Imagine a patient walks in to your exam room with a chief complaint of mouth and throat prickling with hives and itchy skin after eating peanuts. You know this I’m allergic reaction. What would you first be thinking of?
Another example would be a patient comes into your trauma room after a car accident going approximately 55 miles per hour, unrestrained with airbag deployment. They are unconscious, have an obvious broken femur, multiple oozing lacerations, are intubated from the field with unequal pupils. What’s your first priority?
In emergency medicine, there’s an easy checklist to run through in your head in order of prioritization. With experience and practice, many are done simultaneously. They’re called the ABCs Trauma Primary Survey.
ABCDEFGHI
• A is for airway – without this patent the person will not last long. Your looking at their alertness level (Alert, Verbal, Painful, Unresponsive), maintaining cervical spine precautions, and keeping their airway open.
• B is for breathing – cause again the person will not do well without this. Are they breathing effectively? Is they’re rate and rhythm enough to sustain them without assistance?
• C is for circulation – have bleeding controlled and palpable pulses. Also inspect the skin color, temperature, and moisture. The skin can be the first indicator something is wrong!
• D is for disability – pupils and any deformities. Assess for PERRLA and perform a Glasgow Coma Scale.
• E is for examine – expose your patient and check for missed injuries, apply warm blankets. Keep the environment warm.
• F is for full set of vitals – check your patient’s vitals in whatever capacity you can, they can tell you a lot about how your patient is doing. This is usually done earlier or simultaneously with other tasks but it’s included so it’s not forgotten. Also encourage the family to be present during this phase.
• G is for get monitoring – connect them to a monitor, vitals can tell you so much about how your patient is doing. This includes LMNOP: labs, monitor, naso or orogastric tube, oxygen (wean down if able) and capnography (EtCO2), and pain management.
The H and I portions are part of the secondary survey to be completed once your patient is stable.
• H is for head-to-toe assessment – now we listen, palpate, and inspect the whole body. Roll and remove the backboard if present and your patient’s spine has been cleared. A complete history is also done at this time.
• I is for interventions – perform any ordered interventions, get pictures done, and empty the bladder.
Always remember to reassess after any interventions are done to see if it’s helped or not!
This information I pulled from the Emergency Nurses Association (ENA) Trauma Nursing Core Course (TNCC) that I took and is also available online.
Did you find this helpful? Have you used the Primary Survey in practice?
