oxygenation via OPA and IPPV:

Oropharyngeal

Airways (OPA)

BAG VALVE MASK •Ensure effective seal of BVM. •Ensure patient’s jaw is used to pull up and into mask – not pushing mask on to the patient’s face. •Ensure appropriate volume and rate of ventilation.

Oxygenation

Ensure BVM is attached to the oxygen cylinder appropriately. Ensure oxygen is turned on.

Clinical Skill Information Sheets:

You will practice primary surveys in practical workshop this week.

QUESTIONS?

Take Home Message

• BLS is foundation of ALS • BLS and paramedic primary survey are similar • Reassessment is KEY!

BLS and ALS will be revisited next week with further information specific to clinical simulation examination.